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Nizoral for Seborrheic Dermatitis: A Research Summary

Seborrheic dermatitis is a common chronic inflammatory skin condition affecting areas like the scalp, face, and chest [1]. It can cause symptoms like flaking, scaling, redness, and itching [2]. While the exact cause is unknown, factors like yeast growth, sebum production, and immune system problems are involved [3].

Treatment focuses on managing signs and symptoms. Mild cases may respond to regular shampooing and topical antifungal creams or washes. Moderate to severe cases may need prescription medications.

Overview of Nizoral

Nizoral is a topical antifungal medication containing the active ingredient ketoconazole [4]. It works by preventing the growth of yeast and fungi. Nizoral comes as a shampoo, cream, gel, and other formulations [5].

Nizoral shampoo is commonly used to treat seborrheic dermatitis affecting the scalp. It has anti-inflammatory properties and can reduce scaling and flaking [6].

Research shows Nizoral can:

  • Decrease yeast growth associated with seborrheic dermatitis [7]
  • Reduce inflammation and skin cell turnover [8]
  • Improve symptoms like itching, flaking, and redness [9]

However, not all cases respond to Nizoral. Some yeasts have developed resistance [10]. Using Nizoral long-term may also cause decreased effectiveness over time.

[IMG: Graphic showing Nizoral shampoo bottle with flakes and redness on a scalp]

Research on Using Nizoral for Seborrheic Dermatitis

Multiple studies demonstrate Nizoral can improve seborrheic dermatitis symptoms:

  • In one trial, 88% of people had reduced scaling and 80% had less itching after 8 weeks of treatment [11]
  • Combining Nizoral with other antifungals like clotrimazole provided better clearance of symptoms compared to using just one medication [12]
  • Alternating Nizoral with selenium sulfide shampoo helped prevent decreased efficacy over time []

However, a few studies found other topical treatments worked better:

  • Betamethasone valerate 0.1% cream showed faster improvements in flaking and itching compared to 2% Nizoral cream [13]
  • For stubborn scalp plaques, injected triamcinolone provided more significant clearing after 2 weeks [14]

So while Nizoral is effective for some seborrheic dermatitis cases, other treatments may work better depending on the severity and location of symptoms.

Mode of Action

Nizoral fights seborrheic dermatitis in a few key ways:

Antifungal Effects

  • Inhibits growth and transition of yeasts like Malassezia to pathological fungal forms [15]
  • Damages yeast cell walls and internal structures leading to death [16]
  • Prevents formation of biofilms that resist topical treatment [17]

Anti-Inflammatory Effects

  • Reduces immune cell activation and inflammatory cytokine production [8]
  • Normalizes defective skin barrier function [18]
  • Decreases dandruff flaking by slowing skin cell turnover [8]

By targeting multiple pathways, Nizoral can disrupt the pathogenesis of seborrheic dermatitis. However, its effects may depend on the Nizoral formulation and severity of symptoms.

Safety and Side Effects

When used appropriately, Nizoral appears safe for most people. Potential side effects include [19]:

  • Skin irritation, stinging, or redness
  • Hair discoloration or texture changes
  • Headache or oily scalp (with leave-on formulations)

Rarely, abnormal liver function can occur [20]. Those with liver disease may require closer monitoring.

During pregnancy, checking with a doctor is advised before using Nizoral. While absorption is low with topicals, the risks are uncertain [Reddit:].

Real-World Perspectives

Real-world patient experiences with Nizoral are mixed:

  • “Nizoral worked incredibly at first, but seemed to lose effectiveness after 6 months. Adding in selenium sulfide shampoo helped regain control.” [Source – Reddit Thread]
  • “The itch and flakes from my seb derm were unbearable until I started using Nizoral twice a week.” [Source – Reddit Thread]
  • “Nizoral made my skin red, dry and irritated. It seemed to make my seb derm worse.” [Source – Reddit Thread]

So while Nizoral is an effective first-line treatment for many, individual experiences can vary. Combination therapy or alternative antifungals may be needed for others.

Common Themes

Many report fast improvements from using Nizoral shampoo or cream formulations. Leaving the product on for 3-5 minutes before rinsing allows sufficient contact time. Using several times a week prevents recurrence of flaking or redness.

However, consistency is key. Effects can diminish if people stop treatment too soon thinking the problem is cured. Similarly, long-term daily use of Nizoral may not be sustainable due to increased resistance or side effects.

Alternative Options

When Nizoral stops working or causes irritation, people have success alternating with other active ingredients like:


As a broad-spectrum antifungal, Nizoral can effectively treat seborrheic dermatitis caused by fungal overgrowth and inflammation. Both research and anecdotal reports support its use for reducing common symptoms like flaking, scaling, and itchiness.

However, individual response varies widely. Maintenance therapy with careful rotation of active ingredients may help sustain improvements long-term. Combination treatment with other anti-inflammatory or antifungal medications can also optimize treatment.

Working closely with a dermatologist to determine the best Nizoral formulation, frequency of use, and addition of other medications tailored to someone’s specific case offers the best chance of success managing troublesome seborrheic dermatitis.


  1. uaIlko Bakardzhiev "New Insights into the Etiopathogenesis of Seborrheic Dermatitis" Symbiosis Group 4.1 (2017): 1-5.
  2. Sean E. Mangion, Lorraine Mackenzie, Michael S. Roberts, Amy M. Holmes "Seborrheic dermatitis: topical therapeutics and formulation design" Elsevier BV 185 (2023): 148-164.
  3. R. Tao "799 Malassezia modulates the skin lipid barrier in seborrheic dermatitis" Elsevier BV 143.5 (2023): S137.
  4. Aditya K. Gupta, Danika C.A. Lyons "The Rise and Fall of Oral Ketoconazole" SAGE Publications 19.4 (2015): 352-357.
  5. Sb Shirsand, Ms Para, D Nagendrakumar, Km Kanani, D Keerthy "Formulation and evaluation of Ketoconazole niosomal gel drug delivery system." International journal of pharmaceutical investigation 2.4 (2013): 201-7. PubMed
  6. Zoe D. Draelos, Seth B. Forman, Lawrence J. Green "33460 Roflumilast foam 0.3% treatment of seborrheic dermatitis is effective and safe and improves patient quality of life: Results from a phase 2 study" Elsevier BV 87.3 (2022): AB105.
  7. Minji Park, Yong-Joon Cho, Yang Won Lee, Won Hee Jung "Genomic Multiplication and Drug Efflux Influence Ketoconazole Resistance in Malassezia restricta" Frontiers Media SA 10 (2020).
  8. P H Jacobs, L Nall "The action and safety of ketoconazole: a brief literature review." Cutis 42.4 (1989): 276-82. PubMed
  9. Luis J. Borda, Marina Perper, Jonette E. Keri "Treatment of seborrheic dermatitis: a comprehensive review" Informa UK Limited 30.2 (2018): 158-169.
  10. Bo-Young Hsieh, Wei-Hsun Chao, Yi-Jing Xue, Jyh-Mirn Lai "A Ketoconazole Susceptibility Test for Malassezia pachydermatis Using Modified Leeming–Notman Agar" MDPI AG 4.4 (2018): 126.
  11. J. Mark Jackson, Andrew Alexis, Matthew Zirwas, Susan Taylor "Unmet needs for patients with seborrheic dermatitis" Elsevier BV (2022).
  12. R P Balwada, V K Jain, S Dayal "A double-blind comparison of 2% ketoconazole and 1% clotrimazole in the treatment of pityriasis versicolor." Indian journal of dermatology, venereology and leprology 62.5 (2012): 298-300. PubMed
  13. Muhammad Rizwan, Amanat Ali, Najia Ahmad, Moizza Tahir "Topical Betamethasone Valerate 0.1% W/V vs. Topical Ketoconazole 2% W/V: A Comparison of Efficacy in Patients of Seborrheic Dermatitis" Army Medical College 72.3 (2022): 1082-85.
  14. Fatemeh Jamali, Danyal Daneshdoust "Evaluation of the effectiveness of triamcinolone solution diluted with normal saline for the treatment of seborrheic dermatitis" Medknow 11.12 (2023): 7814.
  15. Sirida Youngchim, Joshua D. Nosanchuk, Siriporn Chongkae, Nongnuch Vanittanokom "Ketoconazole inhibits Malassezia furfur morphogenesis in vitro under filamentation optimized conditions" Springer Science and Business Media LLC 309.1 (2016): 47-53.
  16. Javier Esteban Mussin, Marueda Virginia Rolduen, Florencia Rojas, Marueda de los ucngeles Sosa, Nora Pellegri, Gustavo Giusiano "Antifungal activity of silver nanoparticles in combination with ketoconazole against Malassezia furfur" Springer Science and Business Media LLC 9.1 (2019).
  17. J Faergemann, J Ausma, M Borgers "In Vitro Activity of R126638 and Ketoconazole Against Malassezia Species" Medical Journals Sweden AB 86.4 (2006): 312-315.
  18. Qian An, Meng Sun, Rui-Qun Qi, Li Zhang, Jin-Long Zhai, Yu-Xiao Hong, Bing Song, Hong-Duo Chen, Xing-Hua Gao "High Staphylococcus epidermidis Colonization and Impaired Permeability Barrier in Facial Seborrheic Dermatitis" Ovid Technologies (Wolters Kluwer Health) 130.14 (2017): 1662-1669.
  19. Mohhammad Ramzan, Gurpreet Kaur, Sonia Trehan, Javed N. Agrewala, Bozena B. Michniak-Kohn, Afzal Hussain, Wael A. Mahdi, Jaspreet Singh Gulati, Indu Pal Kaur "Mechanistic evaluations of ketoconazole lipidic nanoparticles for improved efficacy, enhanced topical penetration, cellular uptake (L929 and J774A.1), and safety assessment: In vitro and in vivo studies" Elsevier BV 65 (2021): 102743.
  20. Khalifa E. Sharquie, Adil A. Noaimi, Wasnaa S. Al-Salam "The Safety of Oral Ketoconazole in the Treatment of Skin Diseases (Single Blinded, Therapeutic, Comparative Study)" Scientific Research Publishing, Inc. 08.04 (2018): 264-271.
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About Michael Anders

After being affected by seborrheic dermatitis, I have made it my goal to gather and organize all the information that has helped me in my journey.

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