Ketoconazole Shampoo: Uses, Side Effects, and What You Need to Know

When you’re dealing with stubborn dandruff or a flaky, itchy scalp, ketoconazole shampoo, a medicated antifungal shampoo used to treat fungal infections of the scalp. Also known as Nizoral shampoo, it doesn’t just mask symptoms — it targets the root cause: yeast overgrowth. Unlike regular shampoos, ketoconazole works by slowing down the growth of Malassezia, a fungus that thrives on scalp oils and triggers inflammation, redness, and flaking.

This isn’t just for occasional dandruff. People with seborrheic dermatitis, a chronic skin condition causing scaly patches on oily areas like the scalp, face, and chest often find relief with ketoconazole shampoo. It’s also used off-label for fungal infections like tinea capitis and even some cases of hair loss linked to scalp inflammation. The key? Consistency. Most users see improvement after 2–4 weeks of use, typically applied twice a week. But it’s not a cure — stopping too soon means symptoms come back.

It’s not all smooth sailing. Some users report dryness, itching, or a burning sensation at first. Rarely, it can cause hair loss or discoloration. If you’re using it long-term or alongside other scalp treatments, you need to know how it interacts with other products. For example, using heavy oils or steroid creams on the scalp while on ketoconazole can trap the fungus instead of clearing it. And if you’re pregnant or treating a child, you should talk to a doctor first — even though topical use is low-risk, safety data isn’t complete.

What makes ketoconazole shampoo different from other dandruff shampoos? Most anti-dandruff formulas rely on zinc pyrithione or selenium sulfide. Ketoconazole is stronger, especially for resistant cases. But it’s also more likely to be prescribed or recommended by a provider, not just picked off the shelf. That’s because it’s a medication — not a cosmetic. And like all medications, it has limits. It won’t fix psoriasis, eczema, or allergic reactions. If your scalp is cracked, bleeding, or doesn’t improve after 4 weeks, you need a different approach.

Behind every effective treatment is a clear understanding of what you’re dealing with. That’s why the articles below dive into real-world medication safety — from how to spot hidden drug interactions to how to track side effects over time. You’ll find practical advice on using antifungal treatments safely, avoiding common mistakes with OTC products, and when to ask your doctor for help. Whether you’re managing a chronic scalp condition or just tired of flakes, these guides give you the facts — no fluff, no hype, just what works.