To date, only two drugs (each with very different mechanisms of action) have been approved by the US FDA to cure hair loss: Finasteride (Propecia) and Minoxidil (Rogaine). A third drug, Dutasteride (Avodart), may be approved in 2016. Some other drugs such as Spironolactone and RU58841 are also have known to have beneficial effects on scalp hair and have been widely covered in studies and on hair loss forums.
There is, however, one drug that has significant beneficial properties in helping hair loss sufferers, but it never gets enough credit. This drug is Ketoconazole (the active ingredient in Nizoral shampoo) and will likely never be officially approved to treat hair loss because its manufacturer will not file for approval and go through all the clinical trials. Ketoconazole is a synthetic drug that is used to treat fungal infections. In particular, the drug flushes out Malassezia (formerly known as Pityrosporum) fungus, which has been implicated in problems such as dandruff and seborrheic dermatitis.
Ketoconazole was originally available in tablet form, but has since also been developed into topical forms such as creams, lotions and shampoos. While oral ingestion of Ketoconazole can lead to serious side effects such as liver damage in some patients, topical cream and ketoconazole shampoo usage has generally not been linked to such side effects.
A large proportion of hair loss sufferers seem to also get itchy and dry scalp conditions, including dandruff and seborrheic dermatitis. I am one of those, although the severity and frequency of my symptoms is moderate. Some years ago, I started using Nizoral 1% anti dandruff shampoo for hair loss instead of other regular shampoos, and was absolutely amazed at its effectiveness at completely eliminating my scalp itching and dandruff for a day or two each time I used it. My hair itself also looked better and it seemed like my hair shedding rate declined too. There is some evidence that Ketaconozale blocks the synthesis of dihydrotestosterone in the scalp and acts as an antagonist of the androgen receptor (see list of studies at the bottom of this post). Nizoral sometimes also helps improve psoriasis symptoms.
In 2012 or so, it seemed like US drug stores and Amazon.com stopped carrying Nizoral shampoo, at least when it comes to the most popular blue bottle variety (see photo further below). At first, I thought this was because of the warnings related to side effects from taking oral Ketaconozale. Luckily, I had sufficient supplies to last me for a while, since you only need a small amount of Nizoral shampoo to make a big difference, and most people do not need to use Nizoral more than twice a week. This shortage continued in 2013 and I had to pay a significant premium to buy it from a seller on ebay. A lot of people made great profits by selling their surplus Nizoral stock in 2012 and 2013. I later found out that the problems with availability were due to the shampoo’s manufacturer having production issues at its main plants rather than any issues related to side effects.
Good News: Nizoral Shampoo Back on Sale
As of 2014, Nizoral is now back on the market and the shortages are over. You can read numerous favorable reviews of the product on Amazon.
Nizoral and Hair Loss Studies
You can find a number of studies that conclude favorable outcomes for Ketaconozale shampoo use for hair loss. Below I list them in chronological order.
- Ketoconazole shampoo: effect of long-term use in androgenic alopecia (Belgium — 1998).
- Nudging hair shedding by antidandruff shampoos. A comparison of 1% ketoconazole, 1% piroctone olamine and 1% zinc pyrithione formulations (Belgium — 2002).
- Ketoconazole as an adjunct to finasteride in the treatment of androgenetic alopecia in men (US — 2004).
- Topical application of ketoconazole stimulates hair growth in C3H/HeN mice (Japan — 2005).
- Reversal of androgenetic alopecia by topical ketoconzole: Relevance of antiandrogenic activity (Includes photos, Japan — 2007).
- A new ketoconazole topical gel formulation in seborrhoeic dermatitis: an updated review of the mechanism (Sweden — 2007).
- Comparative efficacy of various treatment regimens for androgenetic alopecia in men (India — 2012).
- Promotive effect of topical ketoconazole, minoxidil, and minoxidil with tretinoin on hair growth in male mice (Iraq — 2014).