The Best Ketoconazole Shampoos for Treating Dandruff

I’ve said it before and I’ll say it again…

Ketoconazole is probably the single most effective active ingredient on the market for seborrheic dermatitis sufferers.

True, it doesn’t work for everyone.  No active ingredient does.  But if someone is newly diagnosed with seb derm, there’s a reason so many doctors and dermatologists to a 2% ketoconazole shampoo.  It’s one of, if not the, most effective active ingredients out there.

It worked for me too.  After years of not even knowing what I had, all it took was a diagnosis and a few washes with 2% ketoconazole and I have been set up for almost 20 years.

At the end of this article, we’ll look at our favorite ketoconazole shampoos.  But before I do that, it’s important to look at what ketoconazole is, any risks with using it, and how it helps your condition before recommending the best shampoos on the market today.

What’s in this article:

What Is Ketoconazole?

Ketoconazole is an imidazole derivative, broad-spectrum antifungal. In the UK, a 2% shampoo is available to buy from pharmacies for treating seborrheic dermatitis or dandruff as several brands (Ketopine, Nizoral). If your symptoms are severe, your doctor might want to prescribe the shampoo to monitor the condition.

When ketoconazole is used as a shampoo it’s not absorbed into the bloodstream, and so the antifungal effects are localized to the scalp [1]. It works by inhibiting enzymes necessary for a fungus to synthesize steroids in the cell membrane. This leads to the cells becoming ‘leaky’ – unable to correctly regulate electrolytes – causing them to break down.

For scalp conditions associated with an underlying fungal infection, ketoconazole shampoos should generally be applied once or twice a week [2]. The shampoo should be massaged over the entire scalp and left for 3-5 minutes before thoroughly rinsing – although products can vary, so you should always read the label!

Who Invented It?

The oral formulation of ketoconazole was developed by Janssen Pharmaceuticals in Belgium – the company behind other well-known drugs such as Imodium and Daktarin!

Ketoconazole was first discovered in 1976 and for the first 10 years, it was applied orally.  Relatively soon after it was relatively quickly replaced with less toxic alternatives that didn’t have as many drawbacks [3]:

* Absorption varied by individual

* It couldn’t penetrate the brain for more serious infections

* It resulted in gastrointestinal side effects, and liver toxicity

* Several important drug interactions were discovered

In 2013 due to the risk of liver toxicity, the UK Medicines and Healthcare Products Regulatory Agency (MHRA) formally recommended suspending the license for oral ketoconazole, advising doctors to discuss alternatives with patients [4]. This recommendation specifically excluded topical formulations (e.g. shampoos, creams), because they are not readily absorbed into the bloodstream.

Ketoconazole shampoos have been shown to be effective against a range of fungus and yeast species. These are known to cause several scalp conditions, and so your doctor may prescribe ketoconazole shampoo if your symptoms are consistent with an underlying fungal infection – without needing to send a sample for microbiological testing. Common species susceptible to ketoconazole are summarized below [5]:

Fungus Yeast
T. rubrum

T. mentagrophytes


M. canis

M. audouini

M. gypseum

E. floccosum

P. ovale (Malassezia)

P. orbiculare

C. albicans

C. tropicalis


How Effective Is Ketoconazole At Treating Dandruff

Ketoconazole is one of the few active ingredients to be listed as an official anti-dandruff treatment both in the UK and the USA.

The reason it’s so widely recommended is because it’s proven to be effective, particularly when treating seb derm.

Seborrheic Dermatitis

Numerous studies demonstrate its efficacy in treating seb derm. Among them, a 2015 Cochrane Review identified 51 studies covering over 9000 participants and found those using a ketoconazole shampoo were 31% less likely to have recurrent symptoms within four weeks compared to placebo [6]. The analysis also found that ketoconazole was more effective than ciclopirox, and as effective as steroids – with significantly less adverse effects.

A very recent study published in 2018 [8] showed a 2% ketoconazole shampoo to dramatically improve symptoms of seb derm over 30 days of use – when used once every 3 or 4 days.

Due to the overwhelming success of these studies, Ketoconazle is on the FDA’s approved list of dandruff treatments and in the UK, the National Institute for Health and Care Excellence (NICE) recommend 2% ketoconazole as a first line treatment for seb derm on the scalp. This recommendation is backed by the British Association of Dermatologists.

Scalp Psoriasis

Scalp psoriasis is an inflammatory condition, not typically associated with an underlying fungal infection. The first-line treatment for scalp psoriasis is a short course of corticosteroids. In the 1980s several studies showed that oral ketoconazole could be of some benefit in treating the condition, but the significant adverse effect profile and efficacy of corticosteroids prevented further research [7].

Ketoconazole Availability

The 1-percent ketoconazole products such as Nizoral are available over the counter. The stronger two-percent shampoo must be prescribed by a doctor in the USA. However, in countries like the UK or much of Europe, it is available OTC.

Personally, I think it’s about time the US followed suit…

Ketoconazole Product Brand Names

Ketoconazole is sold under a number of brand names including:

What Are The Risks With Using It?

When used as a shampoo ketoconazole is very well tolerated, not associated with the harmful effects of the oral formulation. In a review of 22 clinical trials covering over 2800 participants, no adverse effects had an incidence of over 1% [2]. The most common reactions occurred in 1 in every 100-1000 people:

  • Dry skin
  • Rash
  • Irritation
  • Abnormal hair texture

The shampoo can cause irritation to the eyes, and so if accidental contact happens, they should be immediately bathed. Certain individuals are more susceptible to adverse reactions, and so a trial of selenium sulfide, zinc pyrithione, piroctone olamine, ciclopirox olaminecoal tarsalicylic acid, tea tree or any of the other active ingredients known to help dandruff may be more suitable alternatives.

Ketoconazole Shampoo Reviews

Here we list the best Ketoconazole dandruff shampoos on the market today.



Designed to treat Seborrheic Dermatitis

Nizoral is probably the most effective shampoo on the market to control dandruff caused by seb derm. It's technically a medicine and is one of few anti-dandruff shampoos approved to make healthcare claims i.e. to treat and prevent dandruff. With a 2% dose of anti-fungal ketoconazole mixed into an 11 ingredient fragrance-free formula, if you suffer from moderate to severe seb derm – it’s a must try. Studies show significant and dramatic improvements in 30 days.

buy now on Amazon
Regenpure DR Dandruff Shampoo

Regenpure DR Dandruff Shampoo

Designed to treat Seborrheic Dermatitis

Regenure DR Hair and Scalp Treatment is a 1% Ketoconazole formulation shampoo combined with Salicylic Acid. The company ave been particularly clever with their formulation and marketing – positioning the shampoo as a gentler alternative to Nizoral. The company have largely achieved that too. Adding Salicylic Acid to get rid of the dandruff and ketoconazole to remove the dandruff is an inspired combination too.

That said, it’s still a 1% ketoconazole shampoo. Given the choice I’d choose 2% every time, but this would require a prescription in Regenpures largest market – the USA.

Overall a very interesting, innovative shampoo.

buy now on Amazon
Ketozal 2% Shampoo

Ketozal 2% Shampoo

Designed to treat Seborrheic Dermatitis

The Ketozal 2% anti-dandruff shampoo would be very effective for severe cases of seb derm and dandruff. A generic of doctor prescribed 2% ketoconazole shampoos, Ketozal 2% is cheaper and arguably (although not clinically proven) as effective. This is the caveat of all generic medicines.

A great stand-by for severe dandruff and seb derm flares.

Pro-tip: You’ll probably need conditioner on hand.

buy now on ebay
Ketozolin 2% Shampoo

Ketozolin 2% Shampoo

Designed to treat Seborrheic Dermatitis

If you have a moderate to severe case of dandruff caused by Seborrheic Dermatitis, purchasing the Ketozolin 2% shampoo is potentially a wise decision. It has the maximum EU allowed dose of anti-fungal ketoconazole – effective against the overgrowth of Malassezia yeast seen in cases of seb derm and dandruff. It can be used to clear dandruff within a week and it can be used to prevent dandruff recurrence when used once weekly.

However, it does contain one or two harsh ingredients, including SLS and a formaldehyde releaser. So use with caution if you have a sensitive scalp.

buy now on ebay
Ket Med Ketoconazole Shampoo

Ket Med Ketoconazole Shampoo

Designed to treat Seborrheic Dermatitis

Your best option in the fight against moderate to severe cases of dandruff and seborrheic dermatitis is a 2% Ketoconazole shampoo. It’s recommended by pharmacists and sometimes also prescribed by doctors.

Ket Med shampoo is an OTC alternative in many countries (and available on eBay in others).

Its 2% Ketoconazole formula promises to be effective and preventative.  However there’s one word of warning, it is not designed for the most allergy prone scalps.

buy now on ebay
boots 2% ketoconazole shampoo

Boots 2% Ketoconazole Shampoo

Designed to treat
Seborrheic Dermatitis

Boots are a UK retail pharmacist similar to Walgreens or CVS in the USA. Walgreens and Boots are actually strategic partners (whatever that actually means). Boots have developed their own 2% Ketoconazole shampoo which is a cheaper alternative to Nizoral. Although it does contain a number of harsh ingredients, it’s definitely worth a look if you want a cheaper alternative. Expect a review in the coming months.

Buy now at

sebizole 2% ketoconazole shampoo

Sebizole 2% Ketoconazole Shampoo

Designed to treat
Seborrheic Dermatitis

Sebizole is another 2% ketoconazole shampoo available in Australia and New Zealand. I have to admit, I don’t know much about this shampoo yet as I haven’t yet reviewed it.

The ingredients are Sodium laureth sulfate, Cocamide DEA, sodium lauryl sarcosinate, PEG -150 distearate, hydrochloric acid, Germall II (preservative), Herb Flower fragrance, erythrosine sodium, purified water.

When I get my hands on a bottle expect a review!
Thanks to Sam in the comments below for those ingredients. Much appreciated!

If you can’t find the shampoo you’re looking for, chances are we’ve already reviewed it.

If not, please let us know in the comments below which shampoos you’d like us to take a look at!


[1] Faergemann, J., Borgers, M., & Degreef, H. (2007). A new ketoconazole topical gel formulation in seborrhoeic dermatitis: an updated review of the mechanism. Expert opinion on Pharmacotherapy, 8(9), 1365-1371.

[2] EMC. (2015). Pinewood Healthcare: Ketoconazole 2% w/w Shampoo. [Accessed: 28/2/17]

[3] Gupta, A. K., Daigle, D., & Foley, K. A. (2015). Drug safety assessment of oral formulations of ketoconazole. Expert Opinion on Drug Safety, 14(2), 325-334.

[4] MRA. (2013). Oral ketoconazole: do not prescribe or use for fungal infections—risk of liver injury outweighs benefits. [Accessed: 28/2/17]

[5] Van Cutsem, J. (1983). The antifungal activity of ketoconazole. The American journal of medicine, 74(1), 9-15.

[6] Cochrane Library. (2015). Antifungal treatments applied to the skin to treat seborrhoeic dermatitis. [Accessed: 28/2/17]

[7] Farr, P. M., Marks, J., Krause, L. B., & Shuster, S. (1985). Response of scalp psoriasis to oral ketoconazole. The Lancet, 326(8461), 921-922.

[8] Chaijan MR1, Handjani F2, Zarshenas M3, Rahimabadi MS4, Tavakkoli A1. (2018) The myrtus communis L. solution versus ketoconazole shampoo in treatment of dandruff: A double blinded randomized clinical trial.

Author Profile

Master of Pharmacy

Ethan graduated a number of years ago after studying pharmacy in the UK, and is now a practicing pharmacist by day.

By night he writes the most stunning articles on a whole range of pharmaceutical subjects both here, and on our sister site at

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  1. Sam April 17, 2016
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