Topical ketoconazole for the treatment of androgenetic alopecia: A systematic review.
Level 3 - non-randomized controlled study
Systematic review of heterogeneous, predominantly non-randomized human and animal studies.
PubMed 31858672 · doi:10.1111/dth.13202
What was done
A systematic review evaluated the efficacy of topical ketoconazole for androgenetic alopecia (AGA). A search was conducted in the MEDLINE database using the terms "ketoconazole" and "alopecia." Forty-seven papers were screened, and seven articles were included in the qualitative synthesis: two animal studies (total 40 subjects) and five human studies (total 318 participants).
What was found
Murine studies showed a significant increase in the mean ratio of hair regrowth to denuded area in ketoconazole-treated groups compared to controls. Human studies reported increased hair shaft diameter, and one study reported a significant increase in pilary index (percent anagen phase × diameter). Improvements were also reported on photographic and subjective assessments. Specific numerical values, effect sizes, and p-values were not provided in the abstract.
Why it matters
Topical ketoconazole represents a potential adjunctive or alternative therapy for individuals with androgenetic alopecia who do not respond adequately to standard treatments such as minoxidil or finasteride.
Limits
The search was restricted to a single database (MEDLINE). The evidence base is small (318 total human participants across five studies) and heterogeneous, including animal models and non-randomized designs. High-quality randomized controlled trials are lacking.
Cited by
- supports Ketoconazole shampoo acts as a mild anti-androgen and 5-alpha reductase inhibitor with studies showing hair growth results comparable to 2% minoxidil.