![]() The side effects of ketoconazole are sometimes harnessed in the treatment of non-fungal conditions. See also: Steroidogenesis inhibitor and CYP17A1 inhibitor Limited clinical studies suggest ketoconazole shampoo used either alone or in combination with other treatments may be useful in reducing hair loss in some cases. ![]() It was speculated that antifungal properties of ketoconazole reduce scalp microflora and consequently may reduce follicular inflammation that contributes to alopecia. Ketoconazole shampoo in conjunction with an oral 5α-reductase inhibitor such as finasteride or dutasteride has been used off label to treat androgenic alopecia. Off-label uses Hair loss Ketoconazole 2% gel Ketoconazole is used orally in dosages of 200 to 400 mg per day in the treatment of superficial and deep fungal infections. However, ketoconazole has largely been replaced as a first-line systemic antifungal medication by other azole antifungal agents, such as itraconazole, because of ketoconazole's greater toxicity, poorer absorption, and more limited spectrum of activity. First made in 1977, ketoconazole was the first orally-active azole antifungal medication. Ketoconazole has activity against many kinds of fungi that may cause human disease, such as Candida, Histoplasma, Coccidioides, and Blastomyces (although it is not active against Aspergillus), chromomycosis and paracoccidioidomycosis. Topical ketoconazole is also used as a treatment for dandruff (seborrheic dermatitis of the scalp) and for seborrheic dermatitis on other areas of the body, perhaps acting in these conditions by suppressing levels of the fungus Malassezia furfur on the skin. Topically administered ketoconazole is usually prescribed for fungal infections of the skin and mucous membranes, such as athlete's foot, ringworm, candidiasis (yeast infection or thrush), jock itch, and tinea versicolor. In addition, its use was restricted in the United States and Canada in 2013. ![]() The formulation that is taken by mouth was withdrawn in the European Union and in Australia in 2013, and in China in 2015. In 2020, it was the 170th most commonly prescribed medication in the United States, with more than 3 million prescriptions. It is available as a generic medication and formulations that are applied to the skin are over the counter in the United Kingdom. Ketoconazole was patented in 1977 by Belgian pharmaceutical company Janssen, and came into medical use in 1981. It is an imidazole and works by hindering the production of ergosterol required for the fungal cell membrane, thereby slowing growth. Other severe side effects when taken by mouth include QT prolongation, adrenocortical insufficiency, and anaphylaxis. Liver problems may result in death or the need for a liver transplantation. Common side effects when taken by mouth include nausea, headache, and liver problems. Ĭommon side effects when applied to the skin include redness. Other uses include treatment of excessive male-patterned hair growth in women and Cushing's syndrome. Taken by mouth it is a less preferred option and only recommended for severe infections when other agents cannot be used. Applied to the skin it is used for fungal skin infections such as tinea, cutaneous candidiasis, pityriasis versicolor, dandruff, and seborrheic dermatitis. Ketoconazole, sold under the brand name Nizoral among others, is an antiandrogen, antifungal, and antiglucocorticoid medication used to treat a number of fungal infections.
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