In past months I have recommended that people try washing their faces with Nizoral shampoo, on the theory that its main ingredient, ketoconazole (which has been shown to be an antiandrogen), may be able to reduce sebum production. Setting aside for the moment all the speculation that sebum production probably only plays an indirect role in acne, nevertheless, being able to reduce it would certainly be desirable.

Somebody just brought to my attention the following Web site article about that very same idea. Following the link is the article itself. Although it was written with bodybuilders (steroid users) in mind, it obviously still has implications for the typical teenaged acne sufferer. Although I have minor quibbles with some of the things the author says, I agree with the general thrust of his argument:

http://www.mindandmuscle.net/mindandmuscle...mp;artID=999412

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Steroid Side Effects: Fight Acne with Shampoo?
by Anthony Roberts

One of the most notorious side effects experienced with the use of Anabolic/Androgenic Steroids is the development of Acne. This is, for the more hardcore users, not too big of a deal. Granted, if you are three hundred pounds ripped, are balding with a permanent red face from high blood pressure, and develop a bunch of zits suddenly, that last part is probably the least of your concerns. Large oil filled zits just aren’t a pressing concern to the next Mr. Olympia. However, for most of us, and especially first time steroid users or females, zits are usually something we want to avoid. Acne is the most media-popularized side effect of Anabolic Steroid use, and (next to weight gain) the most outwardly recognizable.

Females especially, want to avoid this for aesthetic reasons, and it’s actually through interaction with one of the female moderators on a bodybuilding message board that I was most recently reminded of this point. She had been experiencing pretty bad acne from Anavar use, but she couldn’t find a suitable answer for how to get rid of it. The most typical answer to the question was “use Retin-A,” which was spouted by nearly everyone she spoke to. It is unfortunate that Retin-A, for many reasons, is a very poor choice for her purposes (one reason being it doesn’t address the cause of the acne appropriately, and it is also a prescription medication). In this particular case, I told her to take some Nizoral (Ketoconazole) Shampoo and rub it on her back and face as a body wash. Huh? What? Shampoo on your face and back? Shampoo is for your hair! Yeah, well that’s what everyone thought. Until now. Okay, I know: shampoo on your face is weird. But, I wouldn’t be writing for Mind and Muscle if I wasn’t three things:

a.) Weird (in the public’s eye)

b.) Creative

c.) Weird

Now, let’s talk about DHT and how it causes acne. We will then discuss why using Nizoral shampoo would be good for getting rid of acne. Development of AAS-related acne and the extent to which it is experienced can be due to a number of varying factors, with the steroids and dosages used being primary factors. It has been established that the receptors of the sebaceous glands have a particularly high affinity to Dihydrotestosterone (1)(2)(3). Anecdotally, it would also seem that DHT-derivations (Winstrol, etc…) cause more acne than others (Testosterone or 19-Nor derived steroids). Thus, we can also safely assume that steroids, which are affected by the 5-alpha-reductase enzyme and turned into DHT in the body, will also be highly probable to cause acne. Increased sebaceous gland activity causes oily skin, and this, in combination with bacteria and dead skin caused by normal wear and tear, then causes pores to become clogged more quickly than the body can deal with them (or than you can exfoliate or unclog them). This causes visible acne and generally terrible looking skin.

So DHT is a primary culprit in all those nasty zits, right? Well, stay with me here, because the next part may get slightly complicated. Nizoral shampoo (the chemical in it is Ketoconazole) is actually a topical anti-androgen. Remember, the catalyst for acne is initially DHT (an androgen) and the sebaceous activity it causes. When used topically, in shampoo form, this particular compound’s effects are limited to the skin/scalp and are not systemic (affecting the whole body) unless you take it orally (drink the shampoo). Ketoconazole’s pharmacokinetics have been studied with oral ingestion (they make a pill, you don’t drink the shampoo of course), and it has been determined that even orally, it is effective against acne, because oral ketoconazole has three delivery routes to the skin (4):

1. Passive uptake by keratinocytes in the basal layer

2. Excretion through the sweat glands

3. (The important one) A massive excretion through the sebaceous glands

In that same study, sebum levels compared with the plasma levels are very high, even with oral ingestion (4), which prompted researchers to simply create a shampoo from the base chemical (Ketoconazole) to prevent androgenic alopecia (balding) caused by DHT. Unfortunately, oral ingestion of an anti-androgen will cause an anti-anabolic effect as well. However, there is almost no effective plasma level to cause an anti-androgenic effect in your body when you topically apply it (4). So this should keep anyone from needlessly worrying about the possibility of an anti-anabolic effect to be had from topically applying Nizoral (even though it’s technically an anti-androgen).

Lets back up a bit and let me give you a little background on how I stumbled on all of this roughly 8 years ago.

I figured out that Nizoral would prevent acne when I had some acne on my forehead during my first cycle. I had been using Nizoral to prevent hair loss, and I always got some shampoo on the top of my forehead when I washed my hair. I soon noticed that the area the shampoo came into contact with was free of acne. So, long story short, I started using it as a topical acne treatment and my steroid-induced acne cleared right up. I tried it on my back acne, and it went away. My girlfriend at the time had some acne, and it cleared that up too. A few years ago, I actually looked for validation on my theory, and found it. The study I first found (4) examined the pill form, but the shampoo is the same active ingredient, and won't have a noticeable systemic effect, but rather will have a localized one wherever you apply it.

Interestingly, about the same year that I had discovered the use of a topical anti-androgen for use in preventing DHT-caused acne (steroid related in my case) scientists completed a study basically saying the same thing. Although I had discovered this use for topical anti-androgens in my shower, and they discovered it in a lab, it’s basically the same idea.

The study I found from that year examining a topical anti-androgen and its effects on the sebaceous glands was very interesting. When a topical anti-androgen was used on rodents, the scientists noted that sebaceous glandular and ductal regression was quite profound. This strongly suggests that a topical anti-androgen could effectively counteract endogenous androgens resulting in a suppression of growth of the sebaceous glands while leaving serum concentrations of both testosterone and dihydrotestosterone intact and not reduced (5). This means, for all intents and purposes, that Nizoral’s anti-androgenic effect on your skin will prevent acne, without it having a systemic effect on your body. In simplest terms, it will leave 100% of the muscle building effects imparted by the steroids you are taking totally unaffected.

Shampoo. It’s not just for hair anymore.

References

1. Am J Clin Dermatol. 2002;3(8):571-8.
2. Clin Dermatol. 2004 Sep-Oct;22(5):419-28.
3. Pol Merkuriusz Lek. 2004 May;16(95):490-2.
4. Int J Tissue React. 1988;10(2):111-3
5. Skin Pharmacol. 1997;10(5-6):288-97.

http://www.kalayacreations.com/acne.html

This does the same thing while treating the other causes. It has NDGA, one of the few products out there that does this. NDGA is one of the few thigns we have now that can normalize keratinization, which IMO is the key to stopping acne. Indeed you can have excess sebum, bacteria and an inflammation response but you can't get acne to form(Maybe blakcheads), if you shed your skin normally. When ihad acne I was looking all over for things that incorporated NDGA but very few did.

The shampoo is probably cheaper though.

Well, you're being a little vague when you say that "NDGA....does this". NDGA does WHAT? I was specifically referring to the use of ketoconazole (in Nizoral shampoo) as an antiandrogen for acne, and NDGA isn't an antiandrogen. It may have other useful properties for acne, though, like an anti-inflammatory effect.



Yes. That's my main point: Nizoral shampoo is relatively cheap, and easy to obtain. People should recognize it as a possible new weapon to use against acne.

Bryan

No, I meant that NDGA is proven to normalize keratinization. That's all it does in terms of helping acne. All the studies done in it for dermatogoly point to this being it's main benefit. When I said that it does other things as well I was referring to other ingredients. The soy and phytoestrogens in it. I don't know how well these affect sebum when compared to the shampoo but they seem to be good at it.

Last time I checked it was 29.00 for the bottle and the lotion taht is even more concentrated. Still more expensive than all but the best quality salon shampoos.

Sorry, didn't meant to derail your thread, I though this product could be an alternative to those that don't want to use the shampoo.

Have you tried this product? Any comments?

How does it compare with retinoic acid?

I tried it and it didn't seem to have any real effect on me. At first I suffered a severe breakout period but I'm not certain it was a reaction to the shampoo. Once that subsided, it just seemed to be acne-neutral.

It seems that my regimen of clindamycin and Differin have lost its effect after being able to control my acne for 3-4months. I stopped using it for a month, used Terminator (salicylic acid with benzoyl peroxide) and aloe vera while still washing my face with a salicylic acid with tea tree oil cleanser (Thursday Plantation) for a month before going back with the clindamycin and Differin regimen. I'm now combining this regimen with Nizoral which I just bought from Target (cheapest there) to lather on face every 3-4 days. I received 2 free bottles of Praventin to stop acne internally which I take 3 times a day (300mg). I also alternate my face wash with Hibiclens which I also got for free.

My face is getting a bit dry from all these so I spray it with called Na-PCA from Twinlabs. A great moisturizer which has aloe vera. It's only been less than a week and it seems that things are under control.

Hi

I got acne on my face and serious acne on the back. I also had very serious dandruff.

My dandruff flakes were so bad, you couldn't call them flakes and it used to be nonstop. I had horrible dandruff for a whopping 16 years (it started when I was 17). I went to many doctors and no medication had any effect. I used Selsun medicated shampoo that is available in Walmart, etc to control it to some extent for about 6 years. That was the closest to a good dandruff shampoo for me. Selsun turned my very serious dandruff into ordinary dandruff. I also tried a host of other shampoos (Head and shoulders is the worst -- pretty useless when it comes to addressing serious dandruff). Head & Shoulders controlled my dandruff for all of 1 hour even if I used it every day. Another shampoo that seemed to work was -- I forget the name, I think it starts with 'C' (one german shampoo that is sold in Indian pharmeceutical shops). That seemed to work for a while, but eventually gave up on that too. I must have tried God knows how many shampoos in all these years. Then, I tried a remedy prescribed by Ramdev (an Indian yoga expert). The remedy was to mix yogurt, crushed neem powder and apply it on the head. It worked almost immediately and my dandruff disappeared, but I guess the remedy wasn't strong enough from making it resurface with a vengeance. Ramdev yoga treatment worked better than Selsun and any other shampoo. Then FINALLY, magic happened with Nizoral 2% that I ordered from a UK shop -- you don't get the 2% version in US, only 1%. I read a lot about DHT and dandruff and I was convinced that my dandruff and acne were related to some DHT disorder. With high hopes, I applied Nizoral 2% and I was a little disappointed after the first try. My dandruff did reduce quite a bit, but I could see some dandruff on my head minutes after I took bath. But after 2 or 3 applications, the dandruff COMPLETELY DISAPPEARED! I was elated. For 2 solid weeks, NO DANDRUFF AT ALL!!! Not a single flake, nothing. I had not even applied it for 2 weeks. I was totally elated. After about 3 weeks, dandruff started resurfacing slowly. But the intensity was far lesser. I still have some dandruff, but it is about 85% less than what I used to have. I continue to apply Nizoral once every week or two weeks.

After reading this thread on acne, I decided to give Nizoral a shot on my back and face. I was hoping for a second round of magic. Today I applied Nizoral for the first time on my back. No love yet . I'll try it for a few times and let you guys know if I spot a difference. (btw, I am not doing advertisement for Nizoral -- I don't care if anybody buys it or not), just sharing my experience).

sn

Be sure to rinse it off; don't keep it on the skin. Be cautious about using any dandruff shampoo on the face; some people have had allergic reactions, possibly attributable to Nizoral shampoo.

I am a distance runner, I put in a lot of training hours. Its very common for women who train hard in endurance sports to have hormonal imbalance issues. Unfortunately I am one of many Americans who doesn't have $300 per month to spend on health insurance I would rarely ever use anyways. So getting tested for imbalance is out of the question and self diagnosis has become the norm for me.

After reading this post, I tried the over the counter version of nizoral shampoo on my face, its only the first day but, already my skin feels a bit calmer and for the first time in a while the skin on my face as a whole doesn't feel stiff and painful as it usually does. I mean my acne from a distance didn't look all that bad but my skin just felt awful and the acne is cystic and persists for months. Im well aware that what is causing my acne is internal and this is only a surface quick fix, but for now Im grateful for any useful advice.

So assuming this works the way we're hoping.. I think it would be a receptor-mediated response with transcription modification... right? That would take at least an hour to start working (I'm using corticosteroids as a model) and then at least a day to see any significant change. And I don't know if cysts that are already there would even be affected... its not like DHT will help clear existing sebum compactions. Just thinking out loud. I kinda wanna try this too, but I'm already using a little too many things i think.