How to use ketoconazole 2% shampoo for dandruff (Pristine shampoo guide)

Ketoconazole 2% shampoo is one of the most effective treatments for stubborn dandruff and seborrhoeic dermatitis. It works on the yeast that drives the flaking, not just the flakes. The way you use it makes a big difference to how well it works.

How to use it: wet your hair, massage the shampoo into your scalp, leave it on for 3 to 5 minutes, then rinse well. Use it twice a week for 2 to 4 weeks, then once every 1 to 2 weeks to keep dandruff away.

How ketoconazole works

Everyone has a yeast called Malassezia on their scalp. In people prone to dandruff, the skin overreacts to it, turning over faster and shedding visible flakes, often with itching and redness. Ketoconazole is an antifungal that reduces the amount of Malassezia, which calms the reaction. That is why it works on dandruff that ordinary shampoos haven’t helped.

Pristine shampoo by Xepa contains ketoconazole 2%, the same strength as other ketoconazole 2% shampoos such as Nizoral 2%.

Step by step

1. Wet your hair and scalp with warm water.
2. Apply enough shampoo to make a lather, and massage it into the scalp with your fingertips (not your nails).
3. Leave it on for 3 to 5 minutes. This contact time is what lets it work, so don’t rinse straight away.
4. Rinse thoroughly.
5. Use your normal mild shampoo and conditioner on the other days if you wash your hair often.

How often to use it

Dandruff tends to come back when treatment stops, so the maintenance wash is what keeps your scalp clear.

Tips for better results

• Scalp, not hair. The yeast lives on the skin, so focus on the scalp.
• In Malaysia’s heat and humidity, sweat and oil feed the yeast. Wash after workouts and don’t leave hair damp under a cap or tudung for long.
• Go easy on styling products, which can build up on the scalp.
• Rotate if it stops working. Alternating with a zinc pyrithione or selenium sulfide shampoo can help.
• Keep it out of your eyes. If it gets in, rinse well with water.

Side effects

Side effects are uncommon. Some people notice itching, burning or dryness, or a change in hair texture. Rarely, it can discolour grey, permed or chemically coloured hair. Stop and see a doctor if you get a rash, blistering or swelling. Very little ketoconazole is absorbed from the shampoo, but check with our doctor first if you are pregnant or breastfeeding.

When to see a doctor

• no improvement after 4 weeks of correct use
• red, thick or silvery patches, or a rash spreading to the face, ears or chest
• hair loss, pain or oozing

These can be signs of seborrhoeic dermatitis needing extra treatment, or another condition such as scalp psoriasis. Not sure which one you have? Read dandruff vs dry scalp vs seborrhoeic dermatitis.