2% Ketoconazole Cream
2% Ketoconazole Cream
Product Description
Product overview
A clinically proven prescription-strength antifungal cream with 2% Ketoconazole — the gold standard topical treatment for seborrheic dermatitis, tinea versicolor, ringworm, athlete's foot, and fungal acne (Malassezia folliculitis). Delivers fast, targeted relief by inhibiting the enzyme lanosterol 14α-demethylase, blocking ergosterol synthesis in the fungal cell membrane.
Broad-Spectrum Antifungal
Ketoconazole 2% targets a wide range of fungal species including Malassezia, dermatophytes, and Candida by blocking ergosterol biosynthesis in the fungal cell membrane.
Texture & feel
SENSORYBroad-Spectrum Antifungal
Ketoconazole 2% targets a wide range of fungal species including Malassezia, dermatophytes, and Candida by blocking ergosterol biosynthesis in the fungal cell membrane.
Treats Seborrheic Dermatitis
Clinically proven to clear Malassezia-driven seborrheic dermatitis on the face, eyebrows, hairline, and body within 2–4 weeks of twice-daily application.
Clears Tinea Versicolor
Highly effective for pityriasis/tinea versicolor — the patchy discoloration caused by Malassezia furfur — with typical clearance in 2–3 weeks of treatment.
Resolves Fungal Acne
The definitive topical treatment for pityrosporum (Malassezia) folliculitis, which mimics bacterial acne but doesn't respond to standard acne treatments.
Minimal Systemic Absorption
Clinical data confirms that plasma concentrations of ketoconazole are undetectable after normal topical application to adult skin, making it a locally acting treatment.
Superior Efficacy vs. 1% Formulas
The 2% concentration delivers faster fungal eradication compared to 1% OTC alternatives, with equivalent efficacy to 4 weeks of clotrimazole 1% treatment in clinical trials.
Safety & compatibility
SAFETopical use is generally considered low-risk due to negligible systemic absorption in adults; however, ketoconazole is classified Category C. Always consult your OB-GYN before use during pregnancy, especially in the first trimester.
Systemic absorption from topical application is negligible. Avoid applying directly to the nipple/areola area. Consult a healthcare provider before use while breastfeeding.
This product is specifically designed to treat Malassezia-related skin conditions, including fungal acne (pityrosporum folliculitis). The active ingredient directly targets and eliminates Malassezia yeast.
Fragrance-free and paraben-free. Most patients tolerate it well. Note: cetyl and stearyl alcohol may cause contact dermatitis in rare cases. Patch test recommended for highly reactive skin types.
Does not contain retinoids, hydroquinone, salicylic acid, or chemical exfoliants. Safe to incorporate into a routine that includes these actives at different times of day.
If used alongside topical steroids, apply the corticosteroid in the morning and ketoconazole in the evening. Gradually taper steroid use over 2–3 weeks to avoid a rebound flare.
Avoid contact with eyes and mucous membranes. Do not apply to open wounds, broken, or severely inflamed skin without medical supervision.
Clinical data exists for use in infants with seborrheic dermatitis; however, plasma absorption was detected in some infants when large body surface areas were treated. Use only under medical guidance in young children.
Ingredient breakdown
INGREDIENTSKetoconazole 2%Proven
The active ingredient and star of this formula. Ketoconazole is a synthetic imidazole antifungal that inhibits the fungal cytochrome P450 enzyme lanosterol 14α-demethylase, blocking the conversion of lanosterol to ergosterol — a critical component of the fungal cell membrane. Without ergosterol, the fungal cell membrane loses integrity, leading to cell death. At 2%, it is highly effective against Malassezia, dermatophytes (Trichophyton, Microsporum, Epidermophyton), and Candida species.
- Mechanism: Inhibits lanosterol 14α-demethylase → disrupts ergosterol synthesis → fungal cell death
- Clinical Trials: Evaluated in 1,079 subjects across 30 clinical trials; equivalent efficacy to clotrimazole 1% for tinea infections
- Spectrum: Active against Malassezia spp., Trichophyton spp., Candida spp., Microsporum spp., Epidermophyton spp.
- Systemic Absorption: Plasma levels undetectable in adults after topical application to normal skin
Propylene Glycol BaseProven
A multifunctional humectant and penetration enhancer that draws moisture into the skin and increases the permeability of ketoconazole into the stratum corneum. It also acts as a solvent and preservative in this formulation. Propylene glycol is present at approximately 200 mg/g (20%) in this cream.
- Function: Humectant, penetration enhancer, solvent
- Skin Benefit: Improves ketoconazole delivery to the infection site; maintains cream texture
- Note: High concentrations can occasionally cause irritation in sensitive individuals
Cetyl Alcohol & Stearyl Alcohol EmollientsProven
Fatty alcohols (not drying "bad" alcohols) that form the creamy base of the formula. They act as emollients, thickeners, and emulsion stabilizers. Cetyl alcohol has a comedogenic rating of 2 and stearyl alcohol around 2, making this base only mildly comedogenic in theory, though the thin application layer keeps real-world risk minimal.
- Function: Emollient, emulsifier, thickener, texture agent
- Comedogenic Rating: 2/5 (mild)
- Sensitivity Note: May cause local skin reactions including contact dermatitis in susceptible individuals per official SmPC
Polysorbate 60 & Polysorbate 80 EmulsifiersProven
Nonionic surfactants and emulsifiers that blend the oil and water phases of the cream to create a stable, smooth texture. Although polysorbates are commonly listed as fungal-acne triggers in general skincare, in this product the 2% ketoconazole active ingredient directly kills Malassezia yeast, completely overriding any potential polysorbate-related concern.
- Function: Emulsifier, solubilizer, cream stabilizer
- FA Note: Generally flagged as FA-risky in leave-on products, but the ketoconazole active makes this a non-issue here
Isopropyl Myristate EmollientProven
An emollient and skin-conditioning agent derived from isopropyl alcohol and myristic acid. It provides a smooth, non-greasy texture and enhances ingredient spreadability. Isopropyl myristate has a higher comedogenic rating (3–5 scale), but in this medical cream it is used at low concentrations and applied in thin layers to targeted areas only — not as a daily all-over moisturizer.
- Function: Emollient, skin-feel agent, penetration enhancer
- Comedogenic Rating: 3–5 in isolation; real-world risk lower given thin application and treatment-only use
Sorbitan Stearate EmulsifierProven
A nonionic emulsifier derived from sorbitol and stearic acid. Works alongside polysorbates to create and maintain the stable oil-in-water emulsion of the cream, ensuring even distribution of ketoconazole throughout the formulation for consistent dosing with each application.
- Function: W/O emulsifier, texture stabilizer
- Safety: Widely regarded as gentle; minimal irritation potential
9 ingredients
Active: Ketoconazole 2%
Inactive: Water (Aqua), Propylene Glycol, Cetyl Alcohol, Stearyl Alcohol, Sorbitan Stearate, Polysorbate 60, Polysorbate 80, Isopropyl Myristate
Where it fits in your routine
ROUTINEApply to clean, dry skin before moisturizer. If using a topical corticosteroid, apply Nizoral in the evening and the corticosteroid in the morning. Allow 5–10 minutes before layering other products to avoid dilution of the active.
How to use
HOW TO USECleanse & Dry Thoroughly
Gently cleanse the affected area with a mild, fragrance-free cleanser. Pat completely dry — moisture trapped under the cream can slow treatment efficacy and potentially worsen fungal conditions.
Apply a Thin Layer
Squeeze a pea-sized amount and apply a thin, even layer to the entire affected area and approximately 2 cm (1 inch) of the surrounding skin. Treating beyond the visible lesion boundaries helps prevent recurrence.
Gently Massage In
Rub the cream in gently using circular motions until fully absorbed. Avoid aggressive rubbing on inflamed or broken skin. For seborrheic dermatitis on the face, avoid the eye area.
Frequency & Duration
Apply once or twice daily as directed. Typical treatment durations: Tinea versicolor — 2–3 weeks; Seborrheic dermatitis — 2–4 weeks; Tinea corporis/cruris — 3–4 weeks; Tinea pedis — 4–6 weeks. Continue for the full recommended period even if symptoms improve early to prevent relapse.
Wash Hands After Application
Always wash hands after applying to prevent inadvertent spread to eyes or mucous membranes. Do not wrap or occlude the treated area unless instructed by a physician, as occlusion increases systemic absorption.
Who is it for?
WHOPerfect for you if:
- You have diagnosed or suspected seborrheic dermatitis (face, scalp line, eyebrows)
- You're dealing with tinea versicolor (patchy skin discoloration)
- You have fungal acne (Malassezia folliculitis) that doesn't respond to standard acne treatments
- You have ringworm (tinea corporis), jock itch (tinea cruris), or athlete's foot (tinea pedis)
- You have cutaneous candidiasis or vulvitis
- You want a fragrance-free, paraben-free pharmaceutical-grade treatment
- Your dermatologist has recommended antifungal therapy
Consider alternatives if:
- Your acne is bacterial (not fungal) — ketoconazole will not help
- You have a known allergy to ketoconazole or any listed inactive ingredients
- You are pregnant and have not consulted your physician
- You want a daily preventive skincare product (this is a targeted treatment, not a moisturizer)
- Your condition is on or near the eye area (not for ophthalmic use)
- You have broken, severely inflamed, or deeply infected skin requiring systemic treatment
Skin type compatibility
SKIN TYPESOily skin is most prone to Malassezia overgrowth and seborrheic dermatitis. The cream formula is non-heavy and absorbs well, leaving a natural-to-matte finish without excessive greasiness.
Effective for treating fungal conditions regardless of skin type. Propylene glycol provides some humectancy, but dry skin types should follow with a gentle moisturizer after the cream absorbs.
Works well across mixed skin zones. The light cream texture integrates into combination skin routines without exacerbating the oily T-zone or drying out drier cheeks.
Fragrance-free and paraben-free, which is a plus. However, cetyl alcohol, stearyl alcohol, and propylene glycol can trigger contact dermatitis in very reactive skin. Patch test before full application and monitor for redness or burning.
The definitive treatment for fungal acne (pityrosporum folliculitis), which is commonly misdiagnosed as bacterial acne. If your acne hasn't responded to traditional treatments, this is the go-to option. Apply only to affected areas.
Can help when eczema is complicated by secondary Malassezia overgrowth. Use with caution as propylene glycol may worsen irritation on compromised skin barriers. Always consult a dermatologist first.
Results timeline
4–6 WEEKSItch & Burning Relief
Most users report a noticeable reduction in itching, burning, and discomfort within the first few days of application. The antifungal action begins immediately upon contact with fungal cells, disrupting cell membrane integrity from the first dose.
~70% noticedVisible Reduction in Redness & Flaking
Redness, scaling, and flaking associated with seborrheic dermatitis begin to significantly reduce. Tinea versicolor patches start to fade. The fungal population is actively being eliminated at this stage.
~75% noticedClearing of Fungal Infection
Most fungal conditions (tinea versicolor, seborrheic dermatitis, fungal acne) show complete or near-complete clearance. Fungal acne pustules flatten, and seborrheic patches resolve. Continue full treatment course to prevent relapse even if skin looks clear.
~85% noticedFull Treatment Completion
Persistent conditions like tinea pedis (athlete's foot) require up to 6 weeks for complete clearance. Post-tinea versicolor pigment changes may take additional weeks to months to normalize, as this is a skin cell renewal process, not active infection.
~90% noticedRatings by platform
1K+ REVIEWSPros & cons
BALANCEDPraised
- Fastest and most effective topical antifungal at 2% concentration
- Broad spectrum — works on Malassezia, dermatophytes, Candida
- The gold standard for fungal acne (pityrosporum folliculitis)
- Works rapidly — itch relief often within days
- Fragrance-free, paraben-free formula
- Negligible systemic absorption in adults
- No evidence of relapse at 8 weeks post-treatment
- Clinically validated in 30 trials across 1,079 subjects
Criticized
- Small tube size (15g/30g) can feel expensive per gram
- Propylene glycol may cause stinging in sensitive individuals
- Cetyl/stearyl alcohol can trigger contact dermatitis rarely
- Isopropyl myristate raises comedogenic concerns for acne-prone users
- Not a quick fix for severe or systemic fungal infections (oral antifungals needed)
- Post-tinea versicolor pigment changes persist for months after clearance
- Prescription required in many countries (can limit easy access)
- Not for ophthalmic use — limits facial application zones
Budget-friendly alternatives (dupes)
DUPESIdentical active ingredient at the same 2% concentration with nearly identical inactive ingredients. Store-brand generics are bioequivalent to Nizoral by FDA standards — same efficacy, significantly lower cost. The only real difference is packaging.
A different antifungal mechanism (also inhibits ergosterol synthesis but via a different binding site) at a lower 1% concentration. Effective for tinea infections but less potent against Malassezia/fungal acne than ketoconazole 2%. Requires longer treatment duration (typically 4 weeks vs. 2–3 weeks for Nizoral). Widely available OTC.
A different antifungal class (hydroxypyridinone) with broad-spectrum activity including against dermatophytes, Candida, and Malassezia. Often used as a Nizoral alternative for seborrheic dermatitis and tinea versicolor. Generally requires a prescription and is in a similar price range. Slightly less clinical data for fungal acne specifically.
Comparison with competitors
SIDE-BY-SIDELamisil AT Terbinafine 1% Cream
Ciclopirox 0.77% Cream (Loprox)
Storage & shelf life
12 MONTHS12 months after opening. Discard any remaining cream after the full treatment course as directed, or after 12 months from first use.
Store below 25°C (77°F). Do not refrigerate or freeze. Keep away from direct sunlight, heat sources, and excessive humidity. Keep out of reach of children.
Aluminum tube (99.7% aluminum) lined with heat-polymerised epoxyphenol resin and a latex cold-seal ring. Available in 15g and 30g sizes. Hygienic tube format prevents contamination between uses.
Yes — the 15g tube is well within the 100ml TSA/airline liquid limit. Lightweight aluminum tube is resistant to breakage during travel. Cap firmly to prevent leakage in luggage.
Frequently asked questions
FAQTopical ketoconazole 2% cream is considered low systemic risk during pregnancy because plasma concentrations are undetectable after normal topical application to adult skin. Official EU/UK prescribing information states there are "no known risks associated with use in pregnancy or lactation" at the topical level. However, ketoconazole has limited human pregnancy safety data and is generally classified as Category C (animal studies show adverse effects; no adequate human data). As a precaution, always consult your OB-GYN or midwife before using any prescription medication during pregnancy or while breastfeeding, especially during the first trimester. Avoid applying to large body surface areas during pregnancy. During breastfeeding, do not apply to the nipple or areola area.
Yes — this is actually the primary treatment for fungal acne (Malassezia folliculitis / pityrosporum folliculitis). Ketoconazole 2% cream directly kills Malassezia yeast by disrupting its cell membrane. While the inactive ingredients include polysorbate 60 and polysorbate 80 (which are flagged as potential Malassezia food sources in pure leave-on skincare), the 2% active completely overrides this concern — the antifungal is eliminating the organism, not feeding it. This product is definitively fungal-acne safe AND effective as a treatment.
Yes, with timing considerations. Ketoconazole cream does not contain active exfoliants, acids, or retinoids, so it does not inherently conflict with these ingredients chemically. However, to avoid diluting the active ingredient and to minimize irritation, it is best practice to use ketoconazole cream at a separate time of day from low-pH actives (AHAs, BHAs, vitamin C) and retinol. For example, apply ketoconazole in the PM and retinol/acids in the AM, or vice versa. Allow 5–10 minutes after ketoconazole application before layering other products. If using a topical corticosteroid alongside, apply the corticosteroid in the AM and ketoconazole in the PM as per official SmPC guidelines.
Nizoral 2% cream is best suited for oily and acne-prone skin types that are most susceptible to Malassezia overgrowth and seborrheic dermatitis. It works across all skin types as a treatment, but is particularly ideal for oily and combination skin. Sensitive skin types should patch test first due to the propylene glycol, cetyl alcohol, and stearyl alcohol content. Dry skin types should follow up with a non-comedogenic moisturizer after the cream absorbs, as propylene glycol can have a slight drying effect with prolonged use on some individuals. This is a treatment product, not a skin type-specific formula — its indication is based on your condition, not your skin type.
Most users notice itch and discomfort relief within the first 1–3 days. Visible reduction in redness, scaling, and flaking typically occurs within 1–2 weeks. For seborrheic dermatitis and fungal acne, expect significant clearing by weeks 2–4 with twice-daily use. Tinea versicolor infections typically clear in 2–3 weeks, though the resulting pigment changes (light or dark patches) may take several additional weeks to months to normalize, as this is a skin cell renewal process not related to active infection. Tinea pedis (athlete's foot) may require 4–6 weeks. Always complete the full recommended treatment duration even if symptoms disappear early to ensure complete eradication and prevent relapse.
Nizoral 2% cream is a treatment product applied after cleansing and toning, but before moisturizer or heavier creams. The correct routine order is: (1) Cleanser → (2) Toner (optional) → (3) Nizoral 2% Cream → (4) Moisturizer → (5) Sunscreen (AM only). Apply to clean, completely dry skin and allow 5–10 minutes for full absorption before layering other products. If using alongside a topical corticosteroid, apply the corticosteroid in the morning and Nizoral at night to prevent a rebound flare when tapering the steroid. Remember this is a targeted treatment — apply only to affected areas, not all over the face as a general skincare step.
The overall comedogenic rating for this cream is 2/5, considered mildly comedogenic. The key ingredient of concern is isopropyl myristate, which has a comedogenic rating of 3–5 in isolation and is known to clog pores in susceptible individuals. Cetyl alcohol and stearyl alcohol each rate around 2. However, real-world comedogenicity risk is significantly lower than theoretical ratings because: (a) this is applied in a very thin layer only to affected areas, not used as an all-over moisturizer; (b) it is a short-term treatment, not a daily indefinite product; and (c) the antifungal active directly addresses Malassezia-driven comedones. To minimize risk, apply a thin layer only to affected zones and avoid using on healthy, unaffected pore-prone areas of the face.
Nizoral 2% cream should be used within 12 months of opening. The aluminum tube packaging is designed to minimize air and moisture exposure, which helps maintain stability. For typical treatment courses (2–6 weeks using once to twice daily application of a pea-sized amount), a single 30g tube is usually sufficient for the full treatment course of a localized area, meaning most of the tube is used up well within the 12-month window. Store below 25°C (77°F) and keep the cap tightly closed after each use. Do not use past the expiry date printed on the tube and outer packaging.
Verdict: Nizoral 2% Ketoconazole Cream is the gold-standard topical antifungal for Malassezia-related skin conditions. With a clinically proven active ingredient, negligible systemic absorption, and a fragrance-free paraben-free base, it delivers reliable, rapid results for seborrheic dermatitis, tinea versicolor, fungal acne, and a broad range of superficial fungal infections — often within days of first use. The short ingredient list of 9 components keeps the formula clean and purposeful. Minor drawbacks include the presence of isopropyl myristate (mild comedogenic risk) and propylene glycol (potential sensitizer in rare cases), but these are offset by the cream's outstanding therapeutic efficacy. For anyone struggling with a fungal skin condition that hasn't responded to standard treatments, this is the most evidence-backed, dermatologist-recommended topical solution available.
Product Overview
Quick product notes are a great way to check if a product is free from commonly avoided ingredients by skincare enthusiasts. These preferences come about for different reasons depending on the ingredient such as personal experiences, sensitivities, health preferences & etc.
Just because a product is not free from a common preference does not mean it's a bad product! You can make a personal decision whether or not you want to use a product that contains these ingredients or not - click the labels of the preference to read more about them.
Quick Product Notes
Ever used a product that promised a certain effect but provided no results? It might not have contained any notable ingredients that could have been responsible for that promised effect. It doesn't matter what the marketing or packaging «promises» it can do, if it doesn't contain anything that can help - then the likelihood of it helping is low.
We help you identify key notable ingredients that have been shown to help with effects such as acne-fighting, brightening, UV-protection, wound healing & anti-aging to help you achieve your skincare goals smarter. Please note that different notable ingredients have varying levels of research behind them, some are extremely well proven yet some have mixed research in their efficacy.
Just because a product doesn't contain any notable ingredients doesn't mean it's bad. And a product with notable ingredients (or even many) doesn't necessarily guarantee the efficacy of the product performing these effects either. There are other factors such as ingredient quality, concentration and formulation that will ultimately determine this.
Be smart and use this as just a starting point for you to make more informed and smarter choices and compare it with reviews to see if the product is right for you
Notable Effects & Ingredients
Why are some products great for some people and horrible for others? Well everyone has different skin types and different reactions to the same ingredients.
We've identified a range of ingredients that are commonly regarded as potentially good or bad for those with Dry, Oily/Acne-Prone or Sensitive skin.
A product that contains good or bad ingredients for your skin type doesn't always flat out make the entire product good or bad for your skin. There are other factors such as ingredient quality, concentration and formulation that will ultimately determine your skins reaction.
One of the best ways to use this section is to troubleshoot products you've had bad experiences with in the past. Check if it contains any of the marked ingredients to point out suspect ingredients to avoid in the future!
Ingredients Related to Skin Types
Ingredient Safety Breakdown refers to the percentage % of ingredients in different risk categories as classified by EWG (Environment Working Group) if they are available. There are almost endless cosmetic ingredients and they are one of the few organisations globally that have assigned ratings to a lot of the more commonly used ingredients which is why we reference them.
EWG is seen by many to be more on the alarmist side in their assignment of health ratings resulting in rating ingredients as riskier than they actually are. We recommend using this a reference point rather than a strict guide of ingredient safety and to always do further research if into ingredients that you may find suspect.
Ingredient Safety Breakdown
Product ingredient list
| EWG | CIR | Ingredient Name & Cosmetic Functions | Notes |
|---|---|---|---|
| 0 |
Ketoconazole
|
|
|
| 1 |
Water
Solvent, Skin Conditioning
|
|
|
| 3 |
Propylene Glycol
Solvent, Skin Conditioning, Fragrance, Humectant, Viscosity Controlling, Viscosity Decreasing Agent, Skin-Conditioningagent - Miscellaneous
|
Hydrating
|
|
| 1 |
Cetyl Alcohol
Emulsion Stabilising, Fragrance, Opacifying, Emulsifying, Surfactant, Foam Boosting, Viscosity Increasing Agent, Emollient, Masking, Viscosity Controlling
|
|
|
| 1 |
Stearyl Alcohol
Emulsion Stabilising, Fragrance, Emulsifying, Surfactant, Viscosity Increasing Agent, Emollient, Foam Boosting, Masking, Opacifying, Refatting, Viscosity Controlling
|
|



