Ketoconazole shampoo is an antifungal medication, that has anti-inflammatory and anti-fungal properties which treat and prevent the root cause of dandruff. Here’s everything you need to know about it.
What You’ll Learn
Ø What causes dandruff
Ø How ketoconazole works
Ø How to use ketoconazole
Ø How to stop dandruff coming back
What actually is dandruff?
Dandruff is closely related to another skin condition called seborrheic dermatitis (SD). The main difference between them is location and severity. Dandruff affects the scalp, causing itchy and flaky skin, whereas SD can affect other areas of the body and is usually more severe.
The main underlying cause of both conditions is an overgrowth of a fungus called Malassezia, which is a natural part of the scalp’s microbiome. This means some people will have the fungus on their scalp, but won’t have dandruff.
Malassezia breaks down the natural scalp oils (sebum) on the scalp into fatty acids like oleic acid. Some people’s scalps are more sensitive to these acids, which can then disrupt the skin barrier and cause inflammation. These disruptions encourage even more growth of Malassezia, creating a cycle that is difficult to fix without help from medication.
How ketoconazole treats dandruff
That’s where a shampoo containing an anti-dandruff active ingredient, like Ketoconazole, comes in. Research so far suggests ketoconazole could be the most effective treatment for dandruff, compared to other anti-dandruff shampoos.
Ketoconazole tackles dandruff by fighting the root issue: Malassezia overgrowth. It disrupts the cell membranes of fungi like Malassezia, helping to reduce levels and keep the population under control. Plus, ketoconazole has anti-inflammatory properties, which also helps to soothe and calm an itchy, irritated scalp.
What the research says
Research generally indicates that ketoconazole 2% is the most effective treatment, while also being well-tolerated with few side effects. Studies demonstrate it’s superior to other anti-dandruff shampoos with ingredients like zinc pyrithione 1% at treating dandruff in the initial treatment phase, and at stopping it from coming back.
Here are a few key studies:
Multi-centre, double-blind, placebo-controlled trial:
575 patients with moderate to severe SD or dandruff used 2% ketoconazole twice weekly for 2-4 weeks.
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88% improved.
To test relapse rates over the next six months, responders were split into groups:
- Placebo: 47% relapsed
- Alternating ketoconazole/placebo: 31% relapsed
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Ketoconazole weekly: 19% relapsed
This study demonstrated ketoconazole 2% was an effective treatment of dandruff and prevented recurrence.
Compared 1% vs 2% ketoconazole shampoos.
- 2% performed better in reducing flakiness, Malassezia density, and improving overall dandruff severity.
- Relapse rates were also lower with 2%
Compared ketoconazole 2% to zinc pyrithione 1% over four weeks.
- Both worked, but 73% improved with ketoconazole vs 67% with zinc pyrithione
- Recurrence was lower with ketoconazole
How to use ketoconazole shampoo
To clear dandruff: Apply twice weekly for 2-4 weeks. Massage a small amount into your hair and scalp until it forms a lather, let it sit for 3-5 minutes, then rinse.
To prevent dandruff coming back: Use once every 1-2 weeks to stop symptoms coming back.
Why you should keep using an anti-dandruff shampoo
Most people think of dandruff like a cold; something that appears occasionally and goes away for good with treatment (unless you catch another one). But dandruff is more like asthma. Asthma can be managed with daily puffs on an inhaler – but if you stop using your inhaler, your symptoms would probably get worse and you might have an asthma attack.
That’s because asthma is a chronic condition, it can be managed but not cured. Dandruff is the same, it will keep coming back unless you use a preventative treatment like ketoconazole regularly.
Even once everything looks clear after a couple of weeks using ketoconazole shampoo as directed, studies show Malassezia levels start to rise just a few days after discontinuing use. It’s best to keep a specific anti-dandruff shampoo in your routine every week or two to stop dandruff from coming back.
All of our blog articles are reviewed by our Medical Director before publication.
