More hair, nice skin: ketoconazole for skin infections

This is part two of “More hair, less dandruff: ketoconazole and hair loss.” Tinea versicolor and seborrheic dermatitis are common infections of the skin caused by yeast normally found on skin. Patients with tinea versicolor exhibit round scaly lesions which may be lighter or darker than natural skin tone on their face, neck, upper arms or torso (1,2). Patients with seborrheic dermatitis have inflamed skin resulting in red patches or greasy scales on the scalp, face, torso, or groin (3). Malassezia are the species of yeast that cause these skin conditions and are present naturally on everyone’s skin. Overgrowth of Malassezia can be caused by oily skin, and warm and humid climates, it does not mean you have poor hygiene. Although these conditions are not usually life threatening, they are highly visible, prompting patients to seek medical treatment.

Topical ketoconazole is currently United States (US) Food and Drug Administration (FDA) approved for treatment of tinea versicolor, dandruff and seborrheic dermatitis of the scalp (4). Nizoral ® is a shampoo containing 2% ketoconazole and is available over the counter for effective treatment against tinea versicolor, dandruff, and seborrheic dermatitis. Ketoconazole’s antifungal properties work by disrupting the production of ergosterol, which is required by the fungal cells to make cell membranes. Without a functioning cell membrane, the cell will die, and the infection will clear up.

Ketoconazole 2% shampoo solution is also effective at decreasing scalp irritation, itching, and discomfort when used two-three times weekly for at least a month (4). To maintain the effects, ketoconazole solutions should continue to be used, however you can decrease the number of times used per week. Always discuss treatment with your doctor to ensure a change in frequency of ketoconazole use is appropriate.

For the areas of affected skin other than the scalp, ketoconazole can be purchased as a cream or foam solution. Just like the topical shampoo, these solutions do not enter the tissue underlying the skin easily, and therefore are more safe for treating superficial mycoses (5) when compared to oral drugs. Follow the directions on the label and avoid exposure to moist areas of the skin like the nostrils, mouth, and eyelids. Keep in mind this does not mean they are risk free, there are still side effects associated with topical ketoconazole. Some of these side effects are: allergic reactions, stinging, itching, and dry skin. Remember to always consult your physician before making any changes to medication, including medicated creams, foams, and shampoos. Your physician will know what will work best for you.

Article by: Dr. C.D. Studholme, Mediprobe Research Inc.

  1. Gupta AK, Bluhm R, Summerbell R. Pityriasis versicolor. J Eur Acad Dermatol Venereol JEADV. 2002 Jan;16(1):19–33.
  2. Gaitanis G, Velegraki A, Mayser P, Bassukas ID. Skin diseases associated with Malassezia yeasts: facts and controversies. Clin Dermatol. 2013 Aug;31(4):455–63.
  3. Shi VY, Leo M, Hassoun L, Chahal DS, Maibach HI, Sivamani RK. Role of sebaceous glands in inflammatory dermatoses. J Am Acad Dermatol. 2015 Nov;73(5):856–63.
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  5. Janssen Pharmaceutica. Nizoral (Ketoconazole) 2% shampoo [Internet]. [cited 2014 Nov 11]. Available from: