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If you're using any other creams, ointments or lotions on the same area of skin, do not put them on at the same time as ketoconazole cream. After putting on the ketoconazole cream, wait 30 minutes before you use different products on the same area. This gives the ketoconazole time to be absorbed into your skin.

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If you're using a mild steroid cream (such as hydrocortisone) to help with swelling or inflammation caused by the skin infection, put the steroid cream on in the morning and the ketoconazole cream in the evening.

Pityriasis versicolor (a fungal infection that causes skin to become scaly and discoloured) gets better within 5 days of treatment with ketoconazole shampoo, or after 2 to 3 weeks of treatment with the cream. However, it can take several weeks or months for your skin colour to return to normal.

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of ketoconazole topical in the elderly. However, some elderly patients may be more sensitive to the side effects of this medicine.

For patients using the cream for ringworm of the groin (tinea cruris; jock itch), the following instructions will help reduce chafing and irritation and will also help keep the groin area cool and dry:

Ketoconazole cream is used to treat tinea corporis (ringworm; fungal skin infection that causes a red scaly rash on different parts of the body), tinea cruris (jock itch; fungal infection of the skin in the groin or buttocks), tinea pedis (athlete's foot; fungal infection of the skin on the feet and between the toes), tinea versicolor (fungal infection of the skin that causes brown or light colored spots on the chest, back, arms, legs, or neck), and yeast infections of the skin. Prescription ketoconazole shampoo is used to treat tinea versicolor. Over-the-counter ketoconazole shampoo is used to control flaking, scaling, and itching of the scalp caused by dandruff. Ketoconazole is in a class of antifungal medications called imidazoles. It works by slowing the growth of fungi that cause infection.

Prescription ketoconazole comes as a cream and a shampoo to apply to the skin. Over-the-counter ketoconazole comes as a shampoo to apply to the scalp. Ketoconazole cream is usually applied once a day for 2 to 6 weeks. Prescription ketoconazole shampoo is usually applied one time to treat the infection. Over-the-counter ketoconazole shampoo is usually used every 3 to 4 days for up to 8 weeks, and then used as needed to control dandruff. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use ketoconazole exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.

If you are using ketoconazole cream, your symptoms should improve at the beginning of your treatment. Continue to use ketoconazole cream even if you are feeling well. If you stop using ketoconazole cream too soon, your infection may not be completely cured and your symptoms may return.

Ketoconazole cream and shampoos are only for use on the skin or scalp. Do not let ketoconazole cream or shampoo get into your eyes or mouth, and do not swallow the medication. If you do get ketoconazole cream or shampoo in your eyes, wash them with plenty of water.

Ketoconazole cream and prescription shampoo are also sometimes used to treat dandruff and seborrheic dermatitis (condition that causes flaking of the skin). Ketoconazole cream is sometimes used to treat tinea manuum (fungal infection of the skin on the hands). Ketoconazole cream is also sometimes used with other medications to treat skin conditions that are often worsened by fungal infection such as diaper rash, eczema (skin irritation caused by allergies), impetigo (blisters caused by a bacterial infection), and psoriasis (a lifelong skin condition). Talk to your doctor about the possible risks of using this drug for your condition.

There are no available data on use in pregnant women to identify a drug-associated risk of birth defects, miscarriage or adverse maternal or fetal outcomes; no reproductive studies in animals have been performed; in animal reproduction studies with pregnant mice, rats and rabbits both embryotoxic and developmental effects (structural abnormalities) were observed following oral dosing of ketoconazole during organogenesis; assuming equivalent systemic absorption of topical and oral ketoconazole doses and a maximum recommended human dose (MRHD) of 8 grams (equivalent to 160 mg ketoconazole), embryotoxic effects were observed at 0.8 to 2.4 times the MRHD and developmental effects were observed at 4.8 times the MRHD

The effects of two topical cream formulations containing clotrimazole 1% and ketoconazole 2%, respectively, were clinically compared in a double-blind, randomized manner for a 28-day therapy of interdigital tinea pedis in 106 treated patients. Ketoconazole was to be used twice daily whereas clotrimazole was administered only once daily. The primary response criterion defined as the number of patients with cure or improvement after 28 treatment days was comparable with 62.0% vs. 64.0% (clotrimazole vs. ketoconazole) for the full analysis set of 100 (50 vs. 50) patients. The mycological response revealed a negative culture and microscopy in 53.1% vs. 52.1% of the patients after 14, in 76.0% vs. 79.2% after 28, and in 83.7% vs. 76.9% after 56 days of observation, indicating a possibly better long-term efficacy of clotrimazole. The development of the overall score of tinea-related signs and symptoms did not show relevant differences between the two drugs and continuously decreased from 11+/-5 in both groups at baseline to 2+/-2 vs. 2+/-1 at day 56. As to the remission and improvement rates of single symptoms, better results were obtained under clotrimazole than under ketoconazole particularly for pruritus (97.8 vs. 89.6%) and burning/stinging (97.5 vs. 89.4%) which both are perceived as most bothersome by the patients. Furthermore, both substances appeared as comparably safe and well tolerable (8 vs. 7 adverse events with only 1 vs. 3 drug related). In conclusion, a successful therapy of tinea pedis can be achieved with both clotrimazole and ketoconazole within 28 days of treatment and once-daily clotrimazole is equally effective as twice-daily ketoconazole with favourable influences on the most irritating symptoms of the disease. Mycological and reliable clinical cure cannot be observed during two weeks after start of treatment.

Androgenetic alopecia (AGA) is common and associated with significant psychosocial distress. Treatment options are needed for patients that do not adequately respond to first line treatments of finasteride or minoxidil. Topical ketoconazole has been proposed as a promising treatment. The goal of this systematic review was to evaluate the efficacy of topical ketoconazole in the treatment of AGA. A systematic literature search was conducted within the MEDLINE database using the key terms "ketoconazole" and "alopecia." Forty-seven papers were screened for inclusion, of which nine were assessed for eligibility. Seven articles were included in the qualitative synthesis, including two animal studies (total of 40 participants) and five human studies (total of 318 participants). Murine studies demonstrated a significant increase in mean ratio of hair regrowth to denuded area in the ketoconazole treatment groups compared to controls. Human studies reported increased hair shaft diameter following ketoconazole use. One study reported a significant increase in pilary index (percent anagen phase diameter) following treatment. Studies also demonstrated clinical improvement of AGA based on photographic assessment and subjective evaluation. Topical ketoconazole is a promising adjunctive or alternative therapy in the treatment of AGA. Randomized controlled trials are needed.

Could a topical anti-androgen be effective in treating AV? Dermatologists have been using topical ketoconazole for years treating seborrheic dermatitis, psoriasis, and dermatophytosis. Ketoconazole inhibits the biosynthesis of fungal ergosterol and is capable of selectively inhibiting 17,20-desmolase and 17-alpha-hydroxylase at a dose of 400-600 mg/day. Ketoconazole can also inhibit the growth of P. acnes and decrease P. acnes lipase activity in a dose-dependent manner. Although oral ketoconazole has been reported to improve AV (5), because of hepatotoxicity and potential QT prolongation, the drug should not be utilized for this purpose.

Chaottawornsak et al evaluated the efficacy and safety of ketoconazole cream in mild adult female acne (AFA) by conducting a randomized, double-blind, placebo-controlled trial using ketoconazole 2% and placebo cream twice daily for 10 weeks. They assessed the improvement of clinical severity, measured by AFA score graded by investigators and participants, and the change of acne count. Forty-one participants enrolled in the study. The proportion of participants with acne improvement from baseline (42.9% vs 9.5%, P = 0.015) and the success rate (45.0% vs 14.3%, P = 0.043) in the ketoconazole group were significantly higher than that of the placebo group. The most common adverse events were dryness and itching. The percentage change of acne count decreased significantly compared with baseline but did not differ statistically between the two groups. Limitations of this study were its short duration in subjects with only mild AV. The authors concluded that ketoconazole monotherapy showed a plausible effect in improving AFA with an excellent safety profile. They suggested that ketoconazole be considered a viable therapeutic option for patients with AFA treatment. (6)

Oral spironolactone is only prescribed for women with acne and the topical ketoconazole study was only performed in women. Currently, no prescription topical antiandrogen is available for AV. Clascoterone cream (CB-03-01, Cortexolone 17α propionate), a novel topical androgen receptor inhibitor is currently under investigation for AV. (7) I have never hesitated prescribing topical ketoconazole for men with seborrheic dermatitis; I see no need to withhold this treatment if it proves to be efficacious for acne in men or women. More studies are warranted for determining if topical ketoconazole is beneficial in men or women with moderate to severe AV. How ironic it would be if a good option for treating acne has been in front of our noses for years (while using it on the sides of the nose)! 041b061a72