Key Points
- Pyrithione zinc is a broad-spectrum antimicrobial, so it can be effective against both bacteria and fungi, while ketoconazole is an antifungal.
- Pyrithione zinc is considered to be milder and better tolerated as compared to ketoconazole.
- Ketoconazole may be more effective than pyrithione zinc in managing skin conditions like dandruff and seborrheic dermatitis.
Dandruff and seborrheic dermatitis are chronic conditions with no permanent cure. However, dandruff shampoos can play an important role in managing these skin conditions.
Pyrithione zinc and ketoconazole are commonly found ingredients in anti-dandruff shampoos. But how do they differ and which among these is more effective?
What is pyrithione zinc?
Pyrithione zinc is a broad-spectrum antimicrobial. It can prevent the growth of fungi and bacteria.
It has been used for many years for dandruff and seborrheic dermatitis. Malassezia, a fungus, is an associated factor in both these skin conditions.
Pyrithione zinc can prevent the growth of Malassezia by interfering with the utilization of nutrients. This can decrease the burden of Malassezia improving these chronic skin conditions.
It may also play a role in skin barrier restoration. Although the evidence is very little, it may help with hair growth.
Side effects
Pyrithione zinc is usually well tolerated. In some people, it can lead to burning, irritation, blistering, or rarely allergic contact dermatitis.
Concentration used
Pyrithione zinc is available over the counter in the following concentrations:
- A concentration of 0.3 to 2 percent in wash-off products.
- A concentration of 0.1 to 0.25 percent in leave-on products.
What is ketoconazole?
Ketoconazole is an azole antifungal agent. It can interfere with the synthesis of lanosterol and can alter the fungal membrane, which can inhibit the growth of fungus.
It is commonly used in the form of shampoo, cream, or gel. It is well known by the brand name – Nizoral.
It is beneficial for fungal infections like ringworm, and tinea versicolor, and skin conditions associated with fungi like dandruff and seborrheic dermatitis. It can also decrease inflammation, which may benefit the skin.
It can also be useful for male pattern baldness aka androgenic alopecia. It can inhibit the enzyme which converts testosterone to dihydrotestosterone (DHT). Dihydrotestosterone is the one behind hair loss.
Side effects
In a few cases, it can lead to redness, burning, irritation, and dryness of hair.
Concentration used
- 1% ketoconazole is available in over-the-counter shampoo.
- 2% ketoconazole shampoo or other topical forms are available only by prescription in the US.
Differences
Both ketoconazole and pyrithione zinc have antifungal properties. They can also benefit the skin by decreasing inflammation or restoring the skin barrier.
In addition, both can help with hair loss or growth. Although, ketoconazole has more evidence to support it.
These ingredients have been directly compared in a few studies in the literature.
A 2002 study compared 2% ketoconazole and 1% zinc pyrithione and found that ketoconazole shampoo was superior to zinc pyrithione in treating dandruff and seborrheic dermatitis.
One study done in a lab found that ketoconazole can start inhibiting the growth of the fungus Malassezia at a lower concentration as compared to zinc pyrithione and selenium sulfide.
Another study that used the 2% ketoconazole and 1% zinc pyrithione shampoos found that patients preferred to use zinc pyrithione shampoo over the ketoconazole shampoo as the hair felt smooth and less frizzy with it.
So, people may be more compliant in using zinc pyrithione shampoo than ketoconazole shampoo.
Overall, ketoconazole is considered more effective than pyrithione zinc in treating dandruff and seborrheic dermatitis.
Which one should you use?
- Zinc pyrithione is considered mild on hair and is a better choice for someone with dry hair or a sensitive scalp.
- If someone is dealing with dandruff and hair loss, ketoconazole may be a better option.
- Ketoconazole might also be a better option for moderate to severe dandruff or seborrheic dermatitis.
Shampoo with ketoconazole
- Nizoral – 1% Ketoconazole (contains fragrance, dyes, and sulfates) [Amazon] []
Shampoos with zinc pyrithione
- Vanicream Free & Clear Medicated Anti-Dandruff Shampoo – 2% zinc pyrithione (free of fragrance and sulfates) [Amazon] [Target]
- Dr. Eddie’s Happy Cappy Medicated Shampoo and Body Wash – 0.95% zinc pyrithione (free of fragrance and sulfates) [Amazon] [Walmart]
- DHS Zinc Dandruff Shampoo – 2% zinc pyrithione (contains fragrance, dyes, and sulfates) [Amazon] [Walmart]
Read more: Best Zinc Pyrithione Shampoos and How to Use Them
Summary
Pyrithione zinc and ketoconazole are two anti-dandruff ingredients used for years for dandruff, seborrheic dermatitis, or fungal infections.
They both have antifungal properties and are effective, however, ketoconazole may be more efficient than pyrithione zinc as seen in a few studies.
If over-the-counter dandruff shampoos do not improve your skin condition, it’s best to see a doctor for alternatives or prescription medications.
Read more:
References
- Piérard-Franchimont C, Goffin V, Decroix J, Piérard GE. A multicenter randomized trial of ketoconazole 2% and zinc pyrithione 1% shampoos in severe dandruff and seborrheic dermatitis. Skin Pharmacol Appl Skin Physiol. 2002 Nov-Dec;15(6):434-41. doi: 10.1159/000066452. PMID: 12476017.
- Draelos ZD, Kenneally DC, Hodges LT, Billhimer W, Copas M, Margraf C. A comparison of hair quality and cosmetic acceptance following the use of two anti-dandruff shampoos. J Investig Dermatol Symp Proc. 2005 Dec;10(3):201-4. doi: 10.1111/j.1087-0024.2005.10127.x. PMID: 16382664.
- Van Cutsem J, Van Gerven F, Fransen J, Schrooten P, Janssen PA. The in vitro antifungal activity of ketoconazole, zinc pyrithione, and selenium sulfide against Pityrosporum and their efficacy as a shampoo in the treatment of experimental pityrosporosis in guinea pigs. J Am Acad Dermatol. 1990 Jun;22(6 Pt 1):993-8. doi: 10.1016/0190-9622(90)70140-d. PMID: 2142498.
- Piérard-Franchimont C, De Doncker P, Cauwenbergh G, Piérard GE. Ketoconazole shampoo: effect of long-term use in androgenic alopecia. Dermatology. 1998;196(4):474-7. doi: 10.1159/000017954. PMID: 9669136.
- Berger RS, Fu JL, Smiles KA, Turner CB, Schnell BM, Werchowski KM, Lammers KM. The effects of minoxidil, 1% pyrithione zinc and a combination of both on hair density: a randomized controlled trial. Br J Dermatol. 2003 Aug;149(2):354-62. doi: 10.1046/j.1365-2133.2003.05435.x. PMID: 12932243.
- Warner RR, Schwartz JR, Boissy Y, Dawson TL Jr. Dandruff has an altered stratum corneum ultrastructure that is improved with zinc pyrithione shampoo. J Am Acad Dermatol. 2001 Dec;45(6):897-903. doi: 10.1067/mjd.2001.117849. PMID: 11712036.
Disclaimer: This blog post is for information purposes only and does not replace medical advice.