FAQs - Ketoconazole

Q. What is ketoconazole?
A. Ketoconazole has been used as an anti-fungal medication for many years, both topically and systemically.  One of its pharmacological actions is to inhibit biosynthesis of ergosterols and other sterols, which damages the cell membrane of fungi.

Q. Why does Regrowth, LLC have a 2% ketoconazole shampoo? 
A. This same pharmacological action inhibits the synthesis of DHT in the scalp, which is why ketoconazole shampoo may be beneficial in the treatment of MPB.  Sebum production is testosterone and DHT dependent.  Studies have shown that the use of a 2% ketoconazole shampoo will reduce the sebum excretion rate (-6.54%) when used over a six-month period.

Q. Does ketoconazole have any side effects?
A. In 11 double-blind trials in 264 patients using ketoconazole 2% shampoo for the treatment of dandruff or seborrheic dermatitis, an increase in normal hair loss and irritation occurred in less than 1% of patients.  In three open-label safety trials in which 41 patients shampooed 4-10 times weekly for six months, the following adverse experiences each occurred once: abnormal hair texture, scalp pustules, mild dryness of the skin, and itching. 

Q. What is salicylic acid? 
A. Salicylic acid is a keratolytic, i.e. it loosens and breaks up clumps of keratin (dandruff), allowing them to be more easily removed from the scalp.  Salicylic acid is the active ingredient in anti-dandruff shampoos such as Neutrogena T-Sal® and Scalpicin®.

Q. Why have both ketoconazole and salicylic acid in the same shampoo? 
A. Ketoconazole and salicylic acid may act synergistically.  Since the salicylic acid can remove some of the dead skin layers of the epidermis, the ketoconazole can be more effective in reducing the DHT in the scalp.  Using Regrowth Treatment Shampoo alone gives you the combined benefits of both Nizoral® 2% shampoo and Neutrogena T-Sal® shampoo.

Q. How should the Regrowth Treatment Shampoo be used? 
A. Apply a small amount of the shampoo to the wet hair and work it into a rich lather, massaging the lather onto the scalp.  Allow the lather to remain on the hair and scalp for five minutes before rinsing with warm water.  This process can be repeated, if desired.  Since the Regrowth Treatment Shampoo has potent cleansing abilities, it will remove most of the oily sebum from the scalp leaving the scalp deficient in oils, resulting in dry and unruly hair. To prevent this, you may wish to follow the shampooing with the application of a hair conditioner of your own choice.

Q. How often should the Regrowth Treatment Shampoo be used? 
A. The 2% ketoconazole / 3% salicylic acid combination in the Regrowth Treatment Shampoo strips the hair and scalp of the natural oils, so you run the risk of scalp irritation if you use Regrowth Treatment Shampoo every day. Only use it 2 or 3 times a week.

Q. Can I use the Regrowth Treatment Shampoo as the sole treatment for MPB? 
A. For those patients who are not sufficiently motivated to apply topical 5% minoxidil or Xandrox® on a daily basis and/or have reservations about the use of finasteride due to cost and/or side effects, the use of Regrowth Treatment Shampoo is highly recommended.  Since everyone with (or without) MPB is going to shampoo anyway, it is only rational to use a shampoo that has benefits in the treatment of MPB.

However, for most patients, Regrowth Treatment Shampoo is recommended as an adjunctive treatment for the prevention or reversal of MPB.  Ketoconazole is not a substitute for the use of topical minoxidil, but it may enhance the actions of azelaic acid or finasteride or spironolactone in suppressing DHT in the scalp.