Hair & Scalp · Remedies & products

Ketoconazole Shampoo: How to Use It, 2% vs 1%, and What It Does for Hair Fall

Written by · Registration TSMC/FMR/36195 · Published: 21 September 2026 · 13 min read · 23 references

Ketoconazole shampoo is an antifungal wash for dandruff and seborrheic dermatitis. It slows the growth of Malassezia, a yeast on the scalp. Lather it in, leave it three to five minutes, then rinse, twice a week.1 In a trial of 575 people, 88% had an excellent response within four weeks.2 It is not an established treatment for pattern hair loss.3

What does ketoconazole shampoo treat? Copy link

Ketoconazole blocks fungi from making ergosterol, an essential part of their cell membrane. The membrane turns leaky, and the yeast stops growing.4

On your scalp, the target is Malassezia, a yeast that is part of normal skin flora, and seborrheic dermatitis comes from an interplay between that yeast, the fats on the skin's surface and individual susceptibility.4,5 Ketoconazole is one of several antifungals used in medicated anti-dandruff shampoo to hold Malassezia in check.6

Licensed uses depend on the country and the strength. In the US, the 1% shampoo is sold over the counter for dandruff,7 while the 2% shampoo carries a prescribing label for tinea versicolor, a yeast rash that leaves pale or dark patches on the trunk.4 A UK 2% shampoo is licensed for seborrheic dermatitis, dandruff and pityriasis versicolor.1 In India, 2% ketoconazole bottles are sold as medicated anti-dandruff shampoo.8

Antifungal shampoos such as ketoconazole are also used alongside oral treatment in tinea capitis, a fungal scalp infection seen mostly in children, to help stop it spreading. The shampoo on its own will usually not cure it.9

How to use ketoconazole shampoo Copy link

Wet your hair, work the shampoo into the skin of your scalp, leave it on for three to five minutes, then rinse.1 The US label for the 2% shampoo gives five minutes.4 For dandruff, use ketoconazole shampoo twice weekly and keep that up for two to four weeks.1

After that, one wash every one to two weeks cuts the chance of the flakes returning, and in the main maintenance trial fewer people relapsed with a weekly wash than with a wash every other week.1,2

In practice, part your hair and lather at the roots, since the yeast lives on the skin. Rinsing straight away shortens the time the antifungal spends there, and because dryness of the hair and scalp is a listed side effect, you may want to condition your lengths afterwards.4 If your scalp gets oily, use a mild ordinary shampoo on the days in between.

Give it four weeks of correct use. If little has changed by then, get the diagnosis checked; the US 1% label also says to ask a doctor if there is no improvement in two to four weeks.7 Psoriasis and tinea capitis can both look like dandruff at first.5

Ketoconazole shampoo wash schedule: two washes a week, five minutes on the scalp each time A seven-tile week strip with two tiles marked as wash days, each carrying a five-minute contact time. Below, three rows: a clearing phase with two washes weekly over two to four weeks, maintenance with one wash every one to two weeks, and each wash lathered and left five minutes before rinsing. SAPIENS · FIG. 1 Two washes a week M T W T F S S 5 min 5 min CLEARING 2 washes a week for 2 to 4 weeks MAINTENANCE 1 wash every 1 to 2 weeks EACH WASH lather, leave 5 minutes, rinse UK label 2025 · US FDA label · schematic [1][4]
Fig. 1. Schematic of the ketoconazole shampoo schedule: two washes weekly during a two-to-four-week clearing phase, about five minutes on the scalp each time, then one wash every one to two weeks. Sources 1, 4.

Ketoconazole shampoo 2% or 1%: which strength do you need? Copy link

Ketoconazole shampoo comes in 1 percent and 2 percent strengths, and for severe dandruff the 2 percent works better.10 In a randomized trial of 66 people with severe dandruff or seborrheic dermatitis, 2% cut flaking and Malassezia counts more than 1% did by week two, the gap held at week four, and the 2% group later showed a trend toward fewer relapses.10 The gap was statistically clear.

That trial was small and open-label, meaning everyone knew which shampoo they had. One of its four authors worked for McNeil Consumer Healthcare.10 Trust the direction of the result more than the size of the gap.

If you have mild dandruff, 1% may be enough where you can find it, since the advantage for 2% was shown in severe cases. Side effects were few at either strength, with six mild adverse events across the whole trial.10

What happens when you stop using ketoconazole shampoo? Copy link

Your flakes will often come back. Of course, the yeast behind them is still there, because it is part of normal skin flora, and adult seborrheic dermatitis follows a relapsing and remitting course.4,5

The 1995 multicenter trial put numbers on it. Among 312 people who had responded to treatment, 47% of those washing weekly with a plain shampoo relapsed within six months, against 19% with a weekly 2% ketoconazole wash and 31% with the two alternated.2 One of the trial's two authors worked for the Janssen Research Foundation, and Janssen made Nizoral.2,4

Plan your maintenance wash from the start. Keep it going once your scalp looks clear.

Relapse of seborrheic dermatitis over six months: 47 percent on placebo, 31 percent alternating, 19 percent on weekly ketoconazole 2% shampoo Three horizontal bars comparing six-month relapse rates in 312 patients who had responded to a first course of treatment. Placebo weekly 47 percent. Ketoconazole alternating with placebo 31 percent. Ketoconazole 2% once weekly 19 percent. SAPIENS · FIG. 2 Relapse over six months PLACEBO WEEKLY KETOCONAZOLE ALTERNATE WEEKS KETOCONAZOLE EVERY WEEK 47% 31% 19% 312 patients who had responded, followed six months Peter & Richarz-Barthauer 1995, Br J Dermatol · schematic [2]
Fig. 2. Schematic of six-month relapse rates among 312 people who had responded to treatment: 47% with a weekly plain shampoo, 31% alternating, 19% with weekly 2% ketoconazole. Source 2.

Does ketoconazole shampoo stop hair fall? Copy link

It can reduce shedding when your scalp is also flaking. It is not an established treatment for pattern hair loss. The evidence that it adds hair is limited.3 What there is points both ways.4,11

A small 1998 study compared 2% ketoconazole shampoo with a plain shampoo, used with or without 2% minoxidil, in androgenetic alopecia, the medical name for pattern hair loss. Hair density and the share of growing hairs improved almost as much with ketoconazole as with minoxidil,11 though that comparison involved four men in each group.3 Two of the four authors worked for Janssen or Johnson & Johnson, and they asked for studies in larger groups.11

A randomized trial published in 2002 followed 150 men with dandruff and shedding tied to male pattern baldness for six months.12 By the end, shedding was down 17.3% in the ketoconazole group, against 16.5% on piroctone olamine and 10.1% on zinc pyrithione. Shaft width rose 5.4% and 7.7% in the first two groups and fell 2.2% on zinc pyrithione. Hair density did not change in any group.12

Piroctone olamine did about as well as ketoconazole. Shedding was scored on a rough scale, and every group used an active shampoo, so no one went untreated for comparison.12

Ketoconazole 1% shampoo versus piroctone olamine and zinc pyrithione over six months: shedding, shaft width and hair density A three-column comparison from a six-month trial in 150 men. Hair shedding fell 17.3 percent with ketoconazole, 16.5 percent with piroctone olamine and 10.1 percent with zinc pyrithione. Mean shaft width rose 5.4 percent, rose 7.7 percent and fell 2.2 percent. Hair density did not change in any group. SAPIENS · FIG. 3 Six months, three actives KETOCONAZOLE PIROCTONE ZINC PYRITHIONE SHEDDING −17.3% −16.5% −10.1% SHAFT WIDTH +5.4% +7.7% −2.2% Hair density: no change in any group Piérard-Franchimont 2002 · 150 men · no untreated group · schematic [12]
Fig. 3. Schematic of six-month results in 150 men using 1% ketoconazole, 1% piroctone olamine or 1% zinc pyrithione shampoo. Figures show percentage change in shedding and shaft width; hair density did not change in any group. Source 12.

The label points the other way for a minority. Across 11 double-blind trials in 264 people, increased hair loss and irritation were reported in under 1%, and alopecia appears among the post-marketing reports.4 The current UK label also lists alopecia as uncommon, a band it defines as at least 1 in 1,000 people but fewer than 1 in 100.1 The rate is low. It still matters if hair fall is the reason you bought the bottle.

Reviews stay cautious. A 2020 systematic review found five human studies with 318 people in total, called ketoconazole promising, and asked for randomized controlled trials.3 A 2025 review describes it as a possible complement to minoxidil and finasteride.13

A 2025 Canadian expert panel placed ketoconazole shampoo among five treatments recommended with near consensus, a tier below the seven it recommends outright.14 Those seven include finasteride and minoxidil, each in tablet and topical form. The panel was funded by an educational grant from Vichy Laboratoires, L'Oréal Canada.14

Does ketoconazole shampoo need a prescription in India? Copy link

Not as the rules are written. Ketoconazole is entry 270 in Schedule H, the list of prescription drugs in India's Drugs Rules, 1945.15 The schedule's own note, though, extends it to preparations of these drugs "excluding those intended for topical or external use".15

A shampoo is for external use, so a plain ketoconazole shampoo sits outside Schedule H as that text reads. The listing still covers ketoconazole in other forms, such as tablets. A separate note does cover topical products that contain a steroid, so a ketoconazole product with a steroid in it needs a prescription.15 Apollo Pharmacy files Ketomac, Ketofly and Kitral, all plain 2% ketoconazole shampoos, among its over-the-counter products,8,16,17 but a shop's category has no legal force, so treat the rules themselves as the reference.

Legal status aside, a scalp that has flaked for months deserves a doctor's look before a fourth bottle.

Check the composition line on the carton before you pay. Some bottles pair ketoconazole with a second active. K Zpto, for example, lists ketoconazole 2% with zinc pyrithione 1%.18 Others contain no ketoconazole at all. Scalpe Pro Daily lists climbazole, piroctone olamine and zinc pyrithione, and its listing states that it has no ketoconazole.19

The trials on this page tested ketoconazole as the only active ingredient. A combination bottle is a different product. Check its own evidence.

What do BP and IP mean on a ketoconazole shampoo carton? Copy link

Look at the carton and you may see ketoconazole shampoo BP or ketoconazole shampoo IP after the name. IP means the drug meets the Indian Pharmacopoeia, India's official book of standards for the identity, purity and strength of drugs,20 while BP refers to the British Pharmacopoeia, the UK's collection of official standards for medicines.21

The percentage beside the letters is the concentration, and 2% w/v means 2 grams in every 100 ml. A shampoo containing ketoconazole IP 2% w/v and one labeled BP 2% w/v hold the same amount of the same active. Neither marking describes the washing base around it.

The best anti-dandruff shampoo with ketoconazole is usually a plain 2% bottle you can afford to keep using, in a base your scalp tolerates. Buy ketoconazole shampoo on price per milliliter and on how your scalp feels after four washes.

Ketoconazole shampoo brands and price in India Copy link

Compare price per milliliter, because bottle sizes vary, and note that the table uses the maximum retail price (MRP) on each Apollo Pharmacy listing, checked on 21 September 2026. Selling prices are often lower after discounts.

Ketoconazole shampoo brands and MRP in India, Apollo Pharmacy listings checked 21 September 2026
ProductActiveSizeMRPPer ml
Ketofly Anti Dandruff Shampoo16Ketoconazole 2%100 ml₹185₹1.85
Ketomac Dandruff Treatment Shampoo8Ketoconazole 2%110 ml₹225₹2.05
Kitral Anti Dandruff Shampoo17Ketoconazole 2%100 ml₹238₹2.38
K Zpto Shampoo18Ketoconazole 2% + zinc pyrithione 1%75 ml₹225₹3.00
Be Bodywise Ketoconazole Dandruff Shampoo22Ketoconazole 1% + salicylic acid100 ml₹399₹3.99

The three plain 2% bottles hold the same active at the same strength, and the dearest costs about 29% more per milliliter than the cheapest. The 1% Be Bodywise bottle, which adds salicylic acid, costs more than twice as much per milliliter as Ketofly for half the ketoconazole.

Does ketoconazole shampoo have side effects? Copy link

Most people tolerate it well. As you'd expect with any shampoo, it can leave hair and scalp oilier or drier.4 The label also lists itching, a burning feeling and a rougher feel to the hair.4

Hair discoloration, loss of curl in permed hair, contact dermatitis and hair loss are recorded too, and post-marketing reports include severe allergic reactions such as anaphylaxis.4 Stop and get medical help for facial swelling, a widespread rash or difficulty breathing.

In the label's studies, ketoconazole was not detected in the blood of 39 people who shampooed four to ten times weekly over six months, or of 33 people who washed two or three times a week for up to 26 months.4 Frequent use was tolerated too. In open-label safety studies of 41 people washing four to ten times weekly over six months, each listed side effect occurred only once.4

In the Cochrane review, ketoconazole products applied to the skin carried a 44% lower risk of side effects than topical steroids, with similar rates of clearing.6

How well does ketoconazole shampoo work? Copy link

Well for flakes, less clearly for hair. The 2015 Cochrane review pooled eight trials of topical 2% ketoconazole against placebo, with 2,520 participants, and found a 31% lower risk of symptoms persisting at four weeks.6 Those trials tested creams and gels as well as shampoos, so the figure is not specific to shampoo.6

The reviewers rated that evidence low quality, with wide variation between studies, and very few trials followed people past four weeks,6 which matters because relapse plays out over months, as the six-month maintenance trial shows.2

The hair data are thinner again. The studies are small, the early work had authors from the manufacturer's side, and the 2002 trial had no untreated group. None of this weakens ketoconazole at its licensed job. It does mean treating any hair-growth claim with caution.

When is ketoconazole shampoo the wrong choice? Copy link

Plaques with sharp edges and loose, silvery scale suggest scalp psoriasis.5 Scaly patches with broken hairs in a child suggest tinea capitis. That needs oral antifungal treatment, because topical treatment alone is ineffective.9

Sudden, diffuse shedding on a clean scalp can point to telogen effluvium, which usually follows its trigger by about three months and settles on its own.23 A widening parting or a hairline that creeps back over years is a different kind of hair loss, with its own treatments.

The US label has not established safety in children, and the 1% label says to ask a doctor under age 12.4,7 Ask your doctor first if you are pregnant or breastfeeding. The label notes there are no adequate, well-controlled studies in pregnancy and advises caution when nursing.4 Stop and get your scalp examined if redness, weeping or new shedding starts after you begin.4

Frequently asked questions Copy link

How long should I leave ketoconazole shampoo on my scalp?

Three to five minutes. The UK label for 2% ketoconazole shampoo says to leave it for three to five minutes before rinsing, and the US label says five. Lather it into the skin at the roots, then wait, because rinsing straight away cuts the antifungal's contact time.

Can I use ketoconazole shampoo every day?

Daily use is not the labeled schedule. The UK label sets two washes weekly over two to four weeks, followed by one every one to two weeks. People have used it four to ten times a week for months with few side effects, but washing more often has not been shown to clear flakes faster.

Is 2% ketoconazole shampoo better than 1%?

For severe dandruff, yes. In a randomized trial of 66 people with severe dandruff or seborrheic dermatitis, 2% reduced flaking and yeast counts more than 1% at two and four weeks. For mild dandruff, 1% may be enough, since the advantage for 2% was shown in severe cases.

Does ketoconazole shampoo regrow hair?

It is not an established regrowth treatment. A small 1998 study reported density gains close to those with 2% minoxidil, but a six-month trial of 150 men found shedding fell while hair density did not change. A 2025 review calls it a possible add-on to minoxidil or finasteride.

How long does ketoconazole shampoo take to work?

Most people see a clear change within two to four weeks of washing twice a week. In a multicenter trial of 575 people, that schedule gave an excellent response in 88%. If nothing has changed by the end of week four, see a doctor to check the diagnosis.

References Copy link

  1. Ketoconazole 2% w/w Shampoo. Summary of Product Characteristics. Electronic medicines compendium (emc), product 4559; text revised 13 May 2025. medicines.org.uk. Accessed 21 September 2026.
  2. Peter RU, Richarz-Barthauer U. Successful treatment and prophylaxis of scalp seborrhoeic dermatitis and dandruff with 2% ketoconazole shampoo: results of a multicentre, double-blind, placebo-controlled trial. British Journal of Dermatology. 1995;132(3):441–445. doi:10.1111/j.1365-2133.1995.tb08680.x. PMID 7718463. Second author affiliated with the Janssen Research Foundation.
  3. Fields JR, Vonu PM, Monir RL, Schoch JJ. Topical ketoconazole for the treatment of androgenetic alopecia: A systematic review. Dermatologic Therapy. 2020;33(1):e13202. doi:10.1111/dth.13202. PMID 31858672.
  4. NIZORAL (ketoconazole) 2% Shampoo. Prescribing information, revised October 2013. US Food and Drug Administration. accessdata.fda.gov. Accessed 21 September 2026.
  5. Tucker D, Syed HA, Masood S. Seborrheic Dermatitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; last updated 1 March 2024. NCBI Bookshelf NBK551707. Accessed 21 September 2026.
  6. Okokon EO, Verbeek JH, Ruotsalainen JH, Ojo OA, Bakhoya VN. Topical antifungals for seborrhoeic dermatitis. Cochrane Database of Systematic Reviews. 2015;(5):CD008138. doi:10.1002/14651858.CD008138.pub3. PMID 25933684.
  7. Label: NIZORAL- ketoconazole shampoo (ketoconazole 1%), Drug Facts, revised 17 March 2026. DailyMed, US National Library of Medicine. dailymed.nlm.nih.gov. Accessed 21 September 2026.
  8. Ketomac 2% Dandruff Treatment Shampoo, 110 ml (Torrent Pharmaceuticals). Apollo Pharmacy product listing, MRP ₹225. apollopharmacy.in. Checked 21 September 2026.
  9. Al Aboud AM, Crane JS. Tinea Capitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; last updated 8 August 2023. NCBI Bookshelf NBK536909. Accessed 21 September 2026.
  10. Piérard-Franchimont C, Piérard GE, Arrese JE, De Doncker P. Effect of ketoconazole 1% and 2% shampoos on severe dandruff and seborrhoeic dermatitis: clinical, squamometric and mycological assessments. Dermatology. 2001;202(2):171–176. doi:10.1159/000051628. PMID 11306850. Open-label; one author affiliated with McNeil Consumer Healthcare.
  11. Piérard-Franchimont C, De Doncker P, Cauwenbergh G, Piérard GE. Ketoconazole shampoo: effect of long-term use in androgenic alopecia. Dermatology. 1998;196(4):474–477. doi:10.1159/000017954. PMID 9669136. Two authors affiliated with Janssen Research Foundation and Johnson & Johnson.
  12. Piérard-Franchimont C, Goffin V, Henry F, Uhoda I, Braham C, Piérard GE. Nudging hair shedding by antidandruff shampoos. A comparison of 1% ketoconazole, 1% piroctone olamine and 1% zinc pyrithione formulations. International Journal of Cosmetic Science. 2002;24(5):249–256. doi:10.1046/j.1467-2494.2002.00145.x. PMID 18498517.
  13. Gupta AK, De Doncker P, Talukder M. Role of Topical Ketoconazole in Therapeutic Hair Care Beyond Seborrhoeic Dermatitis and Dandruff. JEADV Clinical Practice. 2025;4:710–718. doi:10.1002/jvc2.70026.
  14. Landells I, Chow E, Gupta AK, et al. A Canadian Consensus on Androgenetic Alopecia: Approach and Management. Journal of Cutaneous Medicine and Surgery. 2025;29(5 suppl):5S–14S. doi:10.1177/12034754251368849. PMID 40986632. Funded by an unrestricted educational grant from Vichy Laboratoires, L'Oréal Canada.
  15. Central Drugs Standard Control Organization (CDSCO), Ministry of Health and Family Welfare, Government of India. The Drugs Rules, 1945, consolidated text as amended by G.S.R. 360(E), 1 July 2024: Schedule H (prescription drugs), entry 270 (ketoconazole), Note 2 (topical or external use) and Note 4 (topical preparations containing steroids). cdsco.gov.in. Accessed 21 September 2026. Also see: Drugs (Amendment) Rules, 2026, G.S.R. 135(E), 16 February 2026 (published 20 February 2026, CG-DL-E-20022026-270343), which adds footnote 6 to Schedule H excluding the class of drugs at serial number 15 of Schedule K and leaves Notes 2 and 4 unchanged. gazettetracker.com.
  16. Ketofly Anti Dandruff Shampoo, 100 ml (Leeford Healthcare). Apollo Pharmacy product listing, MRP ₹185. apollopharmacy.in. Checked 21 September 2026.
  17. Kitral 2% Anti Dandruff Shampoo, 100 ml (Galpha Laboratories). Apollo Pharmacy product listing, MRP ₹238. apollopharmacy.in. Checked 21 September 2026.
  18. K Zpto Shampoo, 75 ml (Hbc Dermiza Healthcare). Apollo Pharmacy product listing, MRP ₹225. apollopharmacy.in. Checked 21 September 2026.
  19. Scalpe Pro Daily Anti-Dandruff Shampoo, 100 ml (Glenmark Pharmaceuticals). Apollo Pharmacy product listing. apollopharmacy.in. Checked 21 September 2026.
  20. Indian Pharmacopoeia Commission. About IPC. ipc.gov.in. Accessed 21 September 2026.
  21. British Pharmacopoeia. What is the BP? pharmacopoeia.com. Accessed 21 September 2026.
  22. Be Bodywise 1% Ketoconazole Dandruff Shampoo, 100 ml (Mosaic Wellness). Apollo Pharmacy product listing, MRP ₹399. apollopharmacy.in. Checked 21 September 2026.
  23. Hughes EC, Syed HA, Saleh D. Telogen Effluvium. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; last updated 1 May 2024. NCBI Bookshelf NBK430848. Accessed 21 September 2026.

This article is general health information for readers in India and is not a diagnosis or a prescription. Ketoconazole shampoo is a medicine: follow the strength and frequency printed on the pack, and check the composition line, because some bottles pair it with a second active and others contain no ketoconazole at all. Prices are maximum retail prices from Apollo Pharmacy listings checked on 21 September 2026 and change without notice. A scalp that has not improved after four weeks of correct use, or that comes with redness, weeping, swelling or new shedding, needs a registered medical practitioner rather than another bottle. Editorial standards: joinsapiens.in/editorial-standards. Report an error on this page.