Antidandruff shampoo may help combat some types of hair loss

Antidandruff shampoo may help combat some types of hair loss

The question:

Can antidandruff shampoo help with hair loss?

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The science:

On Instagram and TikTok, some dermatologists are praising an off-label use for certain antidandruff shampoos - to help combat hair loss. But while these shampoos may help promote hair health, they are not considered a cure-all.

Some over-the-counter and prescription antidandruff shampoos contain ketoconazole, an ingredient that may help with certain types of hair loss - including those caused by chronic inflammation and sensitivity to hormones, some dermatologists said.

“Healthy hair begins with a healthy scalp, and anything that reduces inflammation or improves the health and well-being of your scalp is going to make sure that your hair is optimized,” said Arash Mostaghimi, vice chair of Clinical Trials and Innovation in the Department of Dermatology at Brigham and Women’s Hospital. Mostaghimi is not among the dermatologists recommending these products on social media.

Ketoconazole is an antifungal medication approved to treat seborrheic dermatitis, an inflammatory condition that causes red, itchy and flaky skin. In rare and severe cases, scratching and inflammation may affect hair growth, some dermatologists said. The condition is associated with, among other factors, an overgrowth of a yeast-like fungus called malassezia, which can be controlled with ketoconazole.

While shampoos containing ketoconazole may be highly effective at treating seborrheic dermatitis and creating an optimal environment for healthy growing hair, it will not reduce hair loss for everyone, said Oma N. Agbai, an associate clinical professor of dermatology and director of Multicultural Dermatology and Hair Loss Disorders at University of California at Davis School of Medicine.

There is also limited research showing that ketoconazole may be effective at treating androgenetic alopecia, the most common form of hair loss, including male and female pattern baldness. This type of hair loss is partly related to hormones called androgens. High levels or increased sensitivity to the androgen dihydrotestosterone (DHT) can shrink hair follicles, causing hair to become thinner, as well as shorten the hair growth cycle, leading to hair loss. Inhibiting DHT may help with pattern baldness.

A 2019 systematic review of animal and human studies reported that, in humans, hair shaft diameter increased after use of topical ketoconazole. The authors noted that while treatment with topical ketoconazole appears promising, randomized controlled trials are needed. While other studies also have shown positive results, most looked at the prescription strength of 2 percent ketoconazole (compared with the 1 percent available in certain over-the-counter antidandruff shampoos) often in combination with well-studied therapies.

Using shampoo containing ketoconazole as part of a broader hair-loss regime prescribed by a dermatologist may be useful, said Adam Friedman, a professor and chair of dermatology at George Washington School of Medicine and Health Sciences.

“But as a solo therapy,” he said, “that’s a pipe dream.”

For people struggling with hair loss who want to try it, some dermatologists recommend lathering a shampoo containing ketoconazole and gently working it into a wet scalp with fingertips, then letting it sit for several minutes before rinsing. Repeat every other wash, typically one to three times per week, they said.

Some dermatologists cautioned that for some people, particularly those who have dry or very curly hair, shampoos containing ketoconazole may cause increased dryness and hair fragility, especially when overused. This may contribute to hair breakage and hair loss, Friedman said. Those who experience adverse reactions such as increased dryness or itching should consult a dermatologist.

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What else you should know:

From scalp massagers to microneedling rollers to hair masks, oils and serums, there are a number of other at-home hair-loss treatments circulating on Instagram and TikTok. Of these, essential oils seem to be a popular alternative to prescription medications on social media.

-- Rosemary oil, shown to have anti-inflammatory and antimicrobial effects, has the potential to improve circulation and stimulate hair growth, some dermatologists said. A 2015 study showed that a topical rosemary oil solution was as effective as 2 percent minoxidil in treating androgenetic alopecia in men. However, Friedman noted that 2 percent minoxidil is a low dose, and studies vary in terms of the purity, potency and mixtures containing rosemary oil, making it difficult to draw a conclusion about the efficacy of the oil.

-- Pumpkin seed oil has been shown in mice to have inhibitory activity against 5-alpha-reductase, an enzyme that converts testosterone into DHT, said Elizabeth Bahar Houshmand, a Dallas-based dermatologist. One study showed that men with androgenetic alopecia had increased hair growth while taking pumpkin seed oil capsules. Another study, which compared pumpkin seed oil to 5 percent minoxidil foam to treat female pattern hair loss, found that regrowing hairs significantly increased after treatment.

-- Other essential oils such as peppermint and lavender may also support hair health, Agbai said, but randomized clinical trials are needed to prove the efficacy of these treatments for hair loss.

“I am not aware of any hair loss patients significantly benefiting from these treatments,” Agbai said in an email. “This doesn’t mean that they have no benefit; we just don’t have sufficient studies to prove their efficacy.”

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The bottom line:

Antidandruff shampoos containing ketoconazole may help with certain types of hair loss, particularly when used in combination with prescription medications intended to treat these conditions, but more research is needed.

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