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Hair & scalp· in 1 product

Ketoconazole

Also listed as Ketoconazole 1% (OTC shampoo), Ketoconazole 2% (prescription) and Nizoral A-D

Strong evidence 1% OTC shampoo; 2% by prescription

Ketoconazole is an antifungal drug sold over the counter in the U.S. as a 1% anti-dandruff shampoo. It targets Malassezia yeast, which plays a central role in dandruff and scalp flaking.

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What it does

The short version.

Ketoconazole blocks ergosterol production in fungal cell membranes, reducing the Malassezia yeast that feeds on scalp oils and drives flaking and itch. Randomized trials have shown ketoconazole shampoo is effective for moderate to severe dandruff and seborrheic scalp flaking, and it is a standard dermatologist recommendation. Some small studies have explored it as an add-on for hair thinning, but that is not an approved use.

Strong evidence

Supported by randomized controlled trials and consistent clinical guidance for dandruff; evidence for hair-growth uses is preliminary.

In our directory: It’s a key ingredient in 1 product we review, most often wash day. Those products are mostly built for dandruff, scalp care and flaking relief.

Reach for it for

DandruffScalp careFlaking relief

Usually a good fit for

All hair typesStraight hairWavy hairCurly hairCoily hair

How to use it

Getting it right.

Lather into the scalp and leave on for about five minutes before rinsing, two or three times a week or as the label directs; alternate with your regular shampoo. People with coily hair may use it once a week.

Layering

Friends & frenemies.

Pairs well with

Salicylic acidTea tree oilRosemary oil

Before you start

Can dry hair, especially chemically treated or coily hair, so follow with conditioner. Rarely causes irritation or changes in hair texture. Stop and see a dermatologist if the scalp worsens, or if flaking comes with hair loss, thick plaques or pain.

References

  1. 1How to treat dandruff — American Academy of Dermatology
  2. 2A randomized, double-blind, placebo-controlled trial of ketoconazole 2% shampoo versus selenium sulfide 2.5% shampoo in the treatment of moderate to severe dandruff — Journal of the American Academy of Dermatology (1993), via PubMed
  3. 3Ketoconazole Shampoo for Seborrheic Dermatitis of the Scalp: A Narrative Review — Cureus (2024), via PubMed Central

Educational, not medical advice. Ingredient guides summarise published research and expert guidance; formulas and concentrations differ between products.

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