Reversal of androgenetic alopecia by topical ketoconzole: Relevance of anti-androgenic activity

I don't remember this study abstract before . . .

great post ! this is the first time that I read the full study. Very interesting

Totally agree. Great find Greece. Its the first time i have seen that as well. Some nice before/after pics as well.

What i found really interesting here is that one of the guys applied topical Keto DURING shampooing and still got great regowth !






Edited: 04/16/2007 at 01:37 AM by chrome

wow, those pictures are very impressive.

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Disclaimer - I am not a physician or an expert and my advice should not be considered medical/expert advice. - If you follow my opinions and/or advice you do so at your own risk.

After seeing this i think most will now be using topical 2% Keto asap.

The big question for Revita users is will the application of 5 times per week work just as well, or will the other ingredients in it "cancel" the Keto out to a certain degree...just like some hypothesise happens with Revivogen ?

Perhaps Revita 2-3 times per week and Topical 2% Keto lotion 2 - 3 times oer week could be a safer option for Revita users concerned that the ingredients may dsomehow hamper the Keto's effectiveness in Revita ??

Perhaps Revita may be the "killer" shampoo after all and may yet prove far superior to the 2% Keto lotion on its own ?

Maybe Tricomin shampoo along with 2% keto lotion afterwards may be pretty good as well, ie copper peptides AND keto ?

Either way, this is VERY interesting.

Edited: 04/16/2007 at 03:19 AM by chrome

Hair Loss Study Abstract: Ketoconazole shampoo: effect of long-term use in androgenic alopecia.

Authors
Pierard-Franchimont C. De Doncker P. Cauwenbergh G. Pierard GE.
Institution: Department of Dermatopathology, University of Liege, Belgium.
Title: Ketoconazole shampoo: effect of long-term use in androgenic alopecia.
Source: Dermatology. 196(4):474-7, 1998.

Abstract

BACKGROUND:The pathogenesis of androgenic alopecia is not fully understood. A microbial-driven inflammatory reaction abutting on the hair follicles might participate in the hair status anomaly.

OBJECTIVE: The aim of our study was to determine if ketoconazole (KCZ) which is active against the scalp microflora and shows some intrinsic anti-inflammatory activity might improve alopecia.

METHOD: The effect of 2% KCZ shampoo was compared to that of an unmedicated shampoo used in combination with or without 2% minoxidil therapy.

RESULTS: Hair density and size and proportion of anagen follicles were improved almost similarly by both KCZ and minoxidil regimens. The sebum casual level appeared to be decreased by KCZ.

CONCLUSION: Comparative data suggest that there may be a significant action of KCZ upon the course of androgenic alopecia and that Malassezia spp. may play a role in the inflammatory reaction. The clinical significance of the results awaits further controlled study in a larger group of subjects.


Here is the FULL study (4 page PDF)
Ketoconazole Shampoo: Effect of Long-Term Use in Androgenic Alopecia




Edited: 04/16/2007 at 02:19 AM by chrome

Topical application of ketoconazole (Nizoral) stimulates hair growth in C3H/HeN mice.
J Dermatol. 2005 Apr;32(4):243-7.
Jiang J, Tsuboi R, Kojima Y, Ogawa H.
Department of Dermatology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.


Ad: Propecia, Avodart, Spectral DNC and more at Hair2go.comBecause this study was in mice and not balding men, it shows that Ketoconazole (Nizoral) has a hair growth stimulant effect separate from its ability to block the actions of male hormones.
Ketoconazole (KCZ) is an imidazole anti-fungal agent that is also effective in topical applications for treating seborrheic dermatitis and dandruff. Recently, topical use of 2% KCZ shampoo has been reported to have had a clinically therapeutic effect on androgenetic alopecia. The present study was conducted with the purpose of quantitatively examining the stimulatory effect of KCZ on hair growth in a mouse model. Coat hairs on the dorsal skin of seven week-old male C3H/HeN mice were gently clipped, and either 2% KCZ solution in 95% ethanol or a vehicle solution was topically applied once daily for three weeks. The clipped area was photographed, and the ratio of re-grown coat area was then calculated. The results demonstrated that 2% KCZ had a macroscopically significant stimulatory effect compared with the vehicle group (p<0.01, n=10). Repeated experiments showed similar effects, confirming the efficacy of KCZ as a hair growth stimulant. Although the therapeutic mechanism of topical KCZ for hair growth is unclear, our results suggest that topical applications of the substance are useful for treating seborrheic dermatitis accompanied by hair regression or male pattern hair loss.

Ketocazole as an adjunct to finasteride in the treatment of androgenetic alopecia in men.

1: Med Hypotheses. 2004;62(1):112-5.

Dihydrotestosterone (DHT) binding to androgen receptors (AR) in hair follicles is commonly accepted as the first step leading to the miniaturizing of follicles associated with androgenetic alopecia (AGA). Testosterone is converted to DHT by the enzyme 5alpha-reductase. Finasateride a 5alpha-reducase inhibitor blocks the production of DHT and is currently used to treat AGA. The inhibition is not complete but a reduction of DHT systemically and in the scalp is accomplished. Ketoconazole has been clinically shown to be effective in the treatment of AGA. In this paper, evidence is presented to support the hypothesis that ketoconazole 2% shampoo has a local disruption of the DHT pathway. It is proposed that using ketoconazole 2% shampoo as an adjunct to finasteride treatment could lead to a more complete inhibition of DHT and thus better treat AGA.

1: J Dermatol. 2002 Aug;29(8):489-98.

Comparative efficacy of various treatment regimens for androgenetic alopecia in men.

Khandpur S, Suman M, Reddy BS.
Department of Dermatology and S.T.D., Maulana Azad Meical College and Associated Lok Nayak Hospital, New Delhi, India.

Our understanding of the aetiology of androgenetic alopecia (AGA) has substantially increased in recent years. As a result, several treatment modalities have been tried with promising results especially in early stages of AGA. However, as far as has been ascertained, there is no comprehensive study comparing the efficacy of these agents alone and in combination with each other.

One hundered male patients with AGA of Hamilton grades II to IV were enrolled in an open, randomized, parallel-group study, designed to evaluate and compare the efficacy of oral finasteride (1 mg per day), topical 2% minoxidil solution and topical 2% ketoconazole shampoo alone and in combination. They were randomized into four groups.

Group I (30 patients) was administered oral finasteride, Group II (36 patients) was given a combination of finasteride and topical minoxidil, Group III (24 patients) applied minoxidil alone and Group IV (10 patients) was administered finasteride with topical ketoconazole. Treatment efficacy was assessed on the basis of patient and physician assessment scores and global photographic review during the study period of one year.

At the end of one year, hair growth was observed in all the groups with best results recorded with a combination of finasteride and minoxidil (Group II) followed by groups IV, I and III. Subjects receiving finasteride alone or in combination with minoxidil or ketoconazole showed statistically significant improvement (p<0.05) over minoxidil only recipients. No signifcant side-effects related to the drugs were observed.

In conclusion, it is inferred that the therapeutic efficacy is enhanced by combining the two drugs acting on different aetiological aspects of AGA.

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.

Question ID:1999 | 2% Nizoral Cream | Asked on 09/09/01

B.E. asked: "I have an entire tube on 2% Nizoral Cream. What are your thoughts on rubbing this into receding and thinning areas of the scalp 2-3 times a week to inhibit DHT.Wouldn't it absorb better since it stays on and you don't rinse it out? Could this be done before appllying minoxidil? and would you continue to use Nizoral Shampoo if doing this? Any negatives about using this cream thanks"

Dr Richard Lee, MD answered: "Assuming you don’t have side effects from its use, there is no problem in using the 2% Nizoral (ketoconazole) Cream on your scalp to reduce the amount of DHT. There isn’t sufficient absorption of topical ketoconazole to cause any systemic side effects. Absorption is partially related to the amount of time that the lotion remains on the skin. I would suggest that you apply the Nizoral 2% Cream after you apply the topical minoxidil to avoid inhibiting the absorption of the minoxidil. If you continue to use Nizoral shampoo, apply topical minoxidil after you shampoo. The untoward side effects of topical Nizoral (ketoconazole) are restricted to the area(s) of application, including irritation, pruritis (itchiness), stinging, and dry skin."

I use nizoral cream mixed with some emu oil (to ease spreading) twice a week instead of topical spiro. As yo effect - well my hair is slowly moving in the right direction but then I have a fairly comprehensive regimen

Hi Chrome, do you need a script for 2% Keto? Are you buying it from a web site? Thank you in advance. beer

If only I knew how to make my own 2% keta... nizoral works so well for me but I want a cream. A non expensive one.

I have been saying this for Nearly 10 years, Nizoral is effective at slowing MPB. It is the only product i have used for that time period,i.e no minoxidil and no propecia. I have similar or better results than those people for the 1st few years, but as time passes MPB continues very slowly in me now. I started thinning at 16 now im 27.


See my post here in 2003 raving about my nizoral results:
http://www.hairlosshelp.com/forums/messageview.cfm?catid=10&threadid=19141&FTVAR_MSGDBTABLE=




Now see my recent post here where i am using a foam made by the makers of minoxidil foam that contains Ketocenazole. Non greasy and easy to apply.

http://www.hairlosshelp.com/forums/messageview.cfm?catid=10&threadid=64351&FTVAR_MSGDBTABLE=

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And now the reason why this products is better than the shampoo for dandruff and hopefully for MPB due to better absorption as per minoxidl foam.
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Efficacy of a new antidandruff thermophobic foam: a randomized, controlled, investigator-blinded trial vs. ketoconazole 2% scalp fluid

* G Quadri,
* W Cavallero &
* M Milani

*
Dermatology Service Savona, Milan, Italy

Correspondence: Dr Massimo Milani MD, Via A. Nota 18, Milan, Italy. E-mail: masmilan@hotmail.com
Keywords: dandruff, shampoo

Accepted for publication January 27, 2005
Summary


Background Ketoconazole (K), zinc pyrithione (ZP), and salicylic acid (SA) are compounds active in the treatment of dandruff. A thermophobic foam formulation containing K 1%, ZP 0.5%, and SA 2% is now available.

Study aim To compare the efficacy of thermo phobic foam with K 2% scalp fluid in the treatment of moderate to severe dandruff.

Patients and methods In a randomized, prospective, parallel-group, investigator-blinded, 4-week treatment trial, a total of 54 patients (mean age 43 ± 8 years) were enrolled. Foam (F group) (n = 37) or K 2% scalp fluid (SF group) (n = 17) was applied daily for 7 days and twice weekly for 3 weeks thereafter. Clinical assessment of the total dandruff severity score (TDSS) was performed at baseline, after 2 and 4 weeks. The TDSS was calculated using a four-grade quantitative score (0 = no dandruff; 3 = severe dandruff) dividing the scalp area into four zones and adding the single score for each area.

Results At baseline, TDSS was 7.1 ± 2 and 5.1 ± 1 in the F and SF groups, respectively. At the end of treatment period, beneficial effects were observed in both groups. The TDSS was reduced to 2.5 ± 1 in the F group and to 3.7 ± 1.2 in the SF group (mean difference in favor of F group: ?1.2; 95% CI: –0.57 to ?1.8) (P = 0.0003). A complete or nearly complete resolution of dandruff was observed in 24 out of 37 (64%: 95%CI: 48–77%) in the F group and in 7 out of 17 (41%: 95% CI: 21–64%) in the SF group (P = 0.06 between groups).

Conclusions This new antidandruff thermophobic foam has shown to be more effective than ketoconazole 2% scalp fluid in the treatment of severe dandruff.



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So people who nizoral has worked for already.... and haven't made or wont make any other changes for 6 months. Get on this products like i have and see if it does work better for hair loss than the shampoo.



p.s u can thank me in the end for doing all the snooping over the last few weeks and putting the mental links together ... if this product turns out as a winner

jk1,

Thanks for mentioning the KetoMousse. Quite interesting.

It DOES use Connetics Versafoam technology according to the manufacturers website (same as used for Rogaine Foam). In fact, it contains THREE different active ingredients : ketoconazole – salicylic acid – zinc pyrithione.

KetoMousse is manufactured by an Italian company called Mipharm. Website is:
http://www.mipharm.it/strategic_alliances.php

"Connetics (January 2004). The licensing agreement grants Mipharm commercial rights in Italy, Spain and Portugal for Ketomousse®, a thermophobic anti dandruff mousse in VersaFoam® technology, containing three important functional substances: ketoconazole – salicylic acid – zinc pyrithione, all of them endowed with an acknowledged profile of activity.This particular combination let the product exercise a complete anti dandruff action."


Ketomousse has a product page,in Italian, for anyomne that may care to translayte ?
http://www.mipharm.it/ketomousse.php


Edited: 04/16/2007 at 02:41 PM by chrome

SO to sum up, use the Nizoral 2% KCZlotion after washing your hair with your regular shampoo. It also says this was done in combination with using Fin. I am about to start using Fin, i will give it a try.

This was a LOTION though, not a shampoo. I have not seen a lotion available anywhere.

Where does one buy KetoMousse or the lotion from? Might as well added to things I put on my head.

See this thread for pictures and info

http://www.hairlosshelp.com/forums/messageview.cfm?catid=10&threadid=66789&FTVAR_MSGDBTABLE=


This is the prodcut and where you can buy it:
http://www.farmaciamontera.it/product_info.php?products_id=11163


The foam has proven to be less irritating than the gel/shampoo in these studies and based on the results and minoxidil foam studies it is very likely the foam procuct has better skin absorption.

So in every way this product is superior to the shampoo. i have been saying this is big news as the Big 3, no 3 item may have just got a lot better !! This prodcut may be a winner and its by chance thorugh plenty of net research that i have found it and been able to get a hold of it !! but we need more people to try it an post their results.


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Also i need some help with italian !! Does this product say you have to leave it in your hair at least 30 minutes before you can wash your hair? or can you leave it in and not wash it out at all ? As i have left in in my hair for 2 days with no adverse reactions.

i.e is it a leave in product or like the shampoo does it have to be washed out ?

MODALITA' DI IMPIEGO
Agitare la bombola prima dell'uso. Erogare la mousse tenendo la bombola capovolta. Distribuire in modo omogeneo sul cuoio capelluto asciutto una quantità di mousse del volume di un’arancia.
Massaggiare fino a completo assorbimento e tenere in loco per circa 30 minuti. Concludere il trattamento lavando i capelli con uno shampoo neutro delicato. Evitare il contatto con gli occhi, nel caso risciacquare con acqua.




SCHEMA DI TRATTAMENTO
Le modalità applicative variano in funzione dell'entità del fenomeno desquamativo, come indicato dalla tabella che segue:

Forfora lieve: 1 volta alla settimana per 1 mese, proseguire con il trattamento di mantenimento.
Forfora moderata: 2 volte alla settimana per 1 mese, proseguire con il trattamento di mantenimento.
Forfora abbondante: 1 volta al giorno per 7 giorni, poi 3 volte alla settimana per 1 mese, proseguire con il trattamento di mantenimento.
Trattamento di mantenimento: 1 volta ogni 2 settimane.

Solo per uso esterno