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Ketoconazole

Antifungal medicine in shampoos for dandruff and seborrhoeic dermatitis Also on labels as: Nizoral (brand), ketoconazole 2%

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What it does

Ketoconazole is an antifungal medicine. In shampoo form it's used to treat dandruff and seborrhoeic dermatitis, where the scalp becomes scaly and dry or greasy, and it can help stop them coming back (NHS). It works against Malassezia, the yeast on the skin that's linked to flaking.

How it's used

  • The NHS says to use ketoconazole shampoo twice a week for 2 to 4 weeks, then once every 1 to 2 weeks to stop dandruff or seborrhoeic dermatitis returning.
  • Leave it on for 3 to 5 minutes before rinsing, and keep it out of your eyes and mouth.
  • Some people use it every week or two for months or years to keep symptoms away.
  • It's sold in pharmacies and shops and is also available on prescription.

Cautions

  • For adults and children aged 12 and over (NHS).
  • Side effects from the shampoo are unlikely if you use the right amount; NICE lists skin reactions, folliculitis and hair changes as possible effects. Serious allergic reactions are rare but possible.
  • The NHS says you can use ketoconazole shampoo in pregnancy and while breastfeeding; the manufacturer advises caution, so check with a pharmacist.
  • Talk to a pharmacist or doctor if symptoms are no better after 4 weeks.

How strong is the evidence?

Evidence: Strong

Licensed medicine or consistent good-quality trials for this use.

Ketoconazole 2% shampoo is a licensed medicine and the usual first choice for seborrhoeic dermatitis of the scalp in NICE guidance for GPs. A 2015 Cochrane review of antifungals for seborrhoeic dermatitis found ketoconazole 2% cleared symptoms more often than placebo over about four weeks (rated low-quality evidence, and many trials were company-funded); a 2015 BMJ Clinical Evidence review rated the evidence for ketoconazole shampoo against placebo as moderate quality and called it first-line for the scalp.

UK rules and availability

Ketoconazole is not allowed in cosmetics in Great Britain, so any shampoo containing it is a licensed medicine. Nizoral 2% shampoo is sold both as a general sale medicine and as a pharmacy medicine, depending on the pack; it's also available on prescription. Read the leaflet before use.

Products on this site that list it

Not medical advice. This guide is general information from the sources listed, not a diagnosis or a substitute for a pharmacist, GP or dermatologist. If you are worried, or symptoms are severe or not improving, get advice. Read our health information policy.

Sources

  1. NHS – About ketoconazole nhs.uk
  2. NHS – Ketoconazole: how and when to use it nhs.uk
  3. NHS – Who can and cannot use ketoconazole nhs.uk
  4. NHS – Ketoconazole: pregnancy, breastfeeding and fertility nhs.uk
  5. NICE CKS – Seborrhoeic dermatitis: scalp and beard cks.nice.org.uk
  6. NICE CKS – Topical imidazoles cks.nice.org.uk
  7. emc – Nizoral Anti-Dandruff Treatment 2% Shampoo (SmPC) medicines.org.uk
  8. Okokon EO et al. Topical antifungals for seborrhoeic dermatitis. Cochrane Database Syst Rev 2015 pubmed.ncbi.nlm.nih.gov
  9. Naldi L, Diphoorn J. Seborrhoeic dermatitis of the scalp. BMJ Clin Evid 2015 pmc.ncbi.nlm.nih.gov
  10. legislation.gov.uk – Cosmetics Regulation Annex II (prohibited substances) legislation.gov.uk