Nizoral Shampoo and Hair Loss: An In-Depth Guide

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Nizoral is a popular option for the treatment of many scalp conditions, including dandruff and seborrheic dermatitis. The active ingredient in Nizoral may also be indicated as beneficial in treating hair loss.

This article will review the good and the bad of Nizoral shampoo, including how it works, potential side effects, and costs.

What is Nizoral Shampoo?

Nizoral shampoo is an over-the-counter product used in the treatment of dandruff, fungal infections, seborrheic dermatitis, and related hair loss, thinning hair, and receding hairlines (1, 2).

This product is produced by numerous companies, each of which are fairly similar to one another.

The active ingredient of Nizoral shampoo, known as ketoconazole, is an anti-fungal medication.

Nizoral shampoo is shown to be an effective method for treating dandruff and seborrheic dermatitis (3).

(Learn more about seborrheic dermatitis here.)

Furthermore, there is limited research to suggest the active ingredient in Nizoral shampoo may help prevent the body from producing DHT which is another underlying cause for hair loss and thinning hair (4).

A woman pouring nizoral shampoo into her palm

This may make it a treatment option for men and women with Androgenetic Alopecia (AGA) (5).

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Nizoral shampoo is not intended to be a daily use shampoo, and should only be used as directed. Typically, the initial period of treatment requires using Nizoral shampoo twice a week for one month which is to be reduced to only a single use every other week if the issue remains chronic.

How Does Nizoral Work?

Nizoral shampoo contains the active ingredient ketoconazole, which is a broad-spectrum synthetic anti-fungal agent effective for treating the underlying skin conditions that cause dandruff.

The mode of action of ketoconazole impairs the body’s ability to synthesize ergosterol which is a vital component of the cell membranes of fungus (7). It also inhibits the growth of dermatophytes and yeasts by reducing the permeability of the cell membrane in these organisms (8).

While these organisms are normally present on the scalp, the significant proliferation of them can be prevented by the formulation.

Ketoconazole is also indicated for the inhibition of 5-alpha-reductase, the enzyme that converts testosterone to DHT (9). When testosterone is converted to DHT this leads to damage of the hair follicle in individuals with AGA, which ultimately kills the follicle.

In addition, there is evidence Malassezia can cause/exacerbate androgenetic alopecia through chronic inflammation of the scalp. Malassezia infection of the scalp is commonly known as dandruff. Ketoconazole is active against Malassezia (a yeast) in addition to fungal agents.

Using Nizoral shampoo two times a week will reduce the proliferation of fungal agents that are causing dandruff or seborrheic dermatitis. Once the noticeable irritation of the skin and presence of dandruff has dissipated, using the shampoo on a bi-weekly basis will help prevent the recurrence of these conditions.

Nizoral shampoo should not replace the regular use of shampoo to wash hair, and should only be used as directed to avoid overuse and the increased potential for side effects.

Does Nizoral Shampoo Really Work?

The effectiveness of Nizoral shampoo depends on the severity of the condition, as well as whether or not it is the appropriate treatment for an individual.

Nizoral shampoo works in the majority of cases for individuals who are experiencing dandruff or less severe instances of seborrheic dermatitis.

There are numerous studies published dedicated to the study of the active ingredient in Nizoral shampoo, however much of the research is inconclusive and more research is necessary to fully understand the effectiveness of Nizoral shampoo.

In the Treatment of Dandruff and Seborrheic Dermatitis

In a study published by the British Medical Journal of Clinical Evidence, the effectiveness of a ketoconazole scalp preparation was compared to a placebo (10). The results showed a statistically significant difference in the reduction of scalp symptoms such as itching, redness, and dandruff over four weeks for people with seborrheic dermatitis.

The use of products that include ketoconazole can be effective in the clearance of dandruff and the long term maintenance of scalp and hair health.

This study recommends the product be used twice a week for four weeks while clearing the condition, which is to be reduced to once a week or every other week in order to prevent a relapse of the condition.

A 2010 study published in the Journal of Pharmacy & Therapeutics states the most effective method of treating seborrheic dermatitis is to address the colonization of yeast and fungus on the skin and reduce the resulting skin inflammation (11). Ketoconazole is one of the most well-studied treatments, having undergone many randomized trials that have demonstrated its effectiveness as a treatment for scalp dermatitis.

The article also suggests that intermittent use of ketoconazole is effective in preventing recurrence of the condition.

In the Treatment of Hair Loss

Research that has been published more recently on ketoconazole suggests it may also play a role in the treatment of androgenetic alopecia.

A 2014 study compared three solutions for the treatment of hair loss in mice (12). They were: minoxidil, ketoconazole, and minoxidil with tretinoin.

The dorsal areas of the mice were clipped and dyed, and the treatments were applied to each group once daily for three weeks.

The group to show the greatest hair growth was the minoxidil-only group. However, the other two groups including ketoconazole also saw significant growth over the three-week period.

And while this study was performed on mice, there is evidence to suggest that the use of ketoconazole would be effective in human subjects as well. One such study was published in 2011 (13).

This study consisted of 15 male patients, all of who received a topical combination of finasteride, dutasteride, and minoxidil. However, the men were also able to choose additional treatments, one of which was ketoconazole shampoo.

Ten of the 15 patients incorporated ketoconazole shampoo into their routine, with one out of 15 using just ketoconazole alongside the above-mentioned topical combination.

As reported by researchers:

“Patients who did not have signs or symptoms of seborrheic dermatitis also reported subjective improvement [of hair growth] with use of 2% ketoconazole shampoo.”

Further research is required to determine the role of ketoconazole in the process of hair growth, beyond its role in promoting skin and hair follicle health in cases of seborrheic dermatitis and other scalp irritations.

Reviews of Nizoral Shampoo

There are many reviews available for Nizoral shampoos, the majority of which offer an overall positive rating for the product.

Numerous consumers agree that Nizoral shampoo is effective in treating the majority of cases of dandruff or low-level seborrheic dermatitis, and is less harsh than other treatments typically used to address such issues.

There are some negative reviews associated with Nizoral shampoo, mainly associated with the potential side effects of using this type of shampoo.

Depending on the severity of the case of seborrheic dermatitis. the use of Nizoral shampoo may not sufficiently address the condition and stronger treatments may be required.

Many users also complain about the cost of the product, which can be expensive when compared to other products on the market.

Cost of Nizoral Shampoo

The cost of Nizoral shampoo will depend on the strength and concentration of ketoconazole. Over the counter options typically cost somewhere in the range of $15 USD for approximately 8 ounces of product.

Prescription strength ketoconazole shampoo will cost more than the name brand Nizoral product. The amount of product needed may vary from one individual to another, as well as the frequency of use.

Possible Side Effects

There are many potential side effects associated with the topical use of the active ingredient in Nizoral shampoo, ketoconazole. The most common side effects include:

  • Skin irritation; itching, stinging, burning
  • Dryness or oiliness of the hair and scalp
  • Headaches

According to the Mayo Clinic, skin irritation is likely to dissipate after multiple uses (14). Should any side effects beyond the irritation of the skin in the areas of use, it is important to seek medical attention and discuss these issues with a physician.

Often, many of the less severe side effects can be managed in consultation with a physician. However, if you experience any of the more serious side effects it is important to discontinue use immediately and seek medical attention.

Those with the following conditions should consult a physician prior to using Nizoral shampoo:

  • Women who are pregnant or are planning to become pregnant
  • Women who are actively breastfeeding
  • Individuals with asthma or chronic obstructive pulmonary disease
  • Individuals who have some form of cardiac condition
  • Individuals who are, or may be, allergic to the ingredients of Nizoral shampoo

Ketoconazole has been shown to be less irritating than similar treatments, though there is a risk of hepatotoxicity (15).

Is Nizoral Shampoo Right for You?

There are a variety of factors to consider when determining whether or not Nizoral shampoo is the correct product for the treatment of dandruff, scalp fungal infection, or seborrheic dermatitis. These include the severity of the condition, your body’s predisposition for experiencing side effects, and health conditions you might have.

In cases of minor dandruff, or if the use of Nizoral shampoo has been successful in the past, you may wish to utilize this product as it is easily available over the counter. Otherwise, you may wish to consult with a physician on the most appropriate method of addressing your scalp condition.

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