ketoconazale question for HairLossTalk.com..............

[harold]

I imagine the cream is not taken because it is not really a cosmetically acceptable solution for many to rub a cream into your hairy/partially hairy scalp. If your hair is buzzed short on the other hand it might not be a problem at all. Oral keto would certainly be a very effective treatment but I believe (the references escape me for the moment) it has more nasty sides (not antiandrogenic sides but liver problems and such) than something like spironolactone and many cannot tolerate it.
hh

Gynecol Endocrinol. 1996 Aug;10(4):249-55. Links
Comparison of four different treatment regimes in hirsutism related to polycystic ovary syndrome.

* Gokmen O,
* Senoz S,
* Gulekli B,
* Isik AZ.

Reproductive Endocrinology Department, Dr Zekai Tahir Burak Women's Hospital, Ankara, Turkey.

Polycystic ovary syndrome is the most common endocrinological problem associated with hirsutism. The objective of this study was to compare four different treatment modalities for hirsutism related to this syndrome. Pelvic ultrasonography was performed on all patients who were referred to our Reproductive Endocrinology Outpatient Clinic because of complaints of hirsutism. After exclusion of hyperandrogenism caused by endocrine abnormalities other than polycystic ovary syndrome, 141 patients were included in the study. Patients were divided into four groups in regard to the drug chosen for treatment. Group 1 (n = 48) received low-dose combined oral contraceptive. Group 2 (n = 65) was treated with cyproterone acetate 100 mg daily for the first 10 days of a 21-day cycle with an oral contraceptive containing 2 mg cyproterone acetate, Group 3 (n = 12) with spironolactone (100-200 mg daily) and Group 4 (n = 16) with ketoconazole (400 mg daily). All patients were followed frequently with respect to side-effects, hirsutism scoring, and lipid and hormonal levels. All four drug regimens were effective in the treatment of hirsutism related to polycystic ovary syndrome, but the most effective seemed to be ketoconazole. The decrement level in hirsutism scoring was the largest in the ketoconazole group, followed by the cyproterone, oral contraceptive and spironolactone groups (34.6 +/- 2.2%, 20.1 +/- 2.7%, 18.1 +/- 2.7% and 12.8 +/- 3.7%, respectively, p < 0.05). Although high-density lipoprotein-cholesterol levels increased in all groups, this increment was smaller in Group 4 than in Groups 1 and 2 (5.1 +/- 2.8%, 34.1 +/- 5.5% and 29.1 +/- 4.9%, respectively, p < 0.05), but not statistically different from that in Group 3 (22.3 +/- 5.9%). The free testosterone levels decreased after treatment in all groups, but the decrement ratios did not differ significantly among groups, although the decrease in free testosterone levels with treatment seemed to be higher in the ketoconazole group than in Groups 1, 2 and 3 (57.0 +/- 2.5%, 22.7 +/- 10.2%, 26.7 +/- 6.5% and 9.5 +/- 19.9%, respectively). In conclusion, ketoconazole seems to be an excellent alternative to more-recognized therapies, but its effect on lipoprotein profile requires further study, because the hyperandrogenism, and the other problems related to hyperandrogenism besides hirsutism, should also be treated.

 

[michael barry]

Thanks for posting that study harold. That is good info.............

 

[Stu85]

Here is the verbiage of the article:

Nizoral 1% Study Shows Benefits for Androgenetic Alopecia

March 04, 2001 - American Academy of Dermatology Meeting - Washington DC - Scientists working for McNeil, makers of Nizoral anti-dandruff shampoo, presented the findings of a study done on 1% Nizoral shampoo which has good news for hair loss sufferers. It has long been known that 2% prescription Nizoral has beneficial effects on Androgenic Alopecia (male pattern baldness). It however has been unclear whether the same benefits can be obtained by using the non-prescription 1% version.
In the study presented (see below), one hundred male volunteers with mild to moderate dandruff and somewhat oily scalp, were using, in a double-blind fashion, either a 1% Nizoral shampoo or a 1% zinc pyrithione shampoo, 2-3 times a week for 6 months.

Analysis of the different parameters set up in the study shows that the hair diameter gradually increased with Nizoral use (+8.46%) over a 6 month period, whereas the diameter showed a trend to decrease with zinc pyrithione use over the same period (-2.28%). The sebum excretion rate was reduced with Nizoral (-6.54%) while it increased with zinc pyrithione (+8.2%) over the same period of time. The number of hair shed over a 24-hour period was reduced by 16.46% with Nizoral and 6.02% with zinc pyrithione after 6 months. Finally, the percentage hairs in anagen phase increased by 6.4% and 8.4% respectively during the study time.

The results are similar to a previous study done on 2% prescription strength Nizoral where it was shown that use of 2% Nizoral yielded a 7% average increase in hair shaft diameter similar to what was achieved by the control group using 2% Minoxidil and a non-medicated shampoo.

So for any hair loss sufferer, this research clearly indicates that using 1% or 2% Nizoral 2-3 times per week, will have positive effects on hair growth as well as controlling dandruff. It is still unclear at this time whether it's the anti-fungal properties or the anti-androgenic properties of Ketokonazole (active ingredient in Nizoral) thats responsible for the hair thickening effects, however because of the decrease in sebum rates as well, it is the authors opinion that the results are due to the anti-androgenic properties of Ketokonazole.




Nizoral 1% Study
The effects of chronic use of 1% ketoconazole or a 1% zinc pyrithione shampoo on the general health of hair and scalp.

G. Piérard 1and G. Cauwenbergh2
1. Dept Dermatopathology, University of Liège, Belgium; 2. Skin research Center, Johnson &Johnson , Skillman, N.J., USA

Hundred male volunteers with mild to moderate dandruff and somewhat oily scalp, have used, in a double-blind fashion, a 1% ketoconazole shampoo or a 1% zinc pyrithione shampoo. The test shampoos were applied 2 to 3 times weekly for a total period of 6 months. Several parameters that affect the general health of hair and scalp were assessed at start, and after 1, 3 and 6 months. These parameters included the percent of hairs in anagen phase, the diameter of the hairs, sebum excretion rate at the hairline, and the number of hairs shed in the 24-hour period prior to each assessment. At the end of the study, the participants were asked to complete a questionnaire regarding the cosmetic acceptability of the test shampoos.

Forty-four ketoconazole users and forty-three zinc pyrithione users completed the 6 month study period. Analysis of the different parameters shows that the hair diameter gradually increases with chronic ketoconazole use (+8.46%) over a 6 month period, whereas the diameter shows a trend to decrease with zinc pyrithione use over the same period (-2.28%). The sebum excretion rate is reduced with ketoconazole (-6.54%) while it increases with zinc pyrithione (+8.2%) over the same period of time. The number of hair shed over a 24-hour period is reduced by 16.46% with ketoconazole and 6.02% with zinc pyrithione after 6 months. Finally, the percentage hairs in anagen phase increased by 6.4% and 8.4% respectively during the study time. Except for the percentage of hairs in anagen, which showed no difference between the two groups, all other parameters were significantly different in favor of the ketoconazole shampoo.

Both shampoos have been shown to be good anti-dandruff ingredients. Assessment of parameters than can affect the health of hair and scalp, suggests that both ingredients show distinct differences in the way they affect the scalp; indicating that ketoconazole increases hair diameter and reduces scalp oil, whereas zinc pyrithione seems to yield opposite effects. This suggests that, besides their effect on the lipophilic yeast Malassezia spp, ketoconazole and zinc pyrithione act though quite different mechanisms. An overall analysis of hair diameter changes as a function of changes in sebum excretion rate suggests that a reduction in scalp oiliness seems to result in an increased hair diameter. This suggests that, in people with oily hair, regular use of ketoconazole shampoo may result in overall hair fullness.

So hang on, does this mean that zinc pyrithione has a harmful effect on hair? Or that it doesn't do anything and so the problem gets worse? If it's the former I'd better stop using Head & Shoulders. Which shampoo is best used alongside Nizoral?

 

[Strat54]

Both Ketoconazole and Piroctone Olamine are better than Zinc pyrithione:

Document title
Nudging hair shedding by antidandruff shampoos. A comparison of 1% ketoconazole, 1% piroctone olamine and 1% zinc pyrithione formulations
Auteur(s) / Author(s)
PIERARD-FRANCHIMONT C. (1) ; COFFIN V. (1) ; HENRY F. (1) ; UHODA I. (1) ; BRAHAM C. (1) ; PIERARD G. E. (1) ;
Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)
(1) Department of Dermatopathology, University Medical Center Sart Tilman, 4000 Liège, BELGIQUE

Abstract
Hair shedding and hair thinning have been reported to be affected by dandruff and seborrhoeic dermatitis. The present study was conducted in 150 men presenting with telogen effluvium related to androgenic alopecia associated with dandruff. They were randomly allocated to three groups receiving each one of the three shampoos in the market containing either 1% ketoconazole (KTZ), 1% piroctone olamine (PTO) or 1% zinc pyrithione (ZPT). Shampoos had to be used 2-3 times a week for 6 months. Hair shedding during shampoo was evaluated semiquantitatively. Hair density on the vertex was evaluated on photographs using a Dermaphot. Trichograms were used for determining the anagen hair percentage and the mean proximal hair shaft diameter using computerized image analysis. The sebum excretion rate (SER, μg cm[-2] h[-1]) was also measured using a Sebumeter [R]. The three treatments cleared pruritus and dandruff rapidly At end point, hair density was unchanged, although hair shedding was decreased (KTZ: -17.3%, PTO: -16.5%, ZPT: -10.1%) and the anagen hair percentage was increased (KTZ: 4.9%, PTO: 7.9%, ZPT: 6.8%). 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%). In conclusion, telogen effluvium was controlled by KTZ, PTO and ZPTshampoos at 1% concentration. In addition, KTZ and PTO increased the mean hair shaft thickness while discretely decreasing the sebum output at the skin surface.
Journal Title
International journal of cosmetic science (Int. j. cosmet. sci.) ISSN 0142-5463 CODEN IJCMDW

A 1% Piroctone Olamine shampoo is hard to find, but you can find Nizoral 1% in any drugstore.
I use both just in case.

 

[powersam]

Im washing one wrist in Nizoral every third day in the shower, and waiting 2 minutes before rinsing it (same day I use the shampoo). I want to see how it affects hair growth there at three months. If it really reduces it.......I would feel awfully good about it.

I wish there had been more tests on ketoconazale shampoos.


Harm, thats whats frustrating about researching hair....................the lack of tests. Im sure Bryan would tell you that. If pubmed could be given 10 volunteers and 10 controls to test the top 20 baldness indications over a 2 year period in a professionally controlled manner, we'd know a hell of alot more than we do now.

Things I'd like to see tested formally.............prox-n, folligen, tricomin (beyond the one phase two study that was done), very high quality saw palmetto extract at about 400 mgs a day, oral and topical beta sitosterol solutions, ketoconazale, spironolactone formally on the human head, apple-poly's product, caffeine topically, fluridil, topical green tea, topical hops, topical thyme, topical curcumin

Now that I think of it..................an entire internal regimine consisting of internal green tea, internal cucumin, internal silica, internal grape seed extract, with high amounts of MSM and vitamin C just to see what nutrition alone can do.

But probably none of the above is ever going to happen.

you know what i'd like to see tested michael barry? dht inhibitor non-responders being treated with anti-fibrotic agents while still on the dht inhibitors. or maybe anti-fibrotics used on a castrate.