What You Need to Know About Ketoconazole Shampoo

A Shampoo That Treats Dandruff and Fungal Infections

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Ketoconazole shampoo is a topical solution that contains the antifungal agent ketoconazole. This medicated shampoo treats scalp conditions like seborrheic dermatitis (dandruff) and psoriasis. Products containing ketoconazole are available over-the-counter (OTC) and by prescription.

This article explains how ketoconazole shampoo works, its uses, types, benefits, and risks.

Woman washing her hair with shampoo

Rattankun Thongbun / Getty Images

How Ketoconazole Shampoo Works

Ketoconazole is in a class of antifungals called imidazoles. In addition to antifungal activity, researchers found that imidazoles have antibacterial, antiviral, anti-inflammatory, and anti=tumor activities.

The shampoo works by slowing the growth of fungus that causes infection. Ketoconazole treats many fungal and yeast skin infections, including tinea versicolor, the fungus associated with dandruff.

What Is Ketoconazole Shampoo Used For?

Ketoconazole shampoo is primarily used to control dandruff, a skin condition that results in a red, flaky scalp. Dandruff is considered the mildest form of seborrheic dermatitis. More severe seborrheic dermatitis results in inflammation and skin discoloration.

Untreated dandruff can sometimes result in secondary bacterial or fungal infections, so keeping it under control is important.

In addition to treating dandruff, people also use ketoconazole shampoo for a few conditions.

Scalp Psoriasis

Psoriasis is an autoimmune condition where the immune system tells skin cells to grow too quickly. It causes skin cells to pile up, resulting in red patches, flaking, and dryness. About half of the people with psoriasis experience scalp psoriasis. Medicated shampoos, including ketoconazole, are a first-line treatment for scalp psoriasis.

Tinea Versicolor

Tinea versicolor is a fungal infection resulting from an overgrowth of yeast on the skin. These yeasts typically live on the outer layer of skin and the hair shaft, which is why they may occur on the scalp. Ketoconazole shampoo is a topical antifungal used when it appears on the scalp.

Tinea Corporis (Ringworm)

Tinea corporis (ringworm) is a fungal skin infection that forms a ring-like rash. When it occurs on the scalp, ketoconazole shampoo can treat it.

Hair Loss

While ketoconazole shampoo is not intended for hair loss, some people use it to try to regrow hair. Little evidence supports this use, but some smaller studies have found that ketoconazole may help regrow hair.

Types of Ketoconazole Shampoo

Ketoconazole shampoo is available OTC at drugstores, pharmacies, and online. In addition, more potent formulas are available by prescription.

OTC Ketoconazole Shampoo

OTC ketoconazole shampoos usually contain 1% ketoconazole. The most common brand is Nizoral. To use OTC shampoos, follow these steps:

  1. Wet your hair.
  2. Apply the shampoo.
  3. Work the shampoo into a thick lather.
  4. Rinse thoroughly.
  5. Repeat.

Make sure the skin on your scalp is not cracked before you use the shampoo, as it could lead to irritation. OTC shampoo is usually applied every three or four days for up to eight weeks, then as needed.

Prescription Ketoconazole Shampoo

Shampoos with 2% ketoconazole usually require a prescription from a healthcare provider. To use prescription shampoos, follow these steps:

  1. Wet your head and hair.
  2. Apply the shampoo.
  3. Work up a good lather.
  4. Leave the shampoo on for 5 minutes.
  5. Rinse thoroughly with water.

A prescription shampoo is usually just applied one time to treat the infection. But you should follow the instructions of a healthcare provider exactly.

These medicated shampoos are intended only for the skin. Avoid getting them in your eyes or mouth, and rinse thoroughly if they go into your eyes while shampooing.

What Are the Benefits of Ketoconazole Shampoo?

Ketoconazole shampoo benefits include the following:

  • Reducing itching
  • Reducing flaking
  • Reducing burning sensations
  • Reducing fungus
  • Easy application

Shampoos make it easier to apply medication to your scalp. In that way, ketoconazole shampoo is practical and user-friendly. In addition, it is an effective method to control dandruff and seborrheic dermatitis of the scalp.

What Are the Side Effects of Ketoconazole Shampoo?

Ketoconazole shampoo comes with some risks and side effects. Since this is a medicated shampoo, discussing its use with a healthcare provider first is essential. Tell them about your symptoms, other medications you use, and health conditions that you have.

Side effects may include:

  • Change in hair texture
  • Scalp blisters
  • Dry hair or scalp
  • Itching
  • Oily hair or scalp
  • Skin irritation

Less commonly, severe reactions may occur. Seek medical attention immediately if you develop a rash, hives, skin irritation, or trouble breathing or swallowing. These symptoms could indicate a severe allergic reaction called anaphylaxis.


Ketoconazole shampoo is a medicated antifungal shampoo primarily used to treat dandruff. It is also used to treat some fungal infections of the scalp, particularly tinea versicolor, and ringworm. Some people also use it for scalp psoriasis.

Ketoconazole comes in 1% OTC strength and 2% prescription strength. It is an effective management strategy for dandruff, but there are some potential risks and side effects, including scalp irritation and a change in hair texture. Consult a healthcare provider before trying ketoconazole shampoo.

9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Serdaliyeva D, Nurgozhin T, Satbayeva E, Khayitova M, Seitaliyeva A, Ananyeva L. Review of pharmacological effects of imidazole derivatives. J CLIN MED KAZ. 2022;19(3):11-5. doi:10.23950/jcmk/12117

  3. NHS. Ketoconazole.

  4. American Academy of Dermatology Association. Seborrheic dermatitis: Overview.

  5. American Academy of Dermatology Association. Scalp psoriasis: Causes.

  6. American Academy of Dermatology. Tinea versicolor.

  7. Centers for Disease Control and Prevention. Treatment for ringworm.

  8. El-Garf, A., Mohie, M. & Salah, E. Trichogenic effect of topical ketoconazole versus minoxidil 2% in female pattern hair loss: a clinical and trichoscopic evaluationBiomed Dermatol 3, 8 (2019). doi:10.1186/s41702-019-0046-y

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By Kathi Valeii
As a freelance writer, Kathi has experience writing both reported features and essays for national publications on the topics of healthcare, advocacy, and education. The bulk of her work centers on parenting, education, health, and social justice.