As a physician who treats everything from acne to dandruff and fungal infections in my practice, I often get questions about ketoconazole shampoo. It’s such an underrated and powerful antifungal but people aren’t always sure how to use it safely and effectively.

Here are answers to the most common questions I get—straight from the exam room to your screen. Let's go through it together.

1. Can I use ketoconazole shampoo on my face?

Yes, in many cases you can—but with care.

Ketoconazole shampoo is sometimes prescribed for facial fungal infections like seborrheic dermatitis. I’ve had patients who struggled for months with dry, irritated skin only to find relief after using ketoconazole on their face a few times a week.

2. How do I use ketoconazole shampoo?

Wet your scalp or affected area, apply a small amount, and lather it in. Let it sit for at least 3–5 minutes before rinsing. A very key and crucial part that many people do not discuss is really making sure thee shampoo gets to the root of your hair and scalp. I like to use a scalp scrubber for this. 

Think of it like a mini-treatment, not just a quick rinse. I tell my patients to set a timer or sing a song (I had one guy use the “Jeopardy” theme) so they remember to leave it on long enough.

3. How often should I use it?

For my patients with dandruff or seborrheic dermatitis I recommend 2 to 3 times a week. Once symptoms improve, you can taper to once a week for maintenance.

I had one patient who used it daily because “more is better,” but she ended up with dry, irritated skin. More isn’t always better—stick with the plan. Which leads to my next question...

5. Can I use ketoconazole shampoo daily?

I do not recommend this for dandruff. Daily use will lead to over dryness and irritation. There are certain conditions where it could be advised like fungal folliculitis. Again, discuss that with your primary care physician. 

6. Does ketoconazole shampoo cause hair loss?

No—in fact ketoconazole has shown to help with hair loss. Read about that here.

In rare cases, patients may notice some shedding, especially early on. This is often due to underlying inflammation or fungal overgrowth, not the shampoo itself. When the scalp calms down, so does the shedding.

One patient came in panicked after a week of use. But after switching to every-other-day use and adding a gentle conditioner, the hair stabilized—and her scalp stopped itching too.

7. How long does it take for ketoconazole shampoo to work?

Most patients start to notice improvement in 1 to 2 weeks. In my clinic, I tell people to give it 4 weeks to really assess results. Don’t quit too soon—fungal issues can be stubborn.

8. What’s the difference between 1% and 2% ketoconazole?

• 1% is the over-the-counter strength (e.g., dandRX and Nizoral shampoo).

• 2% is prescription strength and more effective for moderate to severe cases.

Most, if not all patients with dandruff will do great with 1%. But someone with seborrheic dermatitis flaring around the ears and scalp often needs the 2%.

9. Is ketoconazole shampoo safe in pregnancy?

Generally, yes—but always talk to your OB first. This blog post is not your medical recommendation to do so.

It’s minimally absorbed through the skin, especially when used as shampoo. I’ve had OB-GYNs give the green light when used topically 2–3 times a week. But again, always get your provider’s approval.

10. Can I leave ketoconazole shampoo on overnight?

No. That’s way too long. Ketoconazole is meant to stay on for 3–5 minutes, not hours. Leaving it on overnight can cause irritation, dryness, or even a rash.

11. Can I use ketoconazole shampoo on my beard?

Yes—especially if you're dealing with beard dandruff or fungal folliculitis. Discussed here.

It works similarly to how it does on the scalp. I tell guys to lather a small amount into the beard, leave it for 3–5 minutes, rinse, then moisturize. Avoid the lips and mouth area.

12. Can I use ketoconazole shampoo after a hair transplant?

Yes—but only after the scalp has healed, and with your surgeon’s okay.

Most hair transplant specialists recommend waiting 7–10 days post-op before using any medicated shampoos. Once cleared, ketoconazole can help reduce inflammation and prevent fungal overgrowth on the healing scalp.

If you’ve got more questions, feel free to contact us through the contact us page. And again as always discuss with your primary care provider as this blog post does not serve as medical advice.