2% Ketoconazole Shampoo
2% Ketoconazole Shampoo
Product Description
Product overview
Nizoral 2% Ketoconazole Shampoo is a prescription-strength antifungal treatment by Janssen Pharmaceutica, formulated to combat stubborn dandruff, seborrheic dermatitis, and tinea versicolor. The active ingredient ketoconazole targets Malassezia yeast — the root cause of flaking, itching, and scalp irritation — delivering clinically proven relief where ordinary dandruff shampoos fall short.
Kills Malassezia Yeast
Ketoconazole disrupts fungal cell membranes by blocking ergosterol synthesis — the root cause of dandruff and seborrheic dermatitis.
Texture & feel
SENSORYKills Malassezia Yeast
Ketoconazole disrupts fungal cell membranes by blocking ergosterol synthesis — the root cause of dandruff and seborrheic dermatitis.
Prescription Strength
Double the concentration of OTC Nizoral A-D (1%), delivering rapid relief for moderate to severe scalp conditions within days.
Clinically Proven
Double-blind trials showed 73% success rate in treating tinea versicolor vs. 5% for placebo, with significant dandruff improvement in 30 days.
Anti-Hair Loss Potential
Off-label studies suggest ketoconazole may help block DHT locally on the scalp, making it popular in men's hair loss routines.
Color-Treated Safe
Gentle enough for color-treated, chemically processed, and gray hair with twice-weekly application — no bleaching effect.
Twice-Weekly Use
Only needs 2 applications per week between regular shampoos, making it convenient and cost-effective for long-term maintenance.
Safety & compatibility
SAFEConsult a doctor before use. Ketoconazole is not detected in plasma after topical scalp use, but no well-controlled human pregnancy studies exist.
Actually treats fungal acne (Malassezia folliculitis). No fatty acids, esters, or polysorbates that feed yeast.
Rated 1/5 — rinse-off formula with no oils or heavy emollients that could clog pores or hairline.
Includes SLS (Sodium Lauryl Sulfate) and Parfum, which can irritate very sensitive skin or eyes on contact.
Safe to layer with minoxidil, finasteride, and most scalp treatments. Pairs well in hair loss routines.
Avoid use on inflamed, cut, or broken scalp. Avoid eye contact and do not use on children under 12 without medical advice.
Ingredient breakdown
INGREDIENTSKetoconazole 2%Proven
A broad-spectrum imidazole antifungal that disrupts the synthesis of ergosterol — a vital component of fungal cell membranes. By weakening the Malassezia yeast responsible for dandruff and seborrheic dermatitis, it halts flaking, itching, and scaling at the root cause.
- FDA Approved: Prescription 2% is FDA-approved for tinea versicolor in adults
- Clinical Data: 73% success rate vs. 5% placebo in controlled trials
- Mechanism: Blocks ergosterol production, causing fungal cell death
- Systemic Safety: Not detected in bloodstream after topical scalp use
Sodium Lauryl Sulfate ~5-10%Proven
A powerful anionic surfactant that creates the lather and strips oil, product buildup, and flakes from the scalp. Its strong cleansing action helps the ketoconazole reach the scalp surface where fungal activity occurs.
- Function: Primary cleansing agent and foam booster
- CIR Panel: Considered safe in rinse-off products
Disodium Laureth Sulfosuccinate ~3-5%Proven
A milder co-surfactant that softens the harshness of SLS, contributing to creamier foam and better skin feel. It's considered one of the gentlest sulfate-family cleansers available.
- Function: Secondary surfactant, foam stabilizer
- Gentleness: Low irritation potential; common in baby shampoos
Laurdimonium Hydroxypropyl Hydrolyzed Collagen ~1-2%Promising
A cationic conditioning agent derived from hydrolyzed collagen. It reduces static, smooths the hair cuticle, and counteracts the drying effect of the sulfates in the formula.
- Function: Hair conditioning, anti-static
- Benefit: Helps minimize frizz and protein loss during wash
Methyl Glucose Dioleate ~1-3%Proven
A gentle, plant-derived emollient and emulsifier that adds slip and softness to the formula. It helps improve combability and keeps hair from feeling stripped after a strong antifungal wash.
- Function: Emollient, emulsifier, hair softener
- Source: Derived from glucose and oleic acid
Sodium Chloride ~1-2%Proven
Common table salt, used in shampoos as a viscosity modifier. It thickens the liquid formula to achieve the signature gel-like consistency of Nizoral 2%.
- Function: Viscosity control, texture agent
Hydrochloric Acid & Sodium Hydroxide <1%Proven
These pH adjusters work together to keep the formula within the optimal scalp-friendly range (around pH 5). Ketoconazole requires a stable pH to remain effective and non-irritating.
- Function: pH buffers
- Safety: Present in trace, neutralized amounts
Imidazolidinyl Urea <1%Proven
A broad-spectrum preservative that protects the water-rich formula against bacterial and mold contamination. It is a formaldehyde-releasing preservative used at low safe levels.
- Function: Preservative
- Regulation: Approved by EU and FDA at regulated concentrations
Parfum (Fragrance) <1%Proven
A light, clean fragrance blend used to mask the natural medicinal scent of ketoconazole, giving Nizoral its signature fresh, soapy note appreciated by most users.
- Function: Sensory masking
HC Red No. 3 <0.1%Proven
A cosmetic-grade dye responsible for Nizoral's distinctive red-orange color. It does not stain hair or scalp and is purely aesthetic.
- Function: Colorant
Water (Aqua) ~70-80%Proven
The solvent base of the formula that disperses all active and functional ingredients evenly across the scalp for uniform treatment.
- Function: Solvent, carrier
12 ingredients
Ketoconazole 2%, Disodium Laureth Sulfosuccinate, HC Red No. 3, Parfum, Hydrochloric Acid, Imidazolidinyl Urea, Laurdimonium Hydroxypropyl Hydrolyzed Collagen, Methyl Glucose Dioleate, Sodium Chloride, Sodium Hydroxide, Sodium Lauryl Sulfate, Water.
Where it fits in your routine
ROUTINEUse 2× per week as a treatment shampoo. Leave on scalp for 3-5 minutes before rinsing. On off-days, use your regular gentle shampoo.
How to use
HOW TO USEWet Hair Thoroughly
Fully saturate hair and scalp with warm (not hot) water before applying the shampoo.
Apply a Small Amount
Dispense a small amount (about a teaspoon) directly onto the scalp, not just the hair.
Massage into Lather
Gently massage into the scalp with fingertips, working into a light lather. Focus on affected areas.
Leave On for 3-5 Minutes
This dwell time is critical — it allows the ketoconazole to penetrate and kill the Malassezia yeast.
Rinse Thoroughly
Rinse completely with lukewarm water. Avoid contact with eyes; if contact occurs, rinse immediately.
Repeat Twice a Week
Use every 3-4 days for up to 8 weeks, then reduce to once per week for maintenance as needed.
Who is it for?
WHOPerfect for you if:
- You have persistent dandruff that OTC shampoos haven't solved
- You suffer from seborrheic dermatitis on the scalp or face
- You have fungal acne (Malassezia folliculitis) on hairline, back, or chest
- You have tinea versicolor (light/dark skin patches)
- You're in a DHT-blocking hair loss routine with minoxidil
- You want prescription-strength relief without a long list of fillers
Consider alternatives if:
- You're pregnant or breastfeeding (consult a doctor first)
- You have very dry, damaged, or brittle hair that can't tolerate SLS
- You're allergic to ketoconazole or imidazole antifungals
- You have broken, inflamed, or bleeding scalp
- You need a fragrance-free formula for sensitive skin
- You want a daily-use shampoo (not designed for daily use)
Skin type compatibility
SKIN TYPESStrong sulfate-based cleansing cuts through sebum buildup — ideal for oily, greasy scalps where Malassezia thrives.
May feel drying due to SLS. Use a hydrating conditioner afterward and limit to 1-2× weekly.
Works well for most scalps with flaky, oily T-zone–like behavior. Condition lengths for balance.
Contains SLS, fragrance, and imidazolidinyl urea — patch test first and avoid eye contact.
Fungal acne safe and non-comedogenic — can actually help clear hairline and back acne caused by Malassezia.
Gentle on color-treated, chemically processed, and gray hair with twice-weekly use. Does not bleach.
Results timeline
3-6 MONTHSImmediate Cleansing
Scalp feels cleaner and less itchy right after the first wash. Visible flakes significantly reduced during the shower.
85% noticedItch & Flake Relief
Most users experience dramatic reduction in itching and flaking within the first week of twice-weekly use.
78% noticedClear Scalp
Seborrheic dermatitis patches fade, redness subsides, and the scalp returns to a balanced, healthy state.
72% noticedSustained Control
Full clinical benefit realized. Fungal acne on hairline, chest, and back also clears. Maintenance mode begins.
68% noticedHair Loss Benefits (Off-Label)
Some users report reduced hair shedding and improved hair density when combined with minoxidil/finasteride.
42% reportedRatings by platform
49K+ REVIEWSPros & cons
BALANCEDPraised
- Fast-acting, works within the first 2-3 washes for most users
- Prescription-strength 2% ketoconazole unavailable in OTC formulas
- Short, focused ingredient list (only 12 ingredients)
- Fungal acne safe and non-comedogenic
- Popular in hair loss routines for DHT-blocking properties
- Effective for seborrheic dermatitis, tinea versicolor, and Malassezia folliculitis
- Only needs twice-weekly application
- Backed by strong clinical trial data (73% efficacy rate)
Criticized
- Contains SLS, which can be harsh on dry or damaged hair
- Contains fragrance and imidazolidinyl urea preservative
- Requires prescription in the US (2% strength)
- Can be drying without a follow-up conditioner
- Bottle size is relatively small for the price point
- Caution required during pregnancy and breastfeeding
- Red-orange color may stain light surfaces
- Rare reports of scalp irritation or delayed sensitivity
Budget-friendly alternatives (dupes)
DUPES
Nearly identical generic formula with the same 2% ketoconazole active. Requires prescription in the US but is significantly cheaper than branded Nizoral.
European 2% ketoconazole alternative with near-identical inactive ingredients. Widely available OTC in Germany and much of the EU.
UK pharmacy own-brand version with the same 2% active. Slightly different inactive base but clinically equivalent antifungal action.
Australian/NZ equivalent with 2% ketoconazole. Different surfactant system but same clinical efficacy for dandruff and seborrheic dermatitis.
Contains 2% ketoconazole plus polypeptide-1 for extra hair conditioning. Alternative for those who find pure Nizoral too drying.
Half-strength over-the-counter version by the same brand. No prescription required but slower results; good for mild dandruff maintenance.
Comparison with competitors
SIDE-BY-SIDE
Neutrogena T/Gel Therapeutic
Storage & shelf life
12 MONTHS12 months after opening
Store below 25°C (77°F). Protect from light and freezing.
Opaque plastic squeeze bottle with flip-top cap (protects from light)
Yes, under 100ml (100ml bottle meets TSA/EU carry-on limits)
Frequently asked questions
FAQCaution is advised. Although ketoconazole is not detected in the bloodstream after scalp application, there are no well-controlled studies in pregnant women. The manufacturer recommends using it during pregnancy only if the benefit outweighs the potential risk, and advises caution during breastfeeding. Always consult your doctor before using Nizoral 2% while pregnant or nursing.
Yes — in fact, it actively treats fungal acne. Ketoconazole is one of the most effective topical treatments for Malassezia folliculitis (fungal acne). The formula contains no fatty acids, esters, or polysorbates that feed yeast. Many dermatologists recommend using Nizoral 2% as a body wash on the chest, back, and hairline for fungal acne breakouts.
Yes, Nizoral 2% is a popular addition to hair loss routines and layers safely with minoxidil and finasteride. Apply Nizoral 2× weekly, rinse thoroughly, dry the scalp, and then apply minoxidil or other topicals. Avoid using it at the exact same time as other active scalp treatments — space them out by at least a few minutes.
Nizoral 2% works best for oily to combination scalps with dandruff, seborrheic dermatitis, or fungal acne. It can be drying for very dry or sensitive scalps due to its sulfate base, so those users may want to follow with a hydrating conditioner or alternate with a gentler shampoo on off-days.
Most users see reduced itching and flaking within 2-7 days of starting twice-weekly use. Full clinical benefit is typically achieved within 2-4 weeks, with sustained improvement in seborrheic dermatitis and tinea versicolor by week 8. Clinical trials showed a 73% success rate in treating tinea versicolor within just a few applications.
Use it as your primary shampoo on treatment days (2× per week). Wet hair thoroughly, apply a small amount, lather, and leave on the scalp for 3-5 minutes before rinsing. Follow with a conditioner on hair lengths (avoid the scalp). On off-days, use your regular gentle shampoo.
No — Nizoral 2% has a very low comedogenic rating of 1/5. It's a rinse-off formula with no heavy oils, butters, or comedogenic ingredients. In fact, it can actually help clear fungal acne and hairline breakouts caused by Malassezia overgrowth.
Nizoral 2% has a Period After Opening (PAO) of 12 months. Store it below 25°C (77°F), protect it from direct sunlight, and keep the cap tightly closed between uses. Discard 12 months after opening or by the printed expiration date on the bottle, whichever comes first.
Verdict: Nizoral 2% Ketoconazole Shampoo is the gold standard for prescription-strength dandruff, seborrheic dermatitis, and fungal acne treatment. With a short, focused 12-ingredient INCI list and clinically proven 73% efficacy, it consistently outperforms OTC alternatives for moderate to severe scalp conditions. It does contain SLS and fragrance — so users with dry or highly sensitive scalps should pair it with a hydrating conditioner — but for fungal acne sufferers, dandruff-prone scalps, and those incorporating DHT-blocking into their hair loss routine, this is a non-negotiable staple. Best in class for efficacy, backed by decades of dermatologist recommendations.
Product Overview
What are Quick Product Notes?
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.
Pro Tip Alert!
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
Paraben-Free
Paraben-Free
Understanding Parabens
Parabens are a large group of preservatives which are used to prevent bacteria growing in cosmetic formulations. There has been some healthy controversy surrounding them due to a few studies finding paraben presence in breast tumours and breast tissue. However, the majority of the scientific community have deemed these findings non-conclusive due to the limitations of these studies. There's still a lot of support for avoiding parabens following the better safe than sorry route. If you do we completely support you! If you are concerned about the health safety of parabens, then feel free to avoid them by looking out for the Paraben-Free icon. If not, don't worry about it - they do have had one of the longest safety records as preservatives!
Which Ingredients are classified as Paraben?
A product will be paraben-free if it does not contain any of the following parabens:
- Sodium Isobutylparaben
- Sodium Ethylparaben
- Sodium Butylparaben
- Propylparaben
- Isopropylparaben
- Isobutylparaben
- Sodium Propylparaben
- Butylparaben
- Ethylparaben
- Sodium Methylparaben
- Methylparaben
Sulfate-Free
Sulfate-Free
Understanding Sulfates
Sulfates are a large group of ingredients which act as cleansing agents in Cosmetics. They help loosen up the dirt and grime from your skin and hair to allow for water to wash it away with ease. However some sulfates are so good at their job, they can wash off your skin’s own natural oils that keep it moisturised and protected which can lead to dryness and irritation. Most people will find no issues with sulfate, however if you find your skin doesn't like sulfates then free feel to avoid them by looking out for the sulfate-free icon on Skincarisma.
Which ingredients are classified as sulfates?
We've taken the Sulfates which are considered more harsh for our Sulfate-Free status. A product will be Sulfate-Free if it does not contain any of the following Sulfates:
- TEA-Dodecylbenzenesulfonate
- Ammonium Laureth Sulfate
- Sodium Lauryl Sulfate
- PEG-15 Cocamine
- Sodium Laureth Sulfate
- Sodium Cocoyl Sarcosinate
- Sodium C14-16 Olefin Sulfonate
- Dioctyl Sodium Sulfosuccinate
- Ammonium Xylenesulfonate
- Ammonium Lauryl Sulfate
- Sodium Xylenesulfonate
- Sodium Myreth Sulfate
- Sodium Lauryl Sulfoacetate
Alcohol-Free
Alcohol-Free
Understanding Simple Alcohols
Alcohol ingredients are widely used in cosmetics and come in different types. For the most part alcohols are not problematic at all. However one type of alcohols, simple alcohols can be quite drying to the skin because it evaporates very quickly. This can cause irritation which can also lead to other skin complications. These alcohols should never be used alone on your skin, but combined with other cosmetic ingredients, they are normally without issue. However, for some people with sensitive and easily irritable skin, avoiding products with these simple alcohols may be beneficial. If you find your skin doesn't like these simple alcohols, then free feel to avoid them by looking out for the Alcohol-Free icon.
Which Ingredients are classified as Alcohol?
A product will be alcohol-free if it does not contain any of the following alcohol ingredients:
- SD Alcohol
- Alcohol Denat
- Isopropyl Alcohol
- Alcohol
Silicone-Free
Silicone-Free
Understanding Silicones
If you've ever used a skincare, makeup or beauty product that's made your skin look and feel smoother tempoarily - it's likely contained Silicone. They are a popular class of ingredients found in cosmetics due to their smooth, soft, easy-to-spread and smooth properties that help creates an artificial layer/barrier on top of skin or hair (commonly found in conditioners).
For the same reasons they are popularly used, they are also commonly avoided. Anecdotally, many individuals have reported that Silicones cause/excerbate breakouts, irritation, cause a feeling of skin being unable to breathe, cause clumping of cosmetic products and find it difficult to wash off. As a result, those who find them problematic are avoiding them and increasingly, cosmetic companies are avoiding them as well.
If you have had bad experiences with Silicones in the past, or suspect they are problematic then look out for the tick on the Silicone-free label.
Disclaimer
The Silicone-free label only includes the most common Silicone ingredients that have indentified been reported by individuals that could potentially cause issues.
These include: Amodimethicone, Behenoxy Dimethicone, Bis-Aminopropyl Dimethicone, Cetearyl Methicone, Cetyl Dimethicone, Cyclomethicone, Cyclopentasiloxane, Dimethicone, Dimethicone Copolyol, Dimethiconol, Methicone, Phenyl Trimethicone, Phenyl Trimethicone, Stearoxy Dimethicone, Stearyl Dimethicone, Trimethylsilylamodimethicone.
Note, that this does not include all ingredients part of the Silicone class of ingredients.
EU Allergen-Free
EU Allergen-Free
Understanding the Identified Contact Allergens
The EU's Scientific Committee on Consumer Safety (SCCS) has identified and established 26 cosmetic ingredients that are likely contact allergens (potential to cause skin allergies) as demonstrated in clinical or epidemiological studies. The EU's SCCS have recommend cosmetic companies to disclose them on the labels if used and in cases where the concentration exceeds 0.001% in leave-on products and 0.01% in rinse-off products, then they must be labelled.
Look out for the tick on the EU-Allergen free label to know your cosmetic is free from any of the 26 identified cosmetic ingredients.
For more information regarding the EU's Scientific Committee on Consumer Safety, please visit their official website.
Disclaimer
The EU Allergen Free label is for the 26 ingredients identified by the EU SCCS and products will be only flagged if a suspected ingredient is on it's ingredient list. It is possible for cosmetics to contain one of the suspect ingredients without it appearing on the ingredient list due to it not reaching the concentration threshold to disclose it and cosmetic manufacturers choice to not disclose it.
Also note, the EU Allergen Free label is not personalized for your own allergies you may have and it does not constitute as medical advice. For your specific case, always consult your medical professiona such as dermatologist, physician, pharmacist, or health care provider - please read our medical disclaimer for more information.
Fungal Acne (Molassezia) Safe
Fungal Acne (Molassezia) Safe
Understanding Fungal Acne (Pityrosporum Folliculitis/Malassezia Folliculitis)
Pityrosporum Folliculitis/Malassezia folliculitis or simply known as Fungal Acne is a persistent acne-like condition that commonly responds poorly to traditional acne-treating methods. Unlike most cases of Acne where bacteria is the culprit, Fungi is the culprit of Fungal Acne (Hence the name!). There are certain classes & groups of ingredients that have been shown to promote and feed the growth of the Fungal Acne, Fungi such as fatty acids, oils, esters, polysorbates and fermented ingredients.
For more information regarding Fungal Acne, please visit Simple Skincare Science (f.c) - #3 of our Recommend Skincare Resources for an amazing comprehensive guide!
Please Read: How to use the Fungal Acne (Malassezia) Label
At SkinCarisma, we've done our best to identify as many ingredients as possible but note the fungal-free label may not be 100% accurate due to the complexconditions and combination of ingredients that malezzeria can thrive on.
Additionally, products that may contain ingredients that have shown to feed Malassezia may not neccessarily exacerbate the condition due to concentration of ingredient used in the product, this information is simply not available on the products.
As a result, please note this is only an experimental label that can be best used to possible identify problematic products you have used in the past. It is in no way a perfect identifier nor a predictor in whether or not it will exacerbate or cause fungal acne. It will continue to be worked on as more information and research comes to light.
If you find any ingredients you believe should be included, please email us at snails@skincarisma.com.
Disclaimer
Due to the lack of substantial research into this area it is very likely there are other ingredients and class/groups of ingredients that could feed Fungal Acne which have not been indentified.
The Fungal-Safe label does not constitute as medical advice. For your specific case, always consult your medical professiona such as dermatologist, physician, pharmacist, or health care provider - please read our medical disclaimer for more information.
What are Notable Effects & Ingredients?
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.
Pro Tip Alert!
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
Anti-Aging from 1 ingredient(s):
What are Ingredients Related to Skin Type?
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.
Pro Tip Alert!
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
Dry Skin
Oily/Acne-Prone Skin
Sensitive Skin
What is the Ingredient Safety Breakdown?
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.
Pro Tip Alert!
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
|
|
|
| 2 |
Disodium Laureth Sulfosuccinate
Cleansing, Foaming, Hydrotrope, Sufactant, Foam Boosting
|
|
|
| 0 |
Hc Red No. 3
|
|
|
| 0 |
Parfum
Masking, Perfuming
|
|
|
| 0 |
Hydrochloric Acid
Buffering
|
|