Has anyone had experience with this shampoo and clearing acne? Its active ingredient is ketoconazole, which is an antifungal agent. However, it has been shown to be a potent antiandrogen. I have been using it for 2-3 weeks, an my back and chest do look much better, and seem to be alot less oily. I had also been using panoxyl with this treatment, but i had been using that for months and didn't seem to control the bacne on its own. Antiandrogens are potent acne fighters, thats how aldactone, birth control and retinoids (retinoids have been shown to decrease androgens in the skin) work. Obviously, a topical solution would be best since it would decrease the likelyhood of systemic effects. There is some research which shows ketoconazole can be effective against acne orally (it comes in pill form too), but nothing topically. Bodybuilders have used it to fight acne when they cycle steroids and claim its effective. I would imagine it would work for acne where oil production is a major player. here is some research I found


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1: J Clin Endocrinol Metab. 1990 Aug;71(2):335-9. Links
Ketoconazole therapy for women with acne and/or hirsutism.

* Venturoli S,
* Fabbri R,
* Dal Prato L,
* Mantovani B,
* Capelli M,
* Magrini O,
* Flamigni C.

Institute of Reproductive Physiology and Pathology, University of Bologna, Italy.

The effects of ketoconazole, a synthetic imidazole derivate, were evaluated in 42 women affected by acne (17 cases) and/or hirsutism (36 cases) treated with 400 mg/day for 3-6 months. Androstenedione, total and free testosterone, 5 alpha dihydrotestosterone and dehydroepiandrosterone levels progressively dropped during treatment while 17 alpha hydroxyprogesterone, estradiol, ACTH, cortisol, LH and FSH levels increased. Dehydroepiandrosterone sulfate decreased only towards the end of treatment, while estrone, sex hormone binding globulin, and PRL remained unchanged. Daily mean +/- SD rate of hair growth, measured by a special image analysis processor, decreased within 3 months of therapy from 0.258 +/- 0.058 to 0.184 +/- 0.039 mm/day (P less than 0.02) and mean +/- SD hair diameter from 0.123 +/- 0.015 to 0.110 +/- 0.013 mm (P less than 0.05) together with decreasing hormone levels. The therapeutic effects of ketoconazole on hirsutism was evident at 6 months in only 14 subjects, while no significant change in hirsutism score was recorded in 22 women who failed to complete the therapy. Acne improved in all cases. Several side effects and complications arose during treatment, such as headache, nausea, loss of scalp hair, hepatitis, and biochemical changes. Even though ketoconazole improves hyperandrogenism, only selected patients are eligible for treatment as scrupulous monitoring is required.

PMID: 2166069 [PubMed - indexed for MEDLINE]
Related Links

* Hormonal and clinical effects of ketoconazole in hirsute women. [J Clin Endocrinol Metab. 1988] PMID: 2966183
* Ketoconazole therapy: hormonal and clinical effects in non-tumoral hyperandrogenism. [Eur J Endocrinol. 1994] PMID: 8162160
* A prospective randomized trial comparing low dose flutamide, finasteride, ketoconazole, and cyproterone acetate-estrogen regimens in the treatment of hirsutism. [J Clin Endocrinol Metab. 1999] PMID: 10199771
* Low-dose ketoconazole treatment in hirsute women. [J Endocrinol Invest. 1990] PMID: 2138647
* The impact of a pure anti-androgen (flutamide) on LH, FSH, androgens and clinical status in idiopathic hirsutism. [Clin Endocrinol (Oxf). 1993] PMID: 8370128
* See all Related Articles...
This shows oral ketoconazole is effective against acne.


Clinica Medica Generale e Terapia Medica Institute, La Sapienza, University of Rome, Italy.

Ketoconazole, an imidazolic antimycotic derivative, has proved to have an antiandrogenous effect, which may be observed to inhibit the adrenal and gonadal steroid synthesis. The authors wished to verify this effect of the drug in men and women suffering from acne and seborrhoea, conditions believed to indicate a heightened androgenous effect in the sebaceous gland. They aimed to do this by studying the cutaneous sebum, which is considered a reliable indirect indicator of androgenous activity. They found a statistically significant decrease in the rate of sebum production in all patients administered with a single daily oral dose of ketoconazole (200 mg). Moreover no untoward side-effects were reported. The anti-androgenous property of ketoconazole would therefore suggest that the drug could be proposed as a useful alternative in the treatment of acne and seborrhoea.
More research

There is also a study out there that says that ketoconazole tends to concentrate in the sebacious gland, though i can't find it at the moment. I'll try to summarize. Nizoral=topical ketoconazole=antiandrogen which concentrates in sebaceous glands=less oil=less acne.

Just a thought, this treatment may take a few weeks to show results, since it reduces oil over time, but doesn't really fight any current blemishes. it might be good in conjunction with bp or something of that nature.

i have a bottle of nizoral 2% at home.. ive used it before.. but not for acne. i applied it on my back and shoulders coz i had these white spots that my doc said were fungal, and told me to get this stuff. it really worked for those white spots, i wonder if it will work for acne.

Iv used nizoral in the past when i used to get dandruff (prescription 2%, or you can get it OTC at 1%) and yes it is a fungacide.

i dont know what it would do for acne, but since its an anti-androgen, it would probably hinder oil production.

I used nizoral on my face and it actually made my skin oily....

i dont know why but im guessing cause its supposed to stop your head from flaking with dandruff so thats why...at least my skin doesnt flake when i use it but the downside is oilier skin and more small white heads.

I have found more research about how ketoconazole works, but it is very complicated and I'm not going to bother posting it since it, but if you want to find more just google nizoral ketoconazole and acne into google. Anyway, I just wanted to post that in a few days of using nizoral as a face wash, it has gotten rid of the dermatitis on the sides of my nose and my eyebrow! For the longest time I thought it was a reaction to the bp I have been using forever. I had stopped using bp in the past and the dermatitis went away quickly. I am currently using bp, and the nizoral is the only new factor. My best guess is the bp killed all the bacteria on my face, which allowed for the fungii to takeover instead. This makes sense because many antiacne/antibiotics work by killing bacteria which often result in fungus overgrowth. So far, things seem very promising acne wise. My back, neck and chest have no active acne and are definitely much less oily. Only redmarks remain. MY face still has zits, but I have only been using it for a few days. I didn't really notice anything remarkable until about two weeks or so. I'm crossing my fingers and hoping this could finally be the missing link, the secret ingredient.

Bingo. I found some research which shows that topical ketoconazole is effective against acne.

from http://www.patentstorm.us/patents/5476852-description.html

Example 6

In a double-blind placebo controlled study patients with facial acne vulgaris were asked to apply a gel containing the active ingredient ketoconazole or placebo on small areas of the face with acne lesions. Ketoconazole was provided in 30 g robes containing 2% ketoconazole in a gel formulation. This formulation provided rapid penetration of the active ingredient into the skim. The gel had to be applied twice a day (morning and evening) immediately after cleaning the skin with fresh water. The gel was to be rubbed in gently without causing trauma to the skin and patients were told not press out any acne lesions in the face. Patients were observed at the start and every two weeks for a maximum of 8 weeks. During each visit the following signs and symptoms were evaluated and scored: papules, pustules, nodules, cysts, closed comedones, open comedones, inflammation and skin tension. The following table shows the end-results obtained during the clinical study as the global evaluation given by both the investigator and the patient after 8 weeks of treatment.

TABLE 1
______________________________________
By Investigator By Patient
2% 2%
Ketoconazole Placebo Ketoconazole
Placebo
(b.i.d.) (b.i.d.) (b.i.d.) (b.i.d.)
______________________________________
Excellent
10 5 9 5
Good 10 12 10 9
Moderate
1 2 3 5
Weak 3 5 2 4
Poor 1 6 1 7
Total 25 30 25 30
p-value
p = 0.0208 p = 0.0148
Mann-Whitney U-test
Mann-Whitney U-test
______________________________________



Example 7

In a comparative placebo controlled study the effect of ketoconazole (2%) and ketoconazole (2%)+all-trans retinoic acid (0.01%) was tested in patients with juvenile ache. The study was performed following the protocol described in the previous example and the interim results obtained during the clinical study are shown in Table 2.

TABLE 2
______________________________________
Ketocona- Ketoconazole (2%) +
Placebo
zole all-trans retinoic
(b.i.d.)
(2%, b.i.d.)
acid (0.01%, b.i.d.)
______________________________________
Number of 51 26 14
patients
Score:
excellent to good
51% 69% 79%
moderate 14% 8% 21%
weak to poor
35% 23% 0%
% change in
-34% -60% -57%
inflammation
Mean time to
25 35 30
improvement
(days)
End appreciation:
better 37% 85% 77%
worse 34% 15% 0%
0.05 < p < 0.1
Mann-Whitney U-test
______________________________________

Oops, I guess the studies didn't cut and paste so well. Anywho, just follow the website and scroll down a bit to find those studies.

Any other products contain ketoconazole?

I think the Nizoral shampoo is the only one over the counter in the US. It also comes in creams, pills and stronger shampoos but I think those are all rx. I don't think a stronger shampoo would be better, I think this is one of the areas where less is more. Its a pretty potent androgen inhibitor. The stronger strengths would probably help more with fighting fungi related problems. Besides the shampoo, the only viable alternative might be the cream, sort of like a leave on treatment.

Mixed results so far...
I have been using nizoral on my back neck and chest for 3 weeks, maybe close to a month I'm not exactly sure when I started it. I have been using it on my face for less than a week.

The good news is my back is spotless. No zits and looks great. Feels smooth, awesome!
My chest is a little worse, but only marginally. Maybe 2 or 3 zits more than usual. But it still feels less oily. My neck has cleared up in the back which is where I normally break out, but I got a few minor ones on the front of my neck. They aren't a big deal, but there nonetheless.

MY face is bad, the worst it has been in months. I have been using nizoral twice a day as a face wash. I wouldn't expect the nizoral to clear me that fast that would be WAY to optimistic, the question is if the latest breakouts were aggravated by the nizoral or would have happened anyway, But even after only 5 days or so of using it, I think I can say my face feels a little less oily, not 100% sure on this. Normally, about 8 hours after washing my face in the morning, my face would feel all saturated, almost drippy with oil. Now, while still oily it doesn't feel as heavy. But who knows, maybe its all in my head. I want to believe that this will work, because my back looks great for the first time in a while. I will keep with this regimen for a few more weeks to see if my back stays clear, and see if my other areas improve. Otherwise the derm prescribed my a prescription called Xiana, which is a retin-a + antibiotic combo ointment.

I did alot of research on ketoconazole to find some interesting thngs.

Despite popular belief, ketoconazole is NOT a dht inhibitor, at least not as far as science knows. It is an antiandrogen in that it inhibits some enzymes which are responsible for the formation of testosterone, which is why ketoconazole is effective orally. It reduces overall testosterone levels which is not a good thing. From a skin perspective, about 95% of testosterone in the skin is formed from the testes or other androgen synthesizing organs. only about 5% is synthesized locally. So nizoral should help to inhibit this other 5%. the question is if nizoral only inhibits about 5% of testosterone topically, why is it working so well on my back? Maybe just a fluke? I did some more research and apparently 5 alpha reductase isozyme 1, the one present in sebaceous glands actually as a LOW affinity for testosterone when compared to isozyme 2. So maybe a small change in testosterone could have a large effect on local dht, or there is an unknown mechanism behind nizorals workings.

Well, I guess I was wrong. There is some evidence that ketoconazole may inhibit dht, but not much.

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 5α-reductase. Finasateride a 5α-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.
http://www.sciencedirect.com/science?_ob=A...ac1de205db20140

That is the abstract, i would like to see the full article, but i don't want to pay for it.

There are a bunch of studies which imply that topical ketoconazole inhibits dht, but nothing which examines the question directly. Hopefully someone can prove me otherwise

Ketoconazole competitively binds to the human androgen receptor in the skin. Guess there IS some science behind this.

Ketoconazole, an imidazole anti-fungal agent, has often produced features of androgen deficiency including decreased libido, gynecomastia, impotence, oligospermia, and decreased testosterone levels, in men being treated for chronic mycotic infections. Based on these potent effects on gonadal function in vivo as well as previous work in vitro demonstrating affinity of ketoconazole for receptor proteins for glucocorticoids and 1,25(OH)2 vitamin D3 and for sex steroid binding globulin (SSBG), the binding of ketoconazole to human androgen receptors (AR) in vitro was also examined. Ketoconazole competition with [3H]methyltrienolone (R1881) for androgen binding sites in dispersed, intact cultured human skin fibroblasts was determined at 22 degrees C. Fifty percent displacement of [3H]R1881 binding to AR was achieved by 6.4 +/- 1.8 (SE) x 10(-5) M ketoconazole. Additional binding studies performed with ketoconazole in the presence of increasing amounts of [3H]R1881 showed that the interaction of ketoconazole with AR was competitive when the data were analyzed by the Scatchard method. It should be noted, however, that the dose of ketoconazole required for 50% occupancy of the androgen receptor is not likely to be achieved in vivo, at least in plasma. Finally, androgen binding studies performed with other imidazoles, such as clotrimazole, miconazole, and fluconozole, revealed that in this class of compounds only ketoconazole appears to interact with the androgen receptor. Ketoconazole appears to be the first example of a non-steroidal compound which binds competitively to both SSBG and multiple steroid hormone receptors, suggesting that the ligand binding sites of these proteins share some features in common.

Experiment failed. My clearing was just a fluke. My back and chest acne did improve for a while, but I would attribute that to chance. I would describe my body acne as mild, maybe 1 or 2 actives on my chest, and 4 or 5 on my shoulders neck and back at any one time. Since nizoral is effective at blocking testosterone precursors, I can understand why this might be an effective topical treatment when on certain steroids. Its androgen binding abilities are mild and wasn't enough to push me into 100% clear. I'm gonna try using a loofah with the panoxyl. Maybe a little exfoliation in conjunction with the bp might be enough to push me over that final hill.

you never specified if you were using the 1 or 2% nizoral....