Male pattern baldness is commonly called androgenetic alopecia, which is the shrinking of hair follicles leading to loss of hair. Dihydrotestosterone (DHT) is the main hormone involved in these changes to the hair follicle. Despite the high prevalence of male pattern baldness (up to 70% of men and 40% of women) (1), and the negative psychosocial effect, only a few United States (US) Food and Drug Administration (FDA)-approved medications exist on the market, finasteride (Propecia®) and minoxidil (Rogaine®).
Finasteride (oral) and minoxidil (topical) both require lifelong treatment to maintain the effects, which can become costly. There is also a risk of adverse side effects, even more so with oral therapies. Take a look at the previous blog postings titled “What do I need to know about finasteride” and “Rogaine® (minoxidil) for men and women” to learn more. There are numerous medications available on the market which claim to treat male pattern baldness, however their effectiveness has not been adequately tested, and they are not US FDA approved.
Ketoconazole is not currently US FDA approved for treatment of androgenetic alopecia, however, it is approved for the treatment of tinea versicolor, dandruff and seborrheic dermatitis of the scalp (2). Tune in for my next blog post “More hair, nice skin: ketoconazole for skin infections.”
Nizoral® is a shampoo containing 2% ketoconazole which has been shown to be an effective form of treatment for androgenic alopecia. It has been shown to stimulate hair growth in some men (3,4), and stop the effects of hair loss through inhibition of DHT (2,5). Ketoconazole has been shown to increase the size, proportion, and density of hair follicles in men compared to those using nonmedicated shampoos (6). Recommended use for ketoconazole 2% shampoo was 2-3 times a week, leaving the shampoo on the scalp for 3-5 minutes before rinsing to enhance hair growth and reduce itching and dandruff (2). Although ketoconazole is less effective than minoxidil at promoting increased hair growth and hair follicle diameter (3), when used in combination with other therapies such as finasteride and/or minoxidil, an additive effect is seen with respect to the inhibition of hair loss (7). These results are taken from small pilot studies and studies using mice, which is why it is not currently US FDA approved for treatment of hair loss. Further research using larger groups of participants is needed to get Nizoral® shampoo approved as a topical treatment for hair loss.
Although Nizoral® is available over the counter, you should always talk to your doctor first to ensure the product is safe for you to use. Reported side effects of 2% ketoconazole shampoo are reactions at the site of application, dermatitis, dry skin, abnormal hair texture, itching (pruritus), and tingling or pricking (paresthesia), and ironically hair loss (8). If your doctor approves the use of ketoconazole shampoo, make sure to follow the directions of use consistently to maintain the effect of hair regeneration and to minimize side effects from overuse.
Article by: Dr. C.D. Studholme, Mediprobe Research Inc.
- Santos Z, Avci P, Hamblin MR. Drug discovery for alopecia: gone today, hair tomorrow. Expert Opin Drug Discov. 2015 Mar;10(3):269–92.
- Rafi AW, Katz RM. Pilot Study of 15 Patients Receiving a New Treatment Regimen for Androgenic Alopecia: The Effects of Atopy on AGA. ISRN Dermatol. 2011;2011:241953.
- Aldhalimi MA, Hadi NR, Ghafil FA. Promotive Effect of Topical Ketoconazole, Minoxidil, and Minoxidil with Tretinoin on Hair Growth in Male Mice. ISRN Pharmacol. 2014;2014:1–5.
- Inui S, Itami S. Reversal of androgenetic alopecia by topical ketoconzole: Relevance of anti-androgenic activity. J Dermatol Sci. 2007 Jan;45(1):66–8.
- Hugo Perez BS. Ketocazole as an adjunct to finasteride in the treatment of androgenetic alopecia in men. Med Hypotheses. 2004;62(1):112–5.
- Piérard-Franchimont C, De Doncker P, Cauwenbergh G, Piérard GE. Ketoconazole shampoo: effect of long-term use in androgenic alopecia. Dermatol Basel Switz. 1998;196(4):474–7.
- Khandpur S, Suman M, Reddy BS. Comparative efficacy of various treatment regimens for androgenetic alopecia in men. J Dermatol. 2002;29(8):489–98.
- Lange DS, Richards HM, Guarnieri J, Humeniuk JM, Savin RC, Reyes BA, et al. Ketoconazole 2% shampoo in the treatment of tinea versicolor: a multicenter, randomized, double-blind, placebo-controlled trial. J Am Acad Dermatol. 1998 Dec;39(6):944–50.