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Dr. Bertram Medical Hair Transplant
眉 髮 醫 學 移 植 中 心 ( 香 港 ) |
( 852 ) 3421-1138
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Ketoconazole 2% Shampoo - Medical Treatment for Hair Loss
There are tons of shampoo on the market claiming to restore hair, there is only one that was reported to work according to several research studies.
What is Ketoconazole
Ketoconazole is an antifungal drug initially used to prevent and treat skin and fungal infections. When applied to the scalp it was shown to suppress the production of androgen in the skin. Recent studies claimed that Ketoconazole shampoo helps to reverse or slow down the process of hair loss by:
- Increase hair density
- Increase the size and proportion of anagen hair follicles
Mechanism of Action
It acts in both androgen-dependent and androgen-independent manners.
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Anti-androgen
Androgen is a hormone which, when bound to receptors in the hair follicles, lead to the shrinking of these follicles. When the follicles shrink the life cycle of the hair becomes shorter with every cycle, this leads to hair miniaturization.
Ketoconazole acts as a relatively mild anti-androgen by: |
- Inhibiting DHT production in hair follicles
- Inhibiting the binding of DHT to androgen receptors
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Anti-inflammatory
Bald scalp in AGA was found to have a varying degrees of inflammation around the hair follicles. This inflammation when induced by a yeast called Malassezia may be partly responsible for hair loss. The anti-inflammatory and anti-fungal properties of Ketoconazole account for its beneficial effect in AGA.
Growth Stimulant
A study in mice indicated that ketoconazole may have a direct stimulatory effect on hair growth. |
Indication of Use
The use of ketoconazole shampoo for treating Androgenetic Alopecia ( AGA )is not yet FDA-approved. It is usually used off-labelled in 2 ways :
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Used alone
It is beneficial for AGA patients who cannot tolerate minoxidil because of scalp irritation or contact dermatitis.
Adjunct treatment
Used together, Ketoconazole may enhance the effectiveness of other hair loss treatments such as minoxidil and propecia. |
Dosage and Frequency of Use
Oral Ketoconazole is not advised as the high concentrations required to affect androgen production exceeds the safety limit. In AGA the only tissue that requires a high concentration of Ketoconazole is the hair follicles. A local application in the form of a shampoo is the best way to delivered Ketoconazole to the affected area.
Please note that this shampoo is not used as an cleansing agent, but as a scalp treatment.
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For AGA
Optimal usage is every third day (2 to 3 times a week), leaving the shampoo on the scalp for 3–5 minutes before rinsing. More frequent use is unnecessary but continuous use is required to maintain the benefit. Other shampoo can be used on the other days of the week.
For Dandruff Only
3 times a week for 4 weeks. Repeated only as required. |
Efficacy
In this particular study, 27 subjects used 2% Ketoconazole shampoo exclusively 2–4 times a week for 21 weeks. The remaining 12 in the control group used an un-medicated shampoo. The group using the Ketoconazole shampoo after a course of treatment showed :
- an increase in hair density
- an increase in hair diameter
- an increase in proportion of anagen hair follicles
In another study (Pierard-Franchimont 1998) Ketoconazole 2% shampoo was reported to be almost as effective as Minoxidil 2% topical solution in improving hair density. More confirmatory studies are required.
Possible Side Effects
When first begin treatment with Ketoconazole, it is possible to have more shedding of hair. Don't worry as shedding often indicates better response to treatment and better result.
Reference
Pierard-Franchimont C, De Doncker P, Cauwenbergh G, et al. Ketoconazole shampoo: effect of long-term use in androgenic alopecia. Dermatol 1998;196:474– 7.
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