What is Nizoral Shampoo?
Nizoral shampoo is used to treat and prevent seborrhoeic dermatitis (or, in its milder form, dandruff). It’s active ingredient, Ketoconazole, is approved for use as an anti-fungal agent in the treatment of infections that occur due to fungi and yeasts.
So far, so nothing to do with hair loss. Not so fast. As with a number of hair loss treatments initially developed for different conditions, Nizoral may also do a sideline in treating pattern baldness. Less dandruff and more hair? Does that make you twice as attractive?!?
Nizoral shampoo comes in either 1% or 2% Ketoconazole versions. The 2% version can be requested over-the-counter in the UK and many other countries, however is only available by prescription in the US.
How Does It Work?
As far as Nizoral’s role in treating and preventing hair loss is concerned, there are a number of theories.
According to the American Hair Loss Association, apart from its anti-fungal properties, Nizoral shampoo also has anti-androgenic effects. That is, when ingested orally it is known to inhibit the binding of androgens to receptors in the body, which would include the binding of DHT to hair-follicle receptors (see the ‘Hair Loss Explained’ section for the leading causal theory of hair loss). It may have a similar effect when applied topically (to the scalp).
In addition to its anti-androgenic effects, hair loss researchers cite two other potential mechanisms of action: sebum reduction and anti-inflammation.
Nizoral may reduce the activity of the sebaceous glands, thus reducing sebum production. Since sebaceous glands are attached to hair follicles, overactive glands may clog the hair follicles with excess sebum and disrupt the normal process of hair growth.
Ketoconazole is also said to be instrumental in reducing inflammation. People experiencing androgenetic alopecia (pattern baldness) also experience varying degrees of inflammation of the scalp caused by bacteria in adjoining hair follicles.
Even if inflammation is not causal to pattern baldness, it’s unlikely to create a conducive environment for hair growth on the scalp.
How Effective Is It?
Studies on Nizoral’s effectiveness as a hair loss treatment are few and far between.
A 21-month study was completed in 1998 on 39 men with male pattern baldness aged between 21 and 33 years. Onset of hair loss ranged from between 2 to 6 years. The study included 4 groups, with the two groups using ketoconazole washing their hair with 2% Nizoral shampoo 2-4 times per week, for 3-5 minutes each time.
Results showed that the positive impact of 2% ketoconazole on hair loss was equal to the benefit of using topical 2% Minoxidil. Sebum levels were also positively impacted, with a median reduction of 18% at the end of the 21 months.
However the researchers noted that “[t]he clinical significance of the results awaits further controlled study in a larger group of subjects.”
Another study conducted on mice in 2005, corroborated the stimulatory effect on hair growth. However, while studies on rodents are interesting, they are no substitute for experimenting on humans with pattern baldness.
Based on the limited and inconclusive clinical data (with respect to hair loss), not surprisingly Nizoral Shampoo is only FDA approved for the treatment of seborrheic dermatitis and dandruff. Although Nizoral may be useful as a hair loss remedy, it cannot be endorsed or marketed as one.
Nonetheless there is a significant body of anecdotal evidence available on hair loss forums and websites. Many agree that Nizoral can slow or stop hair loss, rather than regrow hair, normally as part of a broader treatment regimen. Excessive usage of either the 1% or 2% formulation has not been shown to produce better results.
How Long Before I See Results?
Anecdotal reports vary widely and there is not enough clinical data to say with any certainty.
In the 1998 study above, the biggest improvement was seen between months 6-15, with a slight decrease between months 3-6, after which improvements continued.
Best Suited For
Men and women suffering from pattern baldness. Although studies have focused on hair loss on the vertex, or crown, there is very little emphasis on effectiveness in the crown over the hairline in general discussion on efficacy of the treatment.
As with all hair loss treatments, it will likely be more effective in those who have just started to lose their hair.
Guidelines for Effective Use
Reading through the various forums it would seem that people can go crazy with this shampoo – a trap you should avoid. Just because it’s readily available, and in your shower, doesn’t mean it should be used as a daily shampoo. Keep using your normal shampoo on ‘off’ days.
In order to get the greatest benefit I suggest you:
- Apply an amount about the size of a nickel (in the US) or a 20p coin (in the UK) to wet hair as soon as you enter the shower (basically an amount that will produce enough lather to clean hair and scalp)
- Immediately rinse to remove dirt and build up from the previous day
- Reapply a similar amount and allow it to soak for the duration of your shower (and no more than 5 minutes)
- Repeat steps one to three, every 3 days (and be consistent)
If you use Nizoral as a normal shampoo (i.e. you skip step 3.), you may as well not use it. It’s a medicated shampoo. Like all topical medication it needs time to penetrate and do its job.
The above describes usage for the 1% solution. For the 2% solution be sure to follow the recommended dosage and application guidelines on the label.
Availability and Cost
Cost will depend a great deal on where you purchase it and in what quantity.
In the UK you can buy 60ml and 100ml sizes. In the US I’ve seen 1.7 fl oz, 4 fl oz and 7 fl oz. As a rough estimate, it will probably cost you around USD 3.00 and GBP2.50 per month.
On a per bottle basis, I’ve seen the 7 oz version retail for anything from between $11 – $22 in the US. The 100ml version in the UK retails for around GBP 9. You can buy Nizoral here in the US and here in the UK.
There are several other products available on the market which also contain ketoconazole. These include: Regenepure DR, Lipogain, Ketozal Ant-Dandruff Shampoo, and Boots Anti-Dandruff Shampoo (in the UK).
Regenepure DR is the pick of the bunch for me and, for what it’s worth, includes other hair stimulating ingredients such as saw palmetto, emu oil and caffeine. It’s also free of sulfates, parabens, DEA and other harsh chemicals. (Note: since first writing this article I now include Regenepure DR in my updated treatment plan). In the US, purchase price is $25 for an 8 oz bottle. From what I’ve seen, in terms of price, you don’t get a better deal if you buy locally. You can purchase Regenepure DR here.
Possible Side Effects
The more common side effects of Nizoral shampoo include mild skin itching or irritation, dry skin or headache.
Ironically, the more serious, and less common, side-effects include hair loss. Highly unlikely if you use the 1% ketoconazole solution; possible if you ignore the frequency and dosage guidelines for the 2% solution.
For a more complete list of side-effects go here.
As always, just because it’s available over the counter doesn’t mean it’s risk free. If you’re thinking about using the 2% solution in particular, ask a medical professional if it’s right for you before you purchase.
- An approved treatment (although not for hair loss, it does provide some comfort regarding safety)
- Effective in treating dandruff
- Widely available over-the-counter in most countries, and on the internet (for both 1% and 2% Ketoconazole concentrations)
- Can be used in conjunction with other treatments
- Easy to incorporate into your existing routine
- May cause your scalp to itch and increase dryness of your hair
- Stopping treatment will result in your hair loss returning to its previous pattern (assuming you saw some benefit in the first place)
When I came across Nizoral 4 years into my hair loss I had high hopes. The hair loss community was broadly positive in its assessment and it was cheap, readily available and had minimal side-effects. I went straight for the 2% version, thinking more was better.
Although I’d hoped for better results, I did notice my hair loss slowing after about 6 – 8 weeks. I also noticed my hair felt a little thicker at about the 1-2 week mark. Unfortunately, it was also significantly dryer. (You may want to consider a moisturizing conditioner on the off days.)
After that there was no further progression in benefits. My hair kept thinning, albeit at a seemingly slower rate. I eventually dialed back to the 1% version at about the 6 month mark, applying it about once per week, with no reduction in ‘benefit’.
Given that it took me another 4 years to find a treatment that truly worked (see the ‘What Worked for Me’ section), I can probably give Nizoral some credit for the fact that I got to keep enough hair to enable me to keep going out into the world day-to-day.
For most people Nizoral shampoo is unlikely to be a primary hair loss treatment. It may be useful in slowing hair loss and in regrowth as part of a broader treatment regimen, however. As I mentioned above, for those who are not price sensitive, I can vouch for the Regenepure DR product having begun using it in 2015 as part of my treatment plan. It also remains part of my modified plan as I write this update in 2016. I will write a separate review on Regenepure products in an upcoming article.
With regards to Nizoral shampoo, be sure to follow the effective use guidelines. Once you get a feel for how you respond, you can adjust your dosage.
If I had my time again, I’d start with the 1% version of Nizoral or, ideally, try the Regenepure product. This may be a bit flippant, but the 2% solution is probably for those who don’t take the time to apply the shampoo properly.
Let me know how you get on, including the strength used and any combination treatments if you do decide to try.
To see what worked for me go here.