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The Best Ketoconazole Shampoos for Treating Dandruff

Ketoconazole is probably the only only lively ingredient available on the market for seborrheic dermatitis victims.

It doesn’t work for everybody.  No lively ingredient does.  But there’s a purpose why it’s a first-line remedy in each the USA and Europe for treating seb derm.  And that cause is – it’s one among, if not the, best lively components [9] out there.

Yet despite it being so effective, only 4% of the shampoos reviewed include the ingredient. Making it the rarest, together with selenium sulfide, established anti-dandruff lively elements.

So as to find the most effective ketoconazole shampoo available on the market right now, we spoke to 4 board-certified dermatologists for their steerage,  and have put in actually tons of of hours value of analysis, reviewing over a hundred dandruff shampoos within the course of.

In this article, we’ll additionally take a look at what ketoconazole is, how it works and what the most important unwanted side effects are.
Supplying you with the instruments it’s essential make an informed determination on whether that is the ingredient for you, and assist you to select your personal favorite ketoconazole shampoo.

What’s in this article:

The greatest ketoconazole shampoos

Ketozal 2% Shampoo

Designed to deal with Seborrheic Dermatitis

The Ketozal 2% anti-dandruff shampoo can be very effective for severe instances of seb derm and dandruff. A generic of doctor prescribed 2% ketoconazole shampoos, Ketozal 2% is cheaper and arguably (although not clinically proven) as effective. This is the caveat of all generic medicines.

An excellent stand-by for severe dandruff and seb derm flares.

Professional-tip: You’ll in all probability want conditioner available.

Ketozolin 2% Shampoo

Designed to treat Seborrheic Dermatitis

When you’ve got a average to extreme case of dandruff brought on by Seborrheic Dermatitis, buying the Ketozolin 2% shampoo is probably a clever determination. It has the maximum EU allowed dose of anti-fungal ketoconazole – effective towards the overgrowth of Malassezia yeast seen in instances of seb derm and dandruff. It may well be used to clear dandruff inside every week and it can be used to stop dandruff recurrence when used once weekly.

Nevertheless, it does include one or two harsh elements, together with SLS and a formaldehyde releaser. So use with warning if in case you have a sensitive scalp.

Ket Med Ketoconazole Shampoo

Designed to treat Seborrheic Dermatitis

The best choice within the struggle towards average to severe instances of dandruff and seborrheic dermatitis is a 2% Ketoconazole shampoo. It’s really helpful by pharmacists and typically also prescribed by docs.

Ket Med shampoo is an OTC various in lots of nations (and out there on eBay in others).

Its 2% Ketoconazole method guarantees to be efficient and preventative.  Nevertheless there’s one word of warning, it isn’t designed for probably the most allergy susceptible scalps.

boots 2% ketoconazole shampoo

Boots 2% Ketoconazole Shampoo

Designed to treat
Seborrheic Dermatitis

Boots are a UK retail pharmacist just like Walgreens or CVS in the USA. Walgreens and Boots are literally strategic partners (whatever that really means). Boots have developed their own 2% Ketoconazole shampoo which is a less expensive various to Nizoral. Though it does include quite a lot of harsh components, it’s undoubtedly value a look if you’d like a cheaper various. Anticipate a evaluation within the coming months.

Buy now at

sebizole 2% ketoconazole shampoo

Sebizole 2% Ketoconazole Shampoo

Designed to deal with
Seborrheic Dermatitis

Sebizole is another 2% ketoconazole shampoo out there in Australia and New Zealand. I’ve to confess, I don’t know a lot about this shampoo but as I haven’t yet reviewed it.

The elements are Sodium laureth sulfate, Cocamide DEA, sodium lauryl sarcosinate, PEG -150 distearate, hydrochloric acid, Germall II (preservative), Herb Flower perfume, erythrosine sodium, purified water.

Once I get my palms on a bottle anticipate a evaluate!
Because of Sam within the comments under for these components. Much appreciated!

In case you can’t discover the shampoo you’re wanting for, likelihood is we’ve already reviewed it.

If not, please let us know in the feedback under which shampoos you’d like us to try!

How we selected the winners

All our reviewers are specialists in their subject, be that product formulation, pharmacy or haircare.

They assess the first function of the dandruff shampoo, by analyzing the lively components present within the formulation. These lively elements are designed to regulate particular kinds of dandruff and we’ll explain what these are.

Our critiques may even assess the remainder of the formulation, deconstructing the shampoos to their constituent elements and describe the key ones intimately.

As well as, we warn of the presence of any one among over 100 components that can probably itch, irritate and even cause dandruff themselves. A big quantity (~90%) of those chemical compounds have by no means been examined for their impact on human health. Many of these chemical compounds are recognized to have opposed results on our pores and skin and certainly one of these opposed results is dandruff.

In contrast to most evaluation websites, our reviewers personally attempt each shampoo they evaluate they usually additionally assess how the shampoo washes, the way it smells and take a look at the worth point of their market. These could also be medicated shampoos, however that doesn’t mean we need to compromise on just a little bit of luxurious!

What we gained’t do is inform you if the shampoo will work for you. Our responses to the components are extremely private, so we just couldn’t do this.

What we’ll do is clarify, in layman’s terms, the aim of the shampoo and what situation it’s designed to alleviate.

What’s ketoconazole?

Ketoconazole is an imidazole by-product, broad-spectrum antifungal. In the UK, a 2% shampoo is that can be purchased from pharmacies for treating seborrheic dermatitis or dandruff as a number of manufacturers (Ketopine, Nizoral). In case your signs are extreme, your physician may need to prescribe the shampoo to watch the situation.

Dr. Ben Barankin, a Toronto based mostly board-certified dermatologist at the Toronto Dermatology Centre, recommends it’s usage when he advised us, “For mild-moderate dandruff, my most popular over the counter dandruff components embrace: zinc pyrithione, selenium sulfide, ketoconazole, tar and salicylic acid“.

When ketoconazole is used as a shampoo it’s not absorbed into the bloodstream, and so the antifungal results are localized to the scalp [1]. It really works by inhibiting enzymes needed for a fungus to synthesize steroids within the cell membrane. This leads to the cells turning into ‘leaky’ – unable to appropriately regulate electrolytes – causing them to interrupt down.

Who Invented It?

The oral formulation of ketoconazole was developed by Janssen Prescription drugs in Belgium – the corporate behind different well-known medicine comparable to Imodium and Daktarin!

Ketoconazole was first discovered in 1976 and for the first 10 years, it was applied orally.  Relatively quickly after it was relatively shortly replaced with less toxic options that didn’t have as many drawbacks [3]:

  • Absorption assorted by particular person
  • It couldn’t penetrate the mind for more critical infections
  • It resulted in gastrointestinal uncomfortable side effects and liver toxicity
  • A number of necessary drug interactions have been found

In 2013 because of the danger of liver toxicity, the UK Medicines and Healthcare Products Regulatory Company (MHRA) formally advisable suspending the license for oral ketoconazole, advising docs to discuss options with patients [4]. This suggestion specifically excluded topical formulations (e.g. shampoos, creams), as a result of they don’t seem to be readily absorbed into the bloodstream.

Ketoconazole shampoos have been proven to be efficient towards a variety of fungus and yeast species. These are recognized to cause a number of scalp circumstances, and so your physician might prescribe ketoconazole shampoo in case your signs are in keeping with an underlying fungal infection – while not having to send a sample for microbiological testing. Widespread species vulnerable to ketoconazole are summarized under [5]:

Fungus Yeast
T. rubrum

T. mentagrophytes


M. canis

M. audouini

M. gypseum

E. floccosum

P. ovale (Malassezia)

P. orbiculare

C. albicans

C. tropicalis

How effective is ketoconazole at treating dandruff

Ketoconazole is likely one of the few lively components to be listed as an official anti-dandruff remedy each within the UK and the USA.

The purpose it’s so extensively advisable is that it’s proven to be effective, notably when treating seb derm.

Board certified dermatologist Brent Thomas Goedjen M.D., founder of Reside Oak Dermatology in Roswell, GA explains further, “Part of the mechanism behind seborrheic dermatitis is considered an inflammatory immune reaction (resulting in redness, itching, flaking) to an in any other case resident yeast that becomes overly represented on the pores and skin.

Antifungal shampoos similar to ketoconazole are useful to manage the yeast inhabitants and subsequently scale back partially the trigger for the skin irritation. Ketoconazole is helpful for this objective and as a generic is nicely coated with most insurance policy.

Some individuals additionally assume the antiandrogenic effects of ketoconazole may scale back sebum manufacturing additionally when applied topically.”.

Seborrheic Dermatitis

Quite a few research exhibit its efficacy in treating seb derm. Among them, a 2015 Cochrane Assessment identified 51 research masking over 9000 individuals and found those using a ketoconazole shampoo have been 31% less more likely to have recurrent signs within 4 weeks in comparison with placebo [6]. The analysis additionally discovered that ketoconazole was simpler than ciclopirox, and as effective as steroids – with significantly much less antagonistic effects.

A really current research revealed in 2018 [8] confirmed a 2% ketoconazole shampoo to dramatically improve symptoms of seb derm over 30 days of use – when used as soon as each Three or Four days.

Because of the overwhelming success of those research, Ketoconazole is on the FDA’s authorised listing of dandruff remedies and in the UK, the Nationwide Institute for Health and Care Excellence (NICE) advocate 2% ketoconazole as a first line remedy for seb derm on the scalp. This suggestion is backed by the British Association of Dermatologists.

Dr. Caren Campbell, board-certified dermatologist and founder of Caren Campbell MD Dermatology is a fan. “I really like ketoconazole shampoo for quite a lot of circumstances from dandruff aka seborrheic dermatitis of the scalp and beard and tinea versicolor on the chest and again. Each are circumstances brought on by an overgrowth of the traditional yeast that lives on our skin.  Ketoconazole helps scale back the number of those organisms on the skin.

I like it just because it’s effective and its reasonably priced so it’s typically my first line remedy – typically in combination with a topical steroid answer..”

Scalp psoriasis

Scalp psoriasis is an inflammatory condition, not sometimes associated with an underlying fungal an infection. The first-line remedy for scalp psoriasis is a brief course of corticosteroids. Within the 1980s a number of research confirmed that oral ketoconazole might be of some benefit in treating the situation, however the vital antagonistic effect profile and efficacy of corticosteroids prevented further analysis [7].

Where can I purchase it?

The 1-percent ketoconazole merchandise corresponding to Nizoral can be found over the counter. The stronger two-percent shampoo have to be prescribed by a physician in the USA. Nevertheless, in nations like the UK or much of Europe, it is obtainable OTC.

Personally, I feel it’s about time the US adopted go well with…

Widespread model names of ketoconazole shampoos

Ketoconazole is bought underneath a variety of brand names together with:

How typically should I exploit a ketoconazole shampoo?

To make use of a dandruff shampoo, or any shampoo for that matter, shampoo, it is best to all the time comply with the instructions on the label.

Nizoral’s instructions are extremely specific:

  • Moist hair completely.
  • Apply a small quantity of Nizoral Dandruff Shampoo to your and therapeutic massage into a lather.
  • Depart the lather in your scalp for Three – 5 minutes.
  • Rinse completely.
  • Use every 3 or 4 days for 2 – 4 weeks.
  • If your scalp has not cleared within Four weeks, converse to your physician or pharmacist.
  • To maintain your scalp clear and to stop dandruff returning, use Nizoral Dandruff Shampoo once every 1 – 2 weeks. When you cease using Nizoral Dandruff Shampoo altogether, your signs might turn into an issue once more.

Sadly, not all shampoos are as prescriptive as this. For example, Regenpure is a bit vaguer:

Apply a beneficiant amount of shampoo to wet hair and therapeutic massage it into the scalp. Depart the shampoo for three to five minutes after which rinse the shampoo.  Regenepure DR shampoo is suitable for on a regular basis use.  Because of the 1% Ketoconazole, your hair can really feel dry once you use the shampoo daily. You possibly can then choose to scale back the frequency (Three-4 occasions per week) and to not wash your hair on the opposite days. Use a condtioner if desired, ideally Regenepure biotin conditioner.

We appeared slightly further afield.  The European Fee’s Scientific Committee on Shopper Security recommends leaving the shampoo on for 5-10 minutes earlier than rinsing and utilized each 2 to 3 days. But additionally they caveat this by saying that this will differ by model, and depends upon another elements within the shampoo.

So we requested a physician for steerage.

Dr. Matthew Zirwas, a board-certified dermatologist and founding father of Bexley Dermatology in Bexley, Ohio advisable making an attempt a shampoo for, “at least a month because if your old shampoo had ingredients that were causing a dandruff-like rash of their own, it will take 4-8 weeks for that ingredient to work its way out of your body after you start the new stuff.”

For some further clarity, Dr. Ben Barankin, advised us, “For mild-moderate dandruff, I recommend daily shampooing, and ideally alternating 3 shampoos, each with active anti-dandruff ingredients.”

And if it doesn’t work, board-certified dermatologist Adam J. Friedman, MD, FAAD, assistant professor of dermatology and director of dermatologic analysis, Albert Einstein School of Drugs explains by way of the AAD, “For most people, dandruff does not require medical attention. However, sometimes the flaking and itching that appears like dandruff is actually a medical condition, such as seborrheic dermatitis, psoriasis, fungal infections of the scalp, or eczema. If you continue to have symptoms after using a dandruff shampoo, consult a board-certified dermatologist.”

By visiting a board-certified dermatologist, you could be correctly recognized and be prescribed stronger treatment than you’ll be able to decide up on the pharmacy. As Dr. Ben Barankin says, “for moderate to severe cases of dandruff, a steroid shampoo or leave-in lotion can be prescribed. A prescription ciclopirox olamine lotion is often a nice option.”

What are the dangers with utilizing it?

When used as a shampoo ketoconazole could be very properly tolerated, not related to the harmful effects of the oral formulation. In a evaluation of 22 medical trials masking over 2800 members, no opposed effects had an incidence of over 1% [2]. The commonest reactions occurred in 1 in each 100-1000 individuals:

  • Dry pores and skin
  • Rash
  • Irritation
  • Irregular hair texture

The shampoo may cause irritation to the eyes, and so if unintentional contact occurs, they need to be instantly bathed. Sure individuals are extra vulnerable to antagonistic reactions, and so a trial of selenium sulfide, zinc pyrithione, piroctone olamine, ciclopirox olamine, coal tar, salicylic acid, tea tree or any of the opposite lively components recognized to help dandruff could also be extra appropriate options.


[1] Faergemann, J., Borgers, M., & Degreef, H. (2007). A new ketoconazole topical gel formulation in seborrhoeic dermatitis: an up to date evaluation of the mechanism. Skilled opinion on Pharmacotherapy, 8(9), 1365-1371.

[2] EMC. (2015). Pinewood Healthcare: Ketoconazole 2% w/w Shampoo. [Accessed: 28/2/17]

[3] Gupta, A. Okay., Daigle, D., & Foley, Okay. A. (2015). Drug security assessment of oral formulations of ketoconazole. Skilled Opinion on Drug Security, 14(2), 325-334.

[4] MRA. (2013). Oral ketoconazole: don’t prescribe or use for fungal infections—danger of liver damage outweighs advantages. [Accessed: 28/2/17]

[5] Van Cutsem, J. (1983). The antifungal activity of ketoconazole. The American journal of drugs, 74(1), 9-15.

[6] Cochrane Library. (2015). Antifungal remedies applied to the skin to deal with seborrhoeic dermatitis. [Accessed: 28/2/17]

[7] Farr, P. M., Marks, J., Krause, L. B., & Shuster, S. (1985). Response of scalp psoriasis to oral ketoconazole. The Lancet, 326(8461), 921-922.

[8] Chaijan MR1, Handjani F2, Zarshenas M3, Rahimabadi MS4, Tavakkoli A1. (2018) The myrtus communis L. answer versus ketoconazole shampoo in remedy of dandruff: A double blinded randomized medical trial.

[9]Piérard-Franchimont C1, Goffin V, Decroix J, Piérard GE. (2002) A multicenter randomized trial of ketoconazole 2% and zinc pyrithione 1% shampoos in extreme dandruff and seborrheic dermatitis.Pores and skin Pharmacol Appl Pores and skin Physiol. 2002 Nov-Dec;15(6):434-41.

Writer Profile

Grasp of Pharmacy

Ethan graduated numerous years ago after learning pharmacy within the UK, and is now a training pharmacist by day.

By night time he writes probably the most beautiful articles on an entire range of pharmaceutical topics each right here, and on our sister website at