Why So Pessimistic About Ketoconazole?
Dr. Rassman,
I enjoy reading your blog, and nearly always agree with you, but I do feel you are a bit to pessimistic about ketoconazole. In another response to another member you dismissed of a Japanese, justifiably I suppose, because of the small sample size. (Have you seen the pictures of the impressive regrowth seen in three of the six patients? They shows an obvious reversal of AGA.)
What about this controlled study: “Comparative efficacy of various treatment regimens for androgenetic alopecia in men”
In this study men were divided into four groups: “Group I (30 patients) was administered oral finasteride, Group II (36 patients) was given a combination of finasteride and topical minoxidil, Group III (24 patients) applied minoxidil alone and Group IV (10 patients) was administered finasteride with topical ketoconazole. Treatment efficacy was assessed on the basis of patient and physician assessment scores and global photographic review during the study period of one year. At the end of one year, hair growth was observed in all the groups with best results recorded with a combination of finasteride and minoxidil (Group II) followed by groups IV, I and III. Subjects receiving finasteride alone or in combination with minoxidil or ketoconazole showed statistically significant improvement (p<0.05) over minoxidil only recipients. No signifcant side-effects related to the drugs were observed. In conclusion, it is inferred that the therapeutic efficacy is enhanced by combining the two drugs acting on different aetiological aspects of AGA.”
I don’t believe this has been mentioned on your blog before, and the results are exactly as most men would expect them to be:
Finasteride + Minoxidil > Finasteride + Ketoconazole > Finasteride Alone > Minoxidil Alone after one year.
I’m sure, like every study, this one also has it’s flaws, but together with all the other research — from Piérard-Franchimont C (1998) to Rajput RJ. (2010) — I’d say that the evidence for the efficacy of ketoconazole in AGA is highly suggestive. It’s certainly much stronger than for the majority of the things men try outside of finasteride/dutasteride and minoxidil.
And we know that all anazoles are somewhat antiandrogenic, but only ketoconazole will compete for the AR, and is used in androgen modulated prostate cancer.
How can you be so pessimistic about it in light of the totality of the evidence? Do you believe it to be dangerous?
I am not pessimistic about ketoconazole. Our job on this site is to educate you, the reader, on the realities of such claims and treatments and warn you if there is danger in using such “stuff”. While I don’t see ketoconazole (better known as Nizoral) as dangerous, it has yet to be proven to my satisfaction that it’s a treatment for hair loss. I’ve always maintained that Nizoral is a good shampoo for treating dandruff and fungal infections.
What I have always maintained is that nothing stops a genetic trait. There are drugs that slow it down and there may be other remedies that also work, but my mantra has always been “buyer beware”. The small study you referenced is indeed suggestive of positive benefits, and if the readers out there want to try it, I think that is their choice to make. But keep in mind that while the 1% ketoconazole is available as an over-the-counter shampoo, 2% ketoconazole (as used in that small study) is a prescription medication and as such, you need a physician to oversee the treatment. Side effects include burning and itching sensations.
I know some people report positive results with Nizoral, but I’ve also read about people that claim it made their hair a lot thinner. Who knows! Personally I’ve tried it, and every single time I used it (either the prescription one, or the over-the-counter version) I would lose twice as much hair when I used it vs. a different shampoo. After several tries I got really paranoid and stopped using it. Maybe it’s like Rogaine, where you may experience increased shedding initially? I wasn’t about to find out.
i am supervised mcneil hasn’t conducted a study of their own if there any suggested benefits
i mean mcneil make both regaine (well rogaine your side of the pond) and nizoril so they could easily sell a hairloss shampoo if they can prove their is any benefit (with a sample size hopefully greater than 36 patients)
I don’t think we’ll ever find the truth about ketoconazole. Nobody is going to fund large scale clinical trials of it, because even if it is effective there is no way to make any money. There are many kinds of generic ketoconazole already available.
Ive used nizroal 1% for about a year. Can confidently say it did diddly for hairloss.
This study holds no water by the way. Finasteride may have just been more effective in specific groups, regardless of what it is used in combination with. Afterall it doesn’t work for everybody.
i used rogaine, nizoral and at last i start using ervamatin.
i find the last one helping me lot to reduce hair fall.
i’ve used minoxidil for years with good results but added nizoral about a year ago.
no additional benefit in my experience, will just finish the bottle.
I am a 50 year old woman. I’ve had some frontal hair thinning and receding hairline. Every night I have applied ketoconazole generic that is sold as a yeast infection product. It works extremely well! I have significant regrowth and anticipate complete fill in within the next month or two. The cream cost $5 at Target. Yeah, ketoconazole in the form of a topical cream works!
I’m tempted to try this treatment, but am wary of side effects. Has anyone had any negative sides from this treatment? Thanks