Ketoconazole Shampoo 2%
Ketoconazole Shampoo 2%
Product Description
Product overview
A clinical-strength antifungal shampoo by Padagis featuring 2% ketoconazole — the FDA-approved active ingredient that targets Malassezia yeast, the root cause of dandruff, seborrheic dermatitis, and tinea versicolor. This AB-rated generic to Nizoral® delivers prescription-level relief from flaking, scaling, itching, and scalp irritation in a red-orange aqueous formula proven to outperform placebo and rival selenium sulfide and zinc pyrithione in clinical trials.
Targets Malassezia Yeast
Ketoconazole impairs ergosterol synthesis — a vital component of fungal cell membranes — eliminating the yeast responsible for dandruff and seborrheic dermatitis.
Texture & feel
SENSORYTargets Malassezia Yeast
Ketoconazole impairs ergosterol synthesis — a vital component of fungal cell membranes — eliminating the yeast responsible for dandruff and seborrheic dermatitis.
Clinically Proven Efficacy
Multicenter trials show 88% excellent response rate in moderate-to-severe seborrheic dermatitis and 73-84% mycological clearing in tinea versicolor.
AB-Rated Generic Equivalent
Therapeutically equivalent to Nizoral® brand 2% shampoo, offering the same prescription-strength active at a more accessible price point.
Free From Common Irritants
No fragrance, parabens, lanolin, MCI/MI, balsam of Peru, or topical antibiotics. Recognized as 91% free of top 11 most common allergens.
Prevents Relapse
Used prophylactically once weekly, reduces seborrheic dermatitis relapse rates from 47% (placebo) to just 19% over 6 months.
Better Tolerated than SeS
Clinically shown to be significantly less irritating than 2.5% selenium sulfide shampoo, with no contact sensitization, phototoxicity, or photoallergy detected.
Safety & compatibility
SAFEFDA Pregnancy Category C — consult a doctor before use. Topical absorption is minimal (undetectable in plasma after months of use), but no controlled studies exist in pregnant women.
Ketoconazole is the gold-standard active for treating Malassezia overgrowth. No fatty acids, esters, or polysorbates that could feed the yeast.
Generally safe for chemically treated and color-processed hair, though label warns it may remove curl from permanently waved hair in rare cases.
May irritate mucous membranes of the eyes. If product enters eyes, rinse thoroughly with water.
Sodium Laureth Sulfate is included as a primary surfactant — can be drying for very dry scalps with extended use.
Ask a doctor before use in children under 12 years old. Not studied for pediatric pediatric scalp conditions outside medical supervision.
Ingredient breakdown
INGREDIENTSKetoconazole 2%Proven
The hero active — a broad-spectrum synthetic imidazole antifungal that inhibits ergosterol biosynthesis in fungal cell membranes, killing Malassezia (Pityrosporum) yeast responsible for dandruff, seborrheic dermatitis, and tinea versicolor.
- Clinical Trial: 88% excellent response rate in 575 patients with moderate-to-severe seborrheic dermatitis treated twice weekly for 2-4 weeks.
- Tinea Versicolor: 73-78% successful response with single-day or three-day regimens versus 5-11% placebo.
- Comparative: 73% improvement in dandruff severity score versus 67% for zinc pyrithione 1% at four weeks (p < 0.02).
- Bonus Effect: Studies suggest topical ketoconazole may complement minoxidil and finasteride for androgenetic alopecia.
Sodium Laureth Sulfate ~10-15%Promising
The primary anionic surfactant providing the cleansing action and lather. Helps lift sebum, scale, and yeast debris from the scalp so the active ketoconazole can reach the follicles effectively.
- Function: Removes oil, dead skin, and product buildup that feeds Malassezia yeast.
- Concentration: Used at standard shampoo levels — generally well-tolerated for twice-weekly use.
Disodium Laureth Sulfosuccinate ~3-5%Promising
A milder secondary surfactant that boosts foam quality while reducing the irritation potential of the primary sulfate. Adds creaminess to the lather and helps stabilize the formulation.
- Role: Co-surfactant that softens harsh anionic detergent action.
- Tolerance: Considered gentle enough for sensitive scalps in regulated concentrations.
Methyl Diethanolamine (Cocamide DEA) ~2-4%Promising
Listed as Coconut Fatty Acid Diethanolamide on the label — a coconut-derived foam booster and viscosity modifier that thickens the shampoo and creates rich, stable lather.
- Function: Thickens consistency and stabilizes foam structure.
- Trade-off: Less popular in modern formulations due to potential for trace nitrosamine formation; manufacturers often substitute cocamidopropyl betaine.
Water (Purified) ~70-80%Proven
The base solvent for the entire formulation. Purified water dissolves and disperses the ketoconazole and other ingredients, creating an aqueous suspension suitable for scalp application.
- Role: Universal solvent and the largest component of the formula.
- Quality: Pharmaceutical-grade purified water meets USP standards for topical preparations.
Laurdimonium Hydroxypropyl Hydrolyzed Collagen ~0.5-1%Promising
A quaternized hydrolyzed collagen that conditions the hair, reducing the harsh feel typical of medicated shampoos. Coats the hair shaft to improve detangling and manageability.
- Function: Cationic conditioner that binds to negatively-charged hair surface.
- Benefit: Helps offset drying potential of sulfates and antifungal active.
PEG-120 Methyl Glucose Dioleate ~0.5-1%Promising
A glucose-derived rheology modifier and emollient that thickens the shampoo and contributes a slight conditioning afterfeel. Considered safe in topical formulations with limited but reassuring research data.
- Role: Viscosity builder that gives the shampoo its body.
- Note: Limited research available, but considered safe to use in skincare products.
Sodium Chloride ~1-2%Proven
Common table salt — used here as a thickening agent to adjust the viscosity of the formula. A simple, well-tolerated cosmetic ingredient.
- Function: Thickens sulfate-based shampoos through ionic interaction.
Sodium Hydroxide & Hydrochloric Acid qsProven
The pH adjustment system — sodium hydroxide raises pH while hydrochloric acid lowers it. Used in trace amounts ("qs" = quantity sufficient) to maintain the optimal scalp-friendly pH range.
- Function: Buffers the formula to a stable, mildly acidic pH compatible with skin and hair.
Imidazolidinyl Urea (Imidurea) ~0.2-0.5%Promising
A formaldehyde-releasing preservative that prevents microbial contamination of the shampoo over its shelf life. Effective against bacteria, yeast, and mold in aqueous formulations.
- Function: Broad-spectrum antimicrobial preservation.
- Allergen Status: Recognized as a possible contact allergen in formaldehyde-sensitive individuals.
CI 16035 (FD&C Red No. 40) tracePromising
A synthetic red dye that gives the shampoo its signature red-orange color, allowing users to see coverage during application. FDA-approved for topical pharmaceutical and cosmetic use.
- Function: Aesthetic colorant only — no therapeutic role.
- Concentration: Used in trace quantities below any sensitivity thresholds.
12 ingredients
Active: Ketoconazole 2%. Inactive: Coconut Fatty Acid Diethanolamide (Methyl Diethanolamine), Disodium Laureth Sulfosuccinate, FD&C Red No. 40 (CI 16035), Hydrochloric Acid, Imidazolidinyl Urea (Imidurea), Laurdimonium Hydroxypropyl Hydrolyzed Collagen, PEG-120 Methyl Glucose Dioleate, Purified Water, Sodium Chloride, Sodium Hydroxide, Sodium Laureth Sulfate (Sodium Lauryl Ether Sulfate).
Where it fits in your routine
ROUTINEUse twice weekly for active treatment (up to 8 weeks), then once weekly or every other week for maintenance. On non-treatment days, use a gentle daily shampoo.
How to use
HOW TO USEWet Hair Thoroughly
Saturate scalp and hair with warm (not hot) water before applying the shampoo.
Apply & Lather
Dispense a small amount (about a teaspoon) into your palm and massage into the scalp, generating a generous lather. Focus on flake-prone or affected areas.
Leave On 3-5 Minutes
For maximum antifungal contact time, allow the lather to remain on the scalp for 3-5 minutes before rinsing. Set a timer if needed.
Rinse Thoroughly
Rinse with warm water until water runs completely clear. Repeat the application if directed by your doctor.
Frequency
Use every 3-4 days (twice weekly) for up to 8 weeks for active treatment of dandruff or seborrheic dermatitis. For tinea versicolor, follow your doctor's specific regimen (typically 1-3 day treatment).
Maintenance
Once symptoms clear, use once weekly or every other week as needed to prevent relapse. Always avoid eye contact.
Who is it for?
WHOPerfect for you if:
- You have moderate-to-severe dandruff that hasn't responded to OTC zinc pyrithione or salicylic acid
- You suffer from scalp seborrheic dermatitis with greasy yellow scales
- You have tinea versicolor (sun fungus) on the scalp, chest, or back
- You experience fungal acne (Malassezia folliculitis) on the scalp or hairline
- You want a fragrance-free, allergen-conscious antifungal cleanser
- You're looking for a more affordable AB-rated alternative to brand-name Nizoral® 2%
- You need a complement to minoxidil for androgenetic alopecia
Consider alternatives if:
- You're pregnant or breastfeeding (consult your doctor first)
- You have very dry, brittle, or chemically damaged hair (sulfates may worsen dryness)
- You have a known allergy to imidazole antifungals or formaldehyde-releasers
- You have permanently waved hair (rare reports of curl loss)
- You have a broken or inflamed scalp (consult a dermatologist first)
- You only have mild flaking — try OTC 1% ketoconazole or zinc pyrithione first
Skin type compatibility
SKIN TYPESIdeal — sulfates effectively cut through excess sebum that feeds Malassezia yeast, the root cause of dandruff.
Use sparingly. Sulfates may worsen dryness — pair with a deeply hydrating conditioner and limit to twice weekly.
Effective for mixed scalps with oily roots and drier ends — focus application on the scalp only.
Fragrance-free and 91% allergen-free per SkinSAFE. Patch test first if reactive to imidurea or sulfates.
The gold standard. Can be used as a body wash on chest, back, and hairline to combat Malassezia folliculitis.
First-line treatment — 88% excellent response in clinical trials with twice-weekly use over 2-4 weeks.
Results timeline
MONTHS 3-6 (MAINTENANCE)Immediate Itch Relief
Many users report reduced scalp itching within hours of the first wash, as the antifungal action begins reducing yeast load.
~60% noticedVisible Flake Reduction
Significant decrease in visible dandruff flakes and scalp scaling. Total dandruff score begins dropping in clinical measurements.
~75% noticedMajor Symptom Clearance
Erythema (redness) and burning subside. In clinical trials, 88% of seborrheic dermatitis patients showed excellent response by this point.
~88% noticedTinea Versicolor Clearing
Mycological clearing rates of 78-84% achieved for fungal skin patches. Discoloration begins to normalize as melanocyte function recovers.
~84% noticedRelapse Prevention
Once-weekly maintenance reduces relapse rates from 47% (untreated) to just 19%, keeping symptoms at bay long-term.
~81% relapse-freeRatings by platform
3K+ REVIEWSPros & cons
BALANCEDPraised
- Prescription-strength 2% concentration — twice the active of OTC Nizoral A-D
- Fast results: many feel relief from itch and flaking within the first 1-2 washes
- FDA AB-rated equivalent to Nizoral® brand at lower cost
- Fragrance-free formula suitable for sensitive scalps
- Excellent for hard-to-treat seborrheic dermatitis and tinea versicolor
- Works as a complementary treatment for hair thinning and androgenetic alopecia
- Twice-weekly application means one bottle lasts a long time
- 91% free of common allergens per Mayo Clinic SkinSAFE rating
Criticized
- Sulfate-based — may dry out hair, especially color-treated or chemically processed
- Red-orange color can stain towels, light fabrics, and grout if spilled
- 4 oz / 120 ml bottle is small for the price (compared to OTC alternatives)
- Contains imidurea (a formaldehyde-releaser) — a known allergen for some
- Rare reports of hair texture changes or curl loss in permanently waved hair
- Pregnancy Category C — not preferred during pregnancy
- May require pairing with a hydrating conditioner to offset dryness
- Not for use on broken or inflamed scalp without medical supervision
Budget-friendly alternatives (dupes)
DUPESSame active ingredient at half the strength (1% vs 2%). Available without a prescription. Great for mild-to-moderate dandruff but less potent for severe seborrheic dermatitis or tinea versicolor.
Generic store-brand ketoconazole 1% — the cheapest path to the active ingredient. Half the concentration but typically a much larger bottle (7-14 oz).
Different antifungal active but similar use case. Clinical trials show ketoconazole 2% is significantly less irritating than selenium sulfide 2.5% with comparable efficacy.
Pleasant scent and gentler on hair, but uses a different antifungal active. May be less effective for fungal-driven scalp conditions than ketoconazole.
Comparison with competitors
SIDE-BY-SIDESelsun Blue Maximum (Selenium Sulfide)
Head & Shoulders Clinical (Pyrithione Zinc)
Storage & shelf life
24 MONTHS24 months after opening when stored properly. Discard if color, odor, or consistency changes noticeably.
Store between 35°F and 86°F (2°C and 30°C). Protect from light and freezing. Keep tightly closed and away from children.
Standard plastic flip-top bottle, 4 fl oz (120 ml). NDC 45802-465-64.
Yes — under 100ml/3.4 oz for carry-on, the 120ml bottle slightly exceeds TSA limits but qualifies for checked luggage.
Frequently asked questions
FAQKetoconazole is FDA Pregnancy Category C, meaning animal studies showed adverse effects but adequate human studies are lacking. Importantly, plasma absorption from topical scalp application is undetectable even after months of use, so the systemic risk is theoretically minimal. However, both pregnant and breastfeeding individuals should consult their physician before use. For pregnancy-period dandruff, OTC zinc pyrithione (Head & Shoulders) is often preferred as a precaution.
Yes — and it's actually one of the gold-standardtreatments for fungal acne (Malassezia folliculitis). Ketoconazole directly kills the Malassezia yeast that causes fungal acne by disrupting its cell membrane synthesis. The formula contains no fatty acids, esters, or polysorbates that could feed the yeast. Many dermatologists recommend using it as a body wash on the chest, back, shoulders, and hairline (leave on 3-5 minutes before rinsing) to clear fungal acne breakouts.
Yes — there are no known interactions between topical ketoconazole shampoo and common skincare actives like retinol, vitamin C, AHAs, or BHAs. Since this is a wash-off scalp product (typically left on for 3-5 minutes then rinsed), systemic interaction is negligible. If you also use ketoconazole as a body wash for fungal acne, simply use it during the cleansing phase, then continue with your regular skincare routine.
It's best suited for oily and combination scalps with active fungal-driven conditions: moderate-to-severe dandruff, seborrheic dermatitis with greasy yellow scales, tinea versicolor (sun fungus), and fungal acne. Sensitive scalps generally tolerate it well thanks to the fragrance-free, allergen-conscious formula. Very dry or chemically damaged hair may find it overly drying — pair with a hydrating conditioner and use no more than twice weekly.
Most users report itch relief within the first 1-2 washes. Visible flake reduction typically occurs within 1-2 weeks. In clinical trials of moderate-to-severe seborrheic dermatitis, 88% of patients showed excellent response after 2-4 weeks of twice-weekly use. For tinea versicolor, mycological clearing rates of 78-84% were achieved with single-day or three-day treatment regimens. Pigment normalization in tinea versicolor patches may take longer (up to 3 months) as melanocytes recover.
Use it as your primary shampoo on treatment days (typically twice weekly). Wet hair thoroughly, apply a teaspoon-sized amount, lather generously, leave on for 3-5 minutes for maximum antifungal contact time, then rinse thoroughly. Follow with conditioner if desired (focus on lengths, not scalp). On non-treatment days, use a gentle, hydrating daily shampoo. After 8 weeks of active treatment, transition to once-weekly maintenance to prevent relapse.
It has a comedogenic rating of 1/5 — very low pore-clogging potential. In fact, ketoconazole is often recommendedagainst Malassezia-driven breakouts on the body, hairline, and back. Some users with congested skin report fewer breakouts after switching to ketoconazole shampoo because it eliminates yeast that contributes to fungal acne. The sulfate base does cleanse thoroughly, leaving no oily residue.
The shampoo has a Period After Opening (PAO) of approximately 24 months when stored at 35-86°F (2-30°C), protected from light and freezing. Since you'll only use it twice weekly (and a small amount per wash), one 4 oz bottle typically lasts 2-3 months. Discard the product if you notice any change in color, odor, or consistency, or if it has passed its printed expiration date.
Verdict: Padagis Ketoconazole Shampoo 2% delivers clinical-grade antifungal performance at a more accessible price than brand-name Nizoral®. As an AB-rated FDA generic, it offers identical therapeutic results — including 88% excellent response in seborrheic dermatitis and 78-84% mycological clearing in tinea versicolor. The fragrance-free, 91% allergen-free formula is well-tolerated for most scalps, though sulfate-driven cleansing can be drying for very dry or color-treated hair without a hydrating conditioner. The 4 oz bottle is on the smaller side for the price, but with twice-weekly use it lasts 2-3 months.Bottom line: if you've outgrown OTC zinc pyrithione or 1% ketoconazole, this is the gold-standard next step for stubborn dandruff, seborrheic dermatitis, tinea versicolor, and fungal acne.
Product Overview
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Quick Product Notes
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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.
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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
|
|
|
| 0 |
Methyl Diethanolamine
|
|
|
| 2 |
Disodium Laureth Sulfosuccinate
Cleansing, Foaming, Hydrotrope, Sufactant, Foam Boosting
|
|
|
| 0 |
CI 16035
Cosmetic Colorant
|
|
|
| 0 |
Hydrochloric Acid
Buffering
|
|





