What is ketoconazole?

Ketoconazole is a prescription treatment that is a potent antifungal agent. Ketoconazole blocks testosterone synthesis, which decreases DHT while also being anti-inflammatory through its actions on 5-lipoxygenase. Blocking 5-lipoxygenase decreases the production of pro-inflammatory leukotrienes.

Why is ketoconazole part of my treatment plan?

Your genetic testing indicated that your steroid-reductase type I and/or type II were more active than usual. This will lead to increased DHT levels and impair hair follicle development. Ketoconazole blocks this by decreasing testosterone availability for steroid-reductase to turn testosterone into DHT. Ketoconazole is used for seborrheic dermatitis, a risk factor for hair loss. Seborrheic dermatitis can cause a very itchy, dry scalp. Frequently this leads to scratching, which can damage hair follicles leading to hair loss. A common cause of this condition is the yeast Malassezia which is associated with hair shedding due to inflammation.1  Ketoconazole has anti-inflammatory properties.

Is topical ketoconazole effective for alopecia?

Treatment with 2% ketoconazole is associated with improved hair growth, density, and proportion of hair in the growth (anagen) phase.2,3

Are there adverse effects from topical ketoconazole?

The topical application of ketoconazole is well tolerated, and adverse events are rare. Reported adverse events, including itching, stinging, allergic reaction, and local irritation.

Why do I need to keep taking ketoconazole?

Ketoconazole should be used once or twice a day as prescribed by your physician. Continuous use for four months is recommended before evaluating treatment response. Hair shedding may occur at the initiation of treatment as hair follicles are being stimulated to reenter the growth phase, but this frequently subsides within two months. Hair growth usually occurs within four to eight months and stabilizes over 12 to 18 months. Hair loss will occur over several months if treatment is stopped because of the nature of the hair growth cycle. Ketoconazole is not a cure for hair loss; it is a treatment.

Drug Summary: Ketoconazole


  1. Nematian J, Ravaghi M, Gholamrezanezhad A, Nematian E. Increased hair shedding may be associated with the presence of Pityrosporum ovale. Am J Clin Dermatol. 2006;7(4):263-266. doi:10.2165/00128071-200607040-00008
  2. Fields JR, Vonu PM, Monir RL, Schoch JJ. Topical ketoconazole for the treatment of androgenetic alopecia: A systematic review. Dermatol Ther. 2020;33(1):e13202. doi:10.1111/dth.13202
  3. Hugo Perez BS. Ketocazole as an adjunct to finasteride in the treatment of androgenetic alopecia in men. Med Hypotheses. 2004;62(1):112-115. doi:10.1016/s0306-9877(03)00264-0