Of Note: In June 2018, Germany’s Stada acquired Nizoral from Johnson & Johnson. Nizoral is a hugely popular Ketoconazole based dandruff shampoo. It has over 6,000 reviews on Amazon, averaging 4.5 out of 5 stars. It costs less than $15, a very affordable price.
Nizoral shampoo (1%) is one of the highest rated and reviewed anti-dandruff shampoos that you can buy without a prescription. I rank it as one of the 10 best hair loss shampoos in the world.
Nizoral A-D Anti-Dandruff Shampoo with Ketoconazole 1%, is consistently rated as one of the best products to counter scalp itching, flaking and fungus. Nizoral sometimes also improves psoriasis symptoms and scaly scalp skin conditions.
A small bottle of this highly rated antifungal product will last for many months. Note that Nizoral 2% shampoo comes in a red bottle and is a different product. The 1% Nizoral is an over-the-counter product, while the medicated 2% requires a prescription in the US.
Also worth noting, Nizral shampoo can help reduce hair loss to a moderate extent due to its anti-androgenic properties. See the studies listed at the end of this post that support this point.
Ketoconazole: the Active Ingredient in Nizoral
To date, only two drugs with very different mechanisms of action have been approved by the US FDA to treat hair loss: Finasteride (Propecia) and Minoxidil (Rogaine). Spironolactone, while not officially approved as a hair loss treatment, is also an important drug for countering androgenic alopecia.
However, there is one other drug that has significant beneficial properties in helping hair loss sufferers. Yet it never gets sufficient credit. This drug is Ketoconazole, the active ingredient in Nizoral shampoo.
Unfortunately, Ketaconazole will likely never be officially approved to treat hair loss, because its manufacturer is unlikely to ever file for approval. With sales of Nizoral already going strong globally, it is probably not worth going through all the rigorous expensive clinical trials to get little added benefit in terms or increased revenue.
Ketoconazole is a synthetic drug that is used to treat fungal infections. In particular, the drug flushes out Malassezia (formerly known as Pityrosporum) yeast fungus. Malassezia has been implicated in problems such as dandruff and seborrheic dermatitis.
Other names for similar fungal infections and overgrowth of the scalp include Pityriasis Versicolor, Pityrosporum Ovale and Malassezia Furfur. Skin conditions such as tinea and ringworm may also benefit from this product.
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 Keto 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.
My Nizoral Experiences
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 my itchy inflamed scalp instead of other regular shampoos. I was absolutely amazed at its effectiveness in completely eliminating my scalp itching and dandruff for at least a day or two after each application. My hair itself also looked better, and it seemed like my hair shedding rate declined too.
There is some evidence that Ketoconazole 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).
How often should you use Nizoral?
I would recommend no more than twice a week to prevent excessive skin dryness. You also do not want your scalp microflora and fungi to become immune to the effects of Ketoconazole. Overuse will make your scalp skin excessively dry and make your hair brittle. I would recommending rotating between several different products among the best dandruff shampoos available.
When you do shampoo with Nizoral, make sure to keep it on your scalp for at least two minutes after lathering and before rinsing. Some people recommend rinsing hair in cold water rather than hot water in the shower. The former prevents excessive moisture loss and skin drying out.
In 2012 or so, it seemed like US drug stores and pharmacies such as Walmart, Walgreens and CVS stopped carrying Nizoral shampoo, at least when it comes to the most popular blue bottle variety (see photo further below). I thought this was because of the warnings related to side effects from taking oral Ketoconazole. 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.
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. Most people do not need to use it more than twice a week. However, this shortage continued in 2013 and I then had to pay a significant premium to buy it from a seller on ebay. A lot of people took advantage of this situation by selling their surplus Nizoral stock online in 2012 and 2013.
In 2014, Nizoral came back on the market and the shortages finally ended. No supply issues have occurred since that time. You can read numerous favorable reviews of Nizoral online.
Nizoral Side Effects
As long as you are not taking Nizoral (i.e., Ketoconazole) orally, side effects are usually limited and transient. The main side that can arise from using Nizoral shampoo include:
- Itchy scalp.
- Dry scalp skin.
- An unnatural hair texture and feel.
- Rashes, hives and other allergic reactions.
- Red inflamed eyes in case the product accidentally gets in there.
Ketoconazole and Hair Loss Studies
You can find many studies that conclude favorable outcomes for Ketoconazole (Nizoral brand or otherwise) 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 ketoconazole: 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).