Ketoconazole shampoo: effect of long-term use in androgenic alopecia

Dermatology. 1998;196(4):474-7. doi: 10.1159/000017954.


Background: The pathogenesis of androgenic alopecia is not fully understood. A microbial-driven inflammatory reaction abutting on the hair follicles might participate in the hair status anomaly.

Objective: The aim of our study was to determine if ketoconazole (KCZ) which is active against the scalp microflora and shows some intrinsic anti-inflammatory activity might improve alopecia.

Method: The effect of 2% KCZ shampoo was compared to that of an unmedicated shampoo used in combination with or without 2% minoxidil therapy.

Results: Hair density and size and proportion of anagen follicles were improved almost similarly by both KCZ and minoxidil regimens. The sebum casual level appeared to be decreased by KCZ.

Conclusion: Comparative data suggest that there may be a significant action of KCZ upon the course of androgenic alopecia and that Malassezia spp. may play a role in the inflammatory reaction. The clinical significance of the results awaits further controlled study in a larger group of subjects.

Publication types

  • Clinical Trial
  • Comparative Study
  • Controlled Clinical Trial

MeSH terms

  • Adult
  • Alopecia / drug therapy
  • Analysis of Variance
  • Antifungal Agents / therapeutic use*
  • Drug Therapy, Combination
  • Hair / drug effects
  • Hair Preparations*
  • Humans
  • Ketoconazole / therapeutic use*
  • Male
  • Minoxidil / therapeutic use
  • Regression Analysis
  • Sebaceous Glands / drug effects
  • Time Factors
  • Treatment Outcome
  • Vasodilator Agents / therapeutic use


  • Antifungal Agents
  • Hair Preparations
  • Vasodilator Agents
  • Minoxidil
  • Ketoconazole