An azole antifungal (mainly topical/shampoo in the UK)
Ketoconazole
An azole antifungal used in the UK mainly as a cream or shampoo for fungal skin conditions and dandruff.
What is Ketoconazole?
Ketoconazole is an azole antifungal used in the UK mainly as a cream or shampoo to treat fungal skin infections, dandruff and seborrhoeic dermatitis. It works by stopping fungi and yeasts from growing on the skin. Oral ketoconazole tablets are heavily restricted in the UK because of a risk of serious liver damage, so the cream and shampoo are the usual forms.
Education and reference only. This is a plain-language guide to Ketoconazole — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Ketoconazole is an antifungal medicine of the azole group. In the UK it is used mostly as a cream or medicated shampoo to treat fungal and yeast conditions of the skin and scalp, including ringworm-type infections, dandruff and seborrhoeic dermatitis (a flaky, itchy skin condition). The tablet form is now rarely used because of a recognised risk of serious liver damage, and is reserved for very limited specialist situations.
How it works
Ketoconazole works by damaging the cell membrane of fungi and yeasts. It blocks an enzyme they need to make a key building block of their cell membrane, so the membrane becomes leaky and the fungus cannot survive. Applied as a cream or shampoo, it acts directly on the affected skin or scalp with very little entering the rest of the body.
Company & origin
Originated / developed by: Originally developed by Janssen Pharmaceutica..
Ketoconazole is an azole antifungal first introduced in the 1980s. In the UK it is now used mainly as a cream or shampoo for fungal skin conditions and dandruff, because oral ketoconazole carries a risk of serious liver damage and is heavily restricted.
Practical use
How to take Ketoconazole
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- For the cream, apply a thin layer to the affected area and a little way around it, as directed.
- For the shampoo, apply it to wet hair, leave it on the scalp for the time stated, then rinse well.
- Use it regularly for the full treatment period, even if symptoms improve early.
- Avoid getting the cream or shampoo in your eyes; rinse with water if you do.
- If using it for dandruff, follow the recommended treatment then maintenance pattern on the label.
Weighing it up
Advantages & disadvantages of Ketoconazole
Advantages
- As a cream or shampoo it is effective and well tolerated for fungal skin and scalp conditions.
- Very little is absorbed into the body, so serious side effects are uncommon with topical use.
- The shampoo is a convenient, established treatment for dandruff and seborrhoeic dermatitis.
Disadvantages
- Oral ketoconazole carries a risk of serious liver damage and is heavily restricted.
- Topical treatment only works on the area it is applied to, not deeper infections.
- Conditions like dandruff and seborrhoeic dermatitis often need repeated or ongoing treatment.
Practical use
Good to know
When used as a cream or shampoo, ketoconazole is generally safe and well tolerated. With the shampoo, you usually apply it, leave it on the scalp for a short time as directed, and then rinse it off. An important safety point is that oral ketoconazole (tablets taken by mouth) can cause serious liver damage, which is why it is heavily restricted in the UK and only used in rare specialist situations. The cream and shampoo do not carry the same risk, as very little is absorbed.
Who should not take it / use with caution
- Anyone who has had an allergic reaction to ketoconazole or other azole antifungals.
- Oral ketoconazole must not be used by people with liver problems, and is restricted to rare specialist use.
- Use during pregnancy or breastfeeding should be discussed with a healthcare professional.
Monitoring
- No routine monitoring is needed for the cream or shampoo.
- Oral ketoconazole, in the rare cases it is used, needs liver monitoring under specialist care.
Side effects
- With the cream or shampoo: mild irritation, itching or redness where applied.
- Dryness or a change in hair texture with the shampoo in some people.
- With oral tablets: a risk of serious liver damage, which is why they are heavily restricted.
Key interactions
- Topical cream and shampoo have few interactions, as very little is absorbed.
- Oral ketoconazole interacts with many medicines and is rarely used; a specialist manages this.
- Tell your pharmacist about other scalp or skin products you are using.
Available as: cream and shampoo
Answers
Ketoconazole: frequently asked questions
What is ketoconazole used for in the UK?
It is used mainly as a cream or medicated shampoo to treat fungal skin infections, dandruff and seborrhoeic dermatitis.
How do I use the shampoo?
Apply it to wet hair, leave it on the scalp for the time stated on the label, then rinse it off well. Follow the recommended treatment and maintenance pattern.
Is ketoconazole safe?
The cream and shampoo are generally safe and well tolerated, as very little is absorbed. Oral ketoconazole tablets, however, can cause serious liver damage and are heavily restricted.
Why are the tablets restricted?
Oral ketoconazole carries a recognised risk of serious liver damage, so in the UK it is reserved for very limited specialist situations and rarely used.
Can I use it for dandruff?
Yes. The shampoo is an established treatment for dandruff and seborrhoeic dermatitis, often used for a treatment period and then less often to keep symptoms under control.
The wider class
About Azole antifungals
Ketoconazole belongs to the azole antifungals class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF
- NICE CKS
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