7 Best Ketoconazole Shampoos, Tested by Dermatologists

Ketoconazole is an established antifungal treatment for dandruff and seborrheic dermatitis, but growing research suggests it may also have a role in treating androgenetic alopecia (AGA). Human studies have reported improvements in hair shedding, shaft diameter, and other markers of hair growth, although the evidence remains considerably smaller than that supporting treatments such as minoxidil, finasteride, and dutasteride.^1-3

The ketoconazole shampoo market also varies broadly in concentration, formulation quality, prescription requirements, and suitability for long-term use. The available options range from conventional 1% over-the-counter shampoos and prescription 2% formulations to newer products developed specifically for patients with thinning hair.

In view of this, we examined seven of the most prominent ketoconazole shampoos currently available and compared them using consistent criteria. Each product was assessed based on ketoconazole concentration, formulation, tolerability, suitability for ongoing use, price accessibility, and transparency.

To help hair loss patients choose the most appropriate option for their goals and preferences, this review compares the advantages and drawbacks of each product and examines the clinical evidence for ketoconazole in hair loss. We also cover the differences between 1% and 2% ketoconazole, potential effects on hair growth, recommended use frequency, and how ketoconazole may fit alongside established treatments for AGA.

Order Ulo’s sulfate-free ketoconazole shampoo today from our No. 1 recommended hair loss telemedicine service — Ulo

At a Glance: Best Ketoconazole Shampoos in 2026

1. Ulo Thickening+ Shampoo	0.9%	OTC	From $28	Sulfate-free, formulated for thinning hair	Best overall balance for thinning hair
2. Keeps Ketoconazole Shampoo	2%	Prescription / telehealth	$11/month	Men’s hair loss platform	Higher-strength Rx for men
3. Nizoral A-D	1%	OTC	Retail dependent	Widely available	Best OTC access
4. Strut Health Ketoconazole Shampoo	2%	Prescription / telehealth	From $25/month	Men’s + women’s hair loss protocols	Best for men and women treating hair loss
5. EasyDerm Ketoconazole Shampoo	2%	Prescription / telehealth	$15/month	Dermatology platform	Best budget prescription option
6. Generic Ketoconazole Shampoo	2%	Prescription / pharmacy	Varies	Manufacturer dependent	Best no-frills pharmacy option
7. AlgoRx Ketoconazole Shampoo	2%	Prescription / telehealth	Varies by plan	Telemedicine platform	2% online option from an overall health and wellness platform

What Is Ketoconazole and How Does It Work?

Ketoconazole is an azole antifungal medication. On the scalp, it suppresses fungi and yeasts, including Malassezia, which has long been associated with dandruff and seborrheic dermatitis.^4-7

Current research suggests dandruff and seborrheic dermatitis is caused by an interaction between Malassezia, sebum composition, epidermal barrier function, inflammation, and individual susceptibility.^8-10 More recent reviews have specifically cautioned against treating Malassezia as the sole cause of seborrheic dermatitis.¹⁰

Nevertheless, antifungal treatment is effective. In a clinical trial of 176 patients, twice-weekly 1% ketoconazole produced a good or excellent dandruff response in 74% of patients after two weeks and 80% after four weeks, compared with 20% and 23% with placebo.⁴

Two percent ketoconazole, a prescription-strength formulation, has been tested in moderate-to-severe disease. In a multicenter trial of 575 patients with moderate-to-severe dandruff or seborrheic dermatitis, 2% ketoconazole used twice weekly for two to four weeks produced an excellent response in 88%.⁶ Among responders who entered a six-month maintenance phase, relapse occurred in 19% of patients using ketoconazole weekly compared with 47% using placebo.⁶

What About Ketoconazole for Hair Loss?

The scalp and the hair follicles are intimately linked, and the state of the scalp has a great influence on hair health and growth. Studies have reliably demonstrated a connection between the presence of inflammatory scalp conditions like dandruff and seborrheic dermatitis and increased hair loss.^3,11

Researchers believe that the inflammatory state these conditions create affects the natural hair cycle in hair follicles. More specifically, the inflammatory state causes hair follicles to prematurely exit their growth phase (anagen) and enter their dormant resting phase (telogen). This leads to increased shedding.^11,12

Hair cycle changes may also contribute to male pattern baldness. Miniaturization, or the shrinking of hair follicle size, is a characteristic feature of androgenetic alopecia (AGA) that drives its appearance. This miniaturization occurs progressively over time, between hair cycles. As a result, anything that prematurely terminates the hair cycle can accelerate the process of miniaturization and, thereby, the rate of pattern hair loss.^12,13

Supporting scalp health and addressing inflammatory conditions are important components of an overall hair health protocol and may be of particular importance if hair loss is a concern. Thus, while ketoconazole has been investigated for its anti-dandruff benefits, it has also been studied for its potential to improve hair loss.

A 1998 study of 2% ketoconazole shampoo reported improvements in hair density, hair size, and hair cycling.² A later six-month study found reduced AGA-associated shedding and dandruff in those who used 1% ketoconazole, 1% piroctone olamine, or 1% zinc pyrithione two to three times weekly. Although the ketoconazole group didn’t appear to regrow hair, participants experienced reduced shedding, an increase in mean hair-shaft diameter, and an increase in the number of anagen hairs.³

A 2020 systematic review of the literature reached a similar conclusion: Topical ketoconazole appears promising as an adjunct for AGA, particularly for improving shaft diameter and related measures, but the evidence base remains small.¹

Ketoconazole Shampoo in 2026: What’s Changed

In 2026, there are many more options for consumers to choose from.

• More prescription options: Two percent ketoconazole is now available through several hair loss and dermatology telehealth platforms.
• More hair-focused formulations: Newer products place greater emphasis on hair health after washing and how easily the shampoo fits into a long-term protocol for hair loss.
• Sulfate-free choices: Sulfate-free ketoconazole shampoos are designed to be non-stripping and non-drying, and support scalp health without leaving hair feeling brittle or dehydrated.

Choosing the Best Ketoconazole Shampoo

✓ 1. Evidence-Aligned Ketoconazole Concentration

A higher concentration of ketoconazole isn’t necessarily a better option, but concentration is still an important consideration. The strongest evidence includes both 1% and 2% products, with 2% performing better in patients with severe dandruff or seborrheic dermatitis.^4-6 For hair loss, both concentrations have limited supportive data.^2,3 While 1% ketoconazole is adequate for controlling dandruff, 2% appears to be better suited to supporting hair density.

✓ 2. Formulation and Scalp Tolerability

One of the most-reported side effects of ketoconazole shampoo is dry hair and/or scalp. This is likely related to the formulation of generic ketoconazole shampoos rather than the ketoconazole itself. Ketoconazole shampoos are typically formulated with harsh sulfates, dyes, and fragrances that may be irritating to some individuals. These drawbacks can make ketoconazole shampoos difficult to use consistently, even if they offer considerable benefits otherwise.

Selecting a sulfate-free formulation, where appropriate, may improve adherence.

✓ 3. Transparent Price and Access

While prices vary considerably among ketoconazole shampoo options, transparent pricing and accessibility relative to formulation quality are key factors to consider when purchasing a ketoconazole shampoo.

Top 7 Ketoconazole Shampoos of 2026

#1: Ulo Thickening+ Shampoo

✓ 0.9% ketoconazole, close to the clinically established 1% level	✗ Lower ketoconazole concentration than 2% Rx options
✓ The only sulfate-free ketoconazole shampoo	✗ More expensive than other options
✓ Developed specifically for thinning hair, with other supportive ingredients like caffeine, saw palmetto, and rosemary
✓ Shipped discreetly to your doorstep, no Rx required
✓ Integrated with an established hair loss service
✓ Additional savings on subscription plans

Ulo ranks first because its strengths align most closely with a patient using ketoconazole as part of a long-term hair loss regimen. With the only sulfate-free formula on the market, Ulo’s Thickening+ Ketoconazole Shampoo allows users to utilize ketoconazole without the accompanying dryness that typically makes adherence more difficult.

The 0.9% concentration closely aligns with 1% ketoconazole over-the-counter concentration, which seems primarily limited to improving scalp health and reducing hair shedding. The shampoo can be purchased without a prescription, is delivered discreetly to your door, and can be paired with other hair loss treatments (like finasteride or minoxidil) within the same platform, making it an option that wins on convenience.

While it costs more than other OTC options, its sulfate-free formula may justify the higher price for some users. Additional savings are also available for select subscription plans.

The formula also includes saw palmetto, caffeine, and rosemary, natural ingredients that offer benefits to thinning hair. Caffeine has emerging clinical support, saw palmetto has supportive data, and rosemary has been shown to be effective in a frequently cited randomized comparative trial.^14-16

Bottom line: Ulo is our top overall pick for users who want ketoconazole primarily as part of a long-term hair loss regimen. Its sulfate-free vehicle and hair-focused formulation make the lower ketoconazole concentration a reasonable trade-off.

#2: Strut Health Ketoconazole Shampoo

✓ 2% ketoconazole	✗ No major formulation advantage over other 2% options
✓ Available for both men and women	✗ Less accessible pricing than other options
✓ Can be paired with other hair loss treatments in the same platform	✗ Requires online medical intake

Strut offers 2% ketoconazole for both men and women through its hair loss treatment platform. Pending physician approval, the 2% formula is widely accessible for both men and women and can be paired with other hair loss treatments, like finasteride and minoxidil, within the same platform.

The 2% formulation is well suited to men and women whose goals are to support hair density or to address dandruff or seborrheic dermatitis more powerfully. However, it has the same issues as other generic shampoo formulations: drying sulfate formulas that interfere with consistent usage. In addition, compared to other platforms, Strut’s pricing is higher.

Bottom line: Strut is our preferred 2% option for men or women who want ketoconazole integrated into a broader hair loss treatment platform.

#3: Nizoral A-D

✓ 1% ketoconazole with direct clinical data	✗ Lower ketoconazole concentration than 2% Rx options
✓ No prescription or telehealth intake	✗ Not developed specifically around thinning hair
✓ Widely available	✗ Some users find medicated shampoos drying
✓ Usually easy to price-shop

Nizoral A-D is one of the most accessible options on our list. It contains the 1% ketoconazole concentration well-studied for dandruff, can be purchased without a prescription, and has direct six-month data showing reductions in shedding and increases in hair shaft diameter among men with dandruff-associated hair loss.^3,4

This ketoconazole shampoo is ideal for someone who wants to try ketoconazole without committing to a telehealth subscription or prescription process, with accessible pricing.

However, the sulfate-containing formula may be too drying for some users, and that may hinder consistent use.

Bottom line: Nizoral A-D is the most accessible OTC option, with the strongest combination of convenience, accessible pricing, and direct evidence at its 1% concentration.

#4: Keeps Ketoconazole Shampoo

✓ 2% ketoconazole	✗ Men’s platform only
✓ Integrated with an established hair loss service	✗ Generic shampoo formula may be drying
✓ Easy add-on for existing finasteride or minoxidil users
✓ Accessible, transparent pricing

Keeps is the strongest option in this review for men who specifically want 2% ketoconazole inside an established hair loss platform.

At a 2% concentration, it offers a formula with more robust evidence for improvements to hair density and a stronger anti-dandruff effect.^2,5 That gives Keeps an evidence-based advantage for hair loss over lower-strength products that are primarily limited to improving scalp health, rather than addressing hair loss. At $11 per month, its pricing model is accessible.

Additionally, men already receiving finasteride, minoxidil, or another treatment from Keeps can add ketoconazole without establishing care elsewhere.

However, the generic formulation of the 2% ketoconazole shampoo means that regular use may contribute to scalp dryness for some users. Keeps is also limited to treating men, which means women will have to look to another platform for a 2% shampoo.

Bottom line: Keeps is our preferred higher-strength prescription option for men, particularly for existing Keeps patients.

#5: EasyDerm Ketoconazole Shampoo

✓ 2% ketoconazole	✗ Generic formulation may be drying
✓ Accessible pricing	✗ Fewer hair loss formulations available
✓ Dermatology-based online review
✓ 120 mL listed as a three-month supply

EasyDerm wins on price for a 2% formula. At a listed $15 per month for 2% ketoconazole, it costs substantially less than several dedicated hair loss platforms while still providing physician oversight.

For someone whose main objective is getting prescription-strength ketoconazole inexpensively, EasyDerm has a clear advantage. However, the ingredients are the same as other prescription generic shampoo formulas and may be drying to the hair and scalp.

However, EasyDerm’s platform is not as focused on hair loss as other platforms. As a result, there are fewer options available for those looking to keep their treatment within one platform.

Bottom line: EasyDerm is the best budget telehealth option for 2% ketoconazole; however, the generic formulation still presents the same issues as other sulfate-containing formulas.

#6: Generic Ketoconazole 2%

✓ 2% ketoconazole	✗ Pricing varies widely
✓ Potentially inexpensive with insurance or pharmacy discounts	✗ Generic formula likely contains sulfate surfactants, fragrance, and dye
✓ Widely available with a prescription	✗ Requires separate prescription access

Generic ketoconazole gives patients access to the same 2% ketoconazole concentration offered by several of the telehealth brands higher on this list, often without paying for an additional subscription or specialty hair loss service.

For patients who already see a dermatologist or primary care physician, this may be one of the simplest ways to get prescription-strength ketoconazole. Cost can also be low depending on insurance coverage and pharmacy pricing, although there is considerably more variation than with providers that publish a fixed monthly price.

The bigger difference is the formulation and convenience. Currently marketed 2% formulas use sulfate surfactants alongside fragrance, dyes, and other conventional shampoo excipients.¹⁷ These ingredients don’t make the medication less effective, but they may be less appealing for patients with dry, brittle, color-treated, or already fragile hair. Additionally, 2% ketoconazole from generic pharmacies requires an outside prescription, adding the complexity of physician visits and potential appointment wait times.

This is where the higher-ranked hair loss shampoos have an advantage. Ulo’s ketoconazole shampoo is intentionally formulated without sulfates, and other prescription platforms offer consultations for prescriptions as early as same-day.

Bottom line: Generic 2% ketoconazole is a straightforward option for patients who already have prescription access and don’t need a specialized formula or bundled hair loss service. Its main advantage is potentially lower cost, whereas its main limitations are formulation, accessibility, and varying pricing between pharmacies.

#7: AlgoRx Ketoconazole Shampoo

✓ 2% ketoconazole	✗ More expensive option
✓ 100% online prescription process	✗ Fewer meaningful differentiators than higher-ranked options
✓ Integrated with a broader telemedicine platform offering support for other aspects of health	✗ Generic shampoo formula may be drying

AlgoRx provides another legitimate route to prescription-strength ketoconazole without an in-person dermatology visit.

The shampoo contains 2% ketoconazole concentration, which can be integrated into other treatments offered by the telehealth platform. AlgoRx is also a broader telemedicine platform, making the 2% ketoconazole a more convenient option if you are accessing medication via telemedicine for other aspects of health.

The main limitation of AlgoRx’s platform is that it offers relatively little advantage beyond convenient online access to 2% ketoconazole. If a patient’s preference is prescription-strength ketoconazole, lower-cost options are available. Those building a broader hair loss regimen may also prefer a platform with more treatment options, while others may prefer a less generic shampoo formulation that addresses adherence challenges.

Bottom line: AlgoRx is a competitive 2% telehealth alternative, but it doesn’t currently have a considerable advantage over other competitors on price, formulation, access, or treatment breadth.

The Clear Winner: Ulo Thickening+ Ketoconazole Shampoo

Ulo’s Thickening+ Ketoconazole Shampoo is our top pick because it offers the best overall balance of ketoconazole concentration, formulation, and suitability for repeated use in patients with thinning hair.

Its 0.9% ketoconazole concentration is lower than the 2% prescription options reviewed here, and patients with more severe dandruff or seborrheic dermatitis may benefit more from a higher-strength formulation.⁵ However, the lower concentration, which approximates the established 1% concentration, utilizes a sulfate-free formulation designed specifically for thinning hair.

This gives the Ulo shampoo an advantage for patients who prioritize scalp tolerability and hair feel alongside antifungal activity, particularly when ketoconazole is being used frequently over a long period of time.

Bottom line: Ulo is our top overall pick because it leverages a near-clinical dose of ketoconazole with a shampoo formulation better suited to long-term use on thinning hair. However, patients who prefer ketoconazole at maximum strength may still be better suited to one of the 2% prescription options above.

Ketoconazole Shampoo Safety

Topical ketoconazole is generally well tolerated. A systematic review found topical ketoconazole to have an overall favorable dermatologic safety profile.¹⁸

Common Side Effects

Common side effects associated with ketoconazole include the following:

• Dryness
• Itching
• Burning or stinging
• Skin irritation
• Changes in hair texture
• Changes in scalp oiliness
• Contact dermatitis

However, it’s important to note that many of these side effects can be due to the formulation rather than the ketoconazole itself. Therefore, changing the shampoo formulation or reducing frequency may help when mild dryness or irritation occurs.

Precautions

Ketoconazole shampoo should be kept out of the eyes and used according to the label or prescribing provider’s instructions. Patients with persistent redness, scaling, crusting, pain, or unexplained hair loss should also consider whether the underlying diagnosis is actually dandruff or seborrheic dermatitis.

Frequently Asked Questions

Do I need a prescription for ketoconazole shampoo?

Not for every product. While prescription-strength 2% formulas require a prescription, over-the-counter formulations like Ulo’s Thickening+ Shampoo and Nizoral A-D are available.

Is 2% ketoconazole better than 1%?

For severe dandruff and seborrheic dermatitis, the available head-to-head evidence favors 2%.⁵ Protocols targeted specifically toward hair density rather than scalp health may also benefit more from the 2% formulations. For milder dandruff or overall scalp-health support, formulas with 1% ketoconazole are suitable.

Will 0.9% ketoconazole work like 1%?

Most likely, although the two concentrations haven’t been compared directly. Clinical studies support 1% ketoconazole for dandruff, while 0.9% falls short by only 0.1%. For this reason, similar dandruff control would be a reasonable expectation, although equivalence hasn’t been clinically proven.

Can women use ketoconazole shampoo?

Yes. Ketoconazole isn’t specific to male hair loss and can be used by both men and women when appropriate. Several providers, including Strut, offer 2% ketoconazole for both men and women.

Can ketoconazole regrow hair?

There is some evidence that ketoconazole may support hair growth, although the research remains limited. Human studies using 1% and 2% ketoconazole have reported reductions in shedding and improvements in hair thickness, hair density, and the number of hairs in active anagen.^1-3 Of the two, 2% seems to outperform 1% ketoconazole for hair density.

How often should I use ketoconazole shampoo?

Most studies and product instructions use ketoconazole approximately two to three times per week.^3-6 The appropriate frequency depends on the concentration and the overall shampoo formulation. Sulfate-free formulas may be used more frequently without dryness, whereas generic Rx formulas may cause excessive dryness if used too frequently.

Can I use ketoconazole with minoxidil or finasteride?

Yes. Ketoconazole is commonly used alongside treatments such as minoxidil and finasteride because each addresses a different aspect of hair loss. Ketoconazole primarily targets dandruff and Malassezia, while finasteride reduces DHT and minoxidil supports hair growth through separate pathways.

Final Remarks

Ketoconazole earns a place in hair loss care for its ability to effectively treat common scalp problems and provide additional hair benefits with minimal extra effort.

At both 1% and 2% concentrations, ketoconazole shampoo addresses itchy, flaky scalp, dandruff, and seborrheic dermatitis. When it comes to moderate or severe cases, 2% ketoconazole outperforms the lower strength. Similarly, 2% ketoconazole has more evidence to support its use for hair growth.

Various online telehealth platforms offer easily accessible, prescription-strength 2% ketoconazole shampoo at varying prices. However, all Rx formulas are limited to a generic shampoo formulation, often made with harsh or drying sulfates that can interfere with long-term adherence.

Ulo’s Thickening+ Ketoconazole Shampoo provides a near-clinical dose of 0.9% ketoconazole while addressing a common obstacle to consistent use: stripping, drying, sulfate-containing formulas. As the only sulfate-free ketoconazole shampoo option, it offers a way to use ketoconazole with an intentional formulation that avoids the stripping, drying effects of sulfates. It’s also the only formulation specifically designed for thinning hair, with additional supportive actives like caffeine, saw palmetto, and rosemary. Ulo’s shampoo stands out as the best option for long-term ketoconazole use.

References

1. Fields JR, Vonu PM, Monir RL, Schoch JJ. Topical ketoconazole for the treatment of androgenetic alopecia: a systematic review. Dermatol Ther. 2020;33(1):e13202. doi:10.1111/dth.13202
2. Piérard-Franchimont C, De Doncker P, Cauwenbergh G, Piérard GE. Ketoconazole shampoo: effect of long-term use in androgenic alopecia. Dermatology. 1998;196(4):474-477. doi:10.1159/000017954
3. Piérard-Franchimont C, Goffin V, Henry F, Uhoda I, Braham C, Piérard GE. Nudging hair shedding by antidandruff shampoos. A comparison of 1% ketoconazole, 1% piroctone olamine and 1% zinc pyrithione formulations. Int J Cosmet Sci. 2002;24(5):249-256. doi:10.1046/j.1467-2494.2002.00145.x
4. Go IH, Wientjens DPWM, Koster M. A double-blind trial of 1% ketoconazole shampoo versus placebo in the treatment of dandruff. Mycoses. 1992;35(3-4):103-105. doi:10.1111/j.1439-0507.1992.tb00828.x
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6. Peter RU, Richarz-Barthauer U. Successful treatment and prophylaxis of scalp seborrhoeic dermatitis and dandruff with 2% ketoconazole shampoo: results of a multicentre, double-blind, placebo-controlled trial. Br J Dermatol. 1995;132(3):441-445. doi:10.1111/j.1365-2133.1995.tb08680.x
7. Danby FW, Maddin WS, Margesson LJ, Rosenthal D. A randomized, double-blind, placebo-controlled trial of ketoconazole 2% shampoo versus selenium sulfide 2.5% shampoo in the treatment of moderate to severe dandruff. J Am Acad Dermatol. 1993;29(6):1008-1012. doi:10.1016/0190-9622(93)70282-x
8. Schwartz JR, Messenger AG, Tosti A, et al. A comprehensive pathophysiology of dandruff and seborrheic dermatitis — towards a more precise definition of scalp health. Acta Derm Venereol. 2013;93(2):131-137.
   doi:10.2340/00015555-1382
9. Hay RJ. Malassezia, dandruff and seborrhoeic dermatitis: an overview. Br J Dermatol. 2011;165 Suppl 2:2-8. doi:10.1111/j.1365-2133.2011.10570.x
10. Chang CH, Chovatiya R. More yeast, more problems?: reevaluating the role of Malassezia in seborrheic dermatitis. Arch Dermatol Res. 2024;316(4):100. doi:10.1007/s00403-024-02830-7
11. Piérard-Franchimont C, Xhauflaire-Uhoda E, Loussouarn G, Saint Léger D, Piérard GE. Dandruff-associated smouldering alopecia: a chronobiological assessment over 5 years. Clin Exp Dermatol. 2006;31(1):23-26. doi:10.1111/j.1365-2230.2005.02026.x
12. Peters EMJ, Liotiri S, Bodó E, et al. Probing the effects of stress mediators on the human hair follicle: substance P holds central position. Am J Pathol. 2007;171(6):1872-1886. doi:10.2353/ajpath.2007.061206
13. Sinclair R. Androgenetic alopecia. Modelling progression and regrowth. Exp Dermatol. 2016;25(6):424-425. doi:10.1111/exd.13029
14. Szendzielorz E, Spiewak R. Caffeine as an active ingredient in cosmetic preparations against hair loss: a systematic review of available clinical evidence. Healthcare (Basel). 2025;13(4):395. doi:10.3390/healthcare13040395
15. Evron E, Juhasz M, Babadjouni A, Atanaskova Mesinkovska N. Natural hair supplement: friend or foe? Saw palmetto, a systematic review in alopecia. Skin Appendage Disord. 2020;6(6):329-337. doi:10.1159/000509905
16. Panahi Y, Taghizadeh M, Marzony ET, Sahebkar A. Rosemary oil vs minoxidil 2% for the treatment of androgenetic alopecia: a randomized comparative trial. Skinmed. 2015;13(1):15-21. PMID:25842469.
17. Preferred Pharmaceuticals Inc. Ketoconazole shampoo, 2% [prescribing information]. DailyMed. Revised May 2026. Accessed September 2026.
    https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d59df5bf-bfa6-45fa-81f6-8c8ee2f24cf8
18. Choi FD, Juhasz MLW, Atanaskova Mesinkovska N. Topical ketoconazole: a systematic review of current dermatological applications and future developments. J Dermatolog Treat. 2019;30(8):760-771.
    doi:10.1080/09546634.2019.1573309