Is my Nizoral regimen reasonable?

[ajbrah]

EOD or every third day I lather 1/2 teaspoon of 1% Nizoral with 8 drops of jojoba oil and leave it in my hair for 5 minutes before washing it out.
Any suggestions? I'm using the jojoba oil to keep my scalp healthy, counteract *SLS dryness, and to try to increase keto penetration, but I'm worried it may actually hurt my scalp because it prevents the SFS from being fully rinsed away.
Thanks!

 

[wilson2]

Have you considered RegenePure. That way you could put in your hair everyday?

 

[Captain Hook]

A lot of misinformation going on in this thread. Firstly there is no such thing as "SFS" it's SLS or sodium laureth sulphate, which isn't as inflammatory as the scaremongering would like you to believe. Granted there are individuals who are sensitive to it, if that's the case, use a low-sulphate shampoo.

http://www.ncbi.nlm.nih.gov/pubmed/9669136

Why not try Nizoral 2%? This is the famous study that shows it regrows as much hair when used twice weekly as 2% minoxidil used twice daily. Some people complain that 2% Nizoral makes their scalp dry but you can easily ameliorate that with a moisturising shampoo left on for 2-3 minutes after shampooing.

I'd stay away from RegenePure DR if you can (unless you're really sensitive to sulphates and you absolutely must use it). Reason being is that there is no standardised amount of ketoconazole in it, sure they claim 1% but as it is not a pharmaceutical grade product it could very well be less than that since there is no regulatory body like US Pharmacopeia or British Pharmacopeia assessing the product so you have no idea as to the actual concentration of ketoconazole.

Also, there's no need to use jojoba oil to increase the penetration of ketoconazole (if it even does this at all). Ketoconazole has a very high protein binding affinity (read: binds to keratin in hair and scalp) and is present in the epidermal layers in therapeutic concentrations for anywhere from 4-10 days so any attempt to increase penetration is unnecessary. Look at the study, they just simply used the 2% shampoo, that's it.

(Reference: Following a single application of ketoconazole shampoo, ketoconazole persists at therapeutic concentrations for 7 days in the epidermal layers. In addition, substantial pityrosporal inhibitory doses of ketoconazole were detected on the hair for several days after use of the shampoo, the mean level at 72 h was 11.6 µ mg. Reference: Pierard GE, Arrese JE, Pierard-Franchimont C, et al: Prolonged effects of antidandruff shampoos-time to recurrence of Malassezia ovalis colonization of skin. International Journal of Cosmetic Science. 1997;19:111-117.)

 

[ajbrah]

My mistake. Not sure why I called it SFS, but I am slightly wary of it since I seem to shed more when I use most SLS shampoos - and I'm ok with spending $30 on my preferred SLS-free shampoo since it makes me look good every day.
I recall references to a study showing that the 1% worked just as well as the 2% but that could be wrong - I only bought the 1% because it was all I could find at the time; I'm still not sure about the best way to obtain the 2% bui I'll keep looking. Good advice on moisturizing and great study. I had no idea it binds to your hair for so long. Thanks!

 

[Captain Hook]

My mistake. Not sure why I called it SFS, but I am slightly wary of it since I seem to shed more when I use most SLS shampoos - and I'm ok with spending $30 on my preferred SLS-free shampoo since it makes me look good every day.
I recall references to a study showing that the 1% worked just as well as the 2% but that could be wrong - I only bought the 1% because it was all I could find at the time; I'm still not sure about the best way to obtain the 2% bui I'll keep looking. Good advice on moisturizing and great study. I had no idea it binds to your hair for so long. Thanks!

To the best of my knowledge the only studies done on 1% ketoconazole shampoos were these ones

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3262531/

http://www.ncbi.nlm.nih.gov/pubmed/18498517

With the former study even stating "the 1% and 2% dosages of ketoconazole shampoo have hair loss benefits; however, the more potent 2% formulation likely produces better results."

I have no doubts that 1% Nizoral is effective it's just since the 2% formulation is easily available (yes, even in the states, my brother lives in Florida and he has no problem either getting a prescription from his dermatologist or ordering it online from a Canadian pharmacy) why wouldn't you want to use the more effective concentration?

Think of it this way, minoxidil is available in 2% and 5% concentrations. How many people here do you see using 2% minoxidil or saying that it's as effective as 5% minoxidil? Puts things into perspective eh?

I honestly think the only reason people recommend 1% Nizoral on this site is because it is an American hair loss forum and since 2% ketoconazole shampoos are prescription only in the US, people like to delude themselves and others into thinking that the 1% concentration is just as effective as the 2% and the only reason being is laziness. If people are going to their dermatologists and getting prescriptions for finasteride they can just as easily ask for a prescription for 2% ketoconazole shampoo. Same goes for those who simply order finasteride online, order some 2% Nizoral along with it.

That being said if you know of a study that concludes 1% ketoconazole is as effective as 2% then I stand corrected.

 

[ajbrah]

^Makes a lot of sense. You were right on the money about buying 1% out of laziness - I really should have tried a little harder to get the 2%. I think I settled on the 1% partly from reading the suggestions of fellow lazy people on this forum haha.
Super helpful studies!

 

[Oriol]

Do you guys really need a prescription to buy 2% Nizoral in US? That doesnt make sense.

Here we just ask for it, its like asking for any other normal shampoo in the pharmacy.

 

[wilson2]

I only recommended RegenePure because I figured he wanted some sort of Ketoconozole shampoo in his hair everyday (i'm not sure I assumed that as he didn't say this in the question lol) and to my knowledge using nizoral 1 or 2 % every day would be pretty harsh on your hair.

 

[Captain Hook]

@Captain Hook:

Do you think that the original Nizoral (2 %) formula is superior to the various 2 % generics (galenics etc.)?

I currently use a generic called "Ketozolin 2%", it contains 2 % ketoconazole, and the inactive ingredients are also mainly identical to the original Nizoral formula, but the generic is fragrance-free (I think this is a bonus, because I use the product "off-label", i.e. every other day and I leave it on for 15 minutes before I rinse it off). My scalp ist just fine.

Absolutely not. If it's a pharmaceutical grade preparation of 2% ketoconazole shampoo, I'm certain it will be equal to 2% Nizoral. The only differences may be the type of detergents and like you said, fragrances, which are more personal preferences. The medication itself will work to the same calibre.

I only recommended RegenePure because I figured he wanted some sort of Ketoconozole shampoo in his hair everyday (i'm not sure I assumed that as he didn't say this in the question lol) and to my knowledge using nizoral 1 or 2 % every day would be pretty harsh on your hair.

If you read my previous posts, you'd see that using any ketoconazole shampoo every day is unnecessary and a waste of shampoo, not to mention RegenePure DR isn't regulated by any Pharmacopeia and hence could contain only a negligible amount of ketoconazole while still having a price tag much higher than Nizoral and generics. Refer to the above studies that state that ketoconazole persists at therapeutic concentrations in the epidermal layers in the scalp for anywhere from 4-10 days. Go read "Kucer's The Use of Antibiotics" if you'd like further evidence.

 

[Captain Hook]

Thanks for explaining that. I don't have access to Nizoral in my country but we have 2% Ketoconazole shampoo called Mycoseb. Here are the ingredients google translated:


What drug containing Mycoseb ?The active substance :The active ingredient is ketoconazole . One gram of shampoo contains 20 mg of ketoconazole .The other ingredients are :Sodium laureth 27% ; disodium lauretsulfosukcinat 40% ; Cocamide DEA 80.5 % ; PEG-20 glicerillaurat ; lauryl dimonijum hydroxypropyl hydrolysed collagen of 35% ; Blue Edition , Dragočaj 0256194 ; sodium methyl parahydroxybenzoate ; hydrochloric acid, concentrated ; sodium sulfite anhydrous ; sodium citrate , pentaseskvihidrat ; color Erythrosine E127 C.I. 45430 ; Purified water .

Looks similar to most ketoconazole shampoo ingredients, it'll definitely suffice.

 

[TransientHair]

I wouldn't rely solely on Ketoconazole to treat Androgenetic Alopecia unless you have a very mild case.

 

[Rudolphus]

I wouldn't rely solely on Ketoconazole to treat Androgenetic Alopecia unless you have a very mild case.

I agree, but I'd also say that even in very mild cases, you should still use finasteride. Topical keto is far less proven than either finasteride or minoxidil, and it is very unlikely that it will successfully halt male pattern baldness, severe or mild, if used as a stand-alone treatment. The best that topical keto might do is slow it down a little, but even that is questionable. It looks like the OP of this thread is also using generic finasteride though, at least according to his signature.

 

[shyyguy123]

That being said if you know of a study that concludes 1% ketoconazole is as effective as 2% then I stand corrected.

http://www.hairlosshelp.com/html/nizoral1study.cfm

That study actually shows 1% being slightly MORE effective than 2%.

I seriously doubt there's going to be a huge difference between 1 and 2%. All the studies we have available show them being similarly effective.

 

[Captain Hook]

http://www.hairlosshelp.com/html/nizoral1study.cfm

That study actually shows 1% being slightly MORE effective than 2%.

I seriously doubt there's going to be a huge difference between 1 and 2%. All the studies we have available show them being similarly effective.

That site contains misconstrued information from the actual PubMed study, for some reason it quotes 8.46% increase in hair shaft diameter for 1% Nizoral when that is in fact not the figure quoted in the study: http://www.ncbi.nlm.nih.gov/pubmed/18498517

"The effect on the mean hair shaft diameter was contrasted between the three groups of volunteers (KTZ: 5.4%, PTO: 7.7%, ZPT: -2.2%)." So that's 5.4% increase for 1% ketoconazole compared to the 7% increase for 2% ketoconazole.

This makes sense, why would a lower concentration be more effective? The only treatment where I can see that being viable is for drugs that follow a hormesis dose response curve like selenium, where too much ceases to cause beneficial effects and too little results in a deficiency. Sites like that pander incorrect information so as to validate the laziness of those in the US who cannot get 2% Nizoral OTC, but is it really that hard to get a prescription or order it online since that's what most people do to acquire finasteride, no?

While this isn't significantly more effective, but is it relevant? Absolutely. The point still stands: why wouldn't you want to use a slightly more effective concentration?

Also I posted this before, I'll post it again: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3262531/

" the 1% and 2% dosages of ketoconazole shampoo have hair loss benefits; however, the more potent 2% formulation likely produces better results."

Oh and Paul, thanks for the correction, even still, 2-4x a week of 2% Nizoral usage producing results similar to 1x daily 2% minoxidil usage is impressive nonetheless.

 

[shyyguy123]

That site contains misconstrued information from the actual PubMed study,

Lol? They're clearly different studies man. All the numbers are different, not just hair shaft diameter. The date is different. Piroctone Olamine was not included. I'm not sure why you think they're the same study?

In this study 1% was simply more effective than similar 2% studies.

 

[Captain Hook]

Lol? They're clearly different studies man. All the numbers are different, not just hair shaft diameter. The date is different. Piroctone Olamine was not included. I'm not sure why you think they're the same study?

In this study 1% was simply more effective than similar 2% studies.

Haha! They've clearly fooled you, I could find no such study on any database like PubMed, from searching the title and authors. Google it yourself if you don't believe me.

Unless you can find the full text or even the abstract itself on a library of medicine or medical journal database (and if you can, please do, I'll stand corrected), then HairLossHelp simply posted fabricated information in the hopes of persuading people like you that 1% ketoconazole is more effective than 2%. It's sad really, the hair loss industry has enough charlatans and you'd think people wouldn't go as far as to post fraudulent clinical studies.

 

[shyyguy123]

They fabricated a small independent Nizoral study just to fool us into thinking 1% is more effective lol??

Can't tell if serious...

Anyway I certainly don't think 1% is more effective than 2%. I just don't think there's much of a difference from 1 to 2%.

The sad truth is that 99.9% of people using Nizoral for hair loss will never actually know how effective it is for them. That's because anyone who's actually using Nizoral specifically for hair loss is also taking either finasteride or minoxidil (or both). So any hair gains will always be attributed to them. And this is why you see countless people on these forums suggesting that Nizoral does nothing for hair loss, despite at least 4-5 studies out there all showing that it does.

 

[Captain Hook]

They fabricated a small independent Nizoral study just to fool us into thinking 1% is more effective lol??

Can't tell if serious...

Anyway I certainly don't think 1% is more effective than 2%. I just don't think there's much of a difference from 1 to 2%.

The sad truth is that 99.9% of people using Nizoral for hair loss will never actually know how effective it is for them. That's because anyone who's actually using Nizoral specifically for hair loss is also taking either finasteride or minoxidil (or both). So any hair gains will always be attributed to them. And this is why you see countless people on these forums suggesting that Nizoral does nothing for hair loss, despite at least 4-5 studies out there all showing that it does.

Why is that so difficult for you to believe? Most (if not all) studies can be found on PubMed or other medical journal databases, if there is no archive anywhere, how can you be certain the study actually exists? I could take some random authors from other studies, make up some results, piece together a 'study' and spread it around various hair loss forums (the only place I've seen your "study" when I googled it). The studies that are actually posted on PubMed that I mentioned earlier in this thread all point to 2% Nizoral's superiority over the 1% formulation, again, if you can find an archived study refuting this, please come forward with it. It's obvious that the studies that are actually archived on PubMed are going to be the more credible ones.

You're absolutely right about the latter part though, many of us will have no idea if Nizoral is helping us or not regardless of the concentration we use. That being said, many of us, myself included, also concomitantly suffer from seborrhoeic dermatitis and hence have to use Nizoral or another antifungal shampoo regardless of our Androgenetic Alopecia, most of us figure it makes sense to use the one that has some evidence behind it showing that it does indeed help Androgenetic Alopecia.

I'm certain there must be a few users who have mild Androgenetic Alopecia and solely use a ketoconazole shampoo, perhaps they can come forward with their results.