Trichogenic effect of topical ketoconazole versus minoxidil 2% in female pattern hair loss: a clinical and trichoscopic evaluation

Abstract Background Female pattern hair loss (FPHL) is a common non-scaring alopecia. Topical minoxidil is the only approved treatment for FPHL; however, it has frequent side effects. Ketoconazole is an antifungal with anti-androgenic properties. Methods The aim of this work was to evaluate the safety and possible trichogenic effects of ketoconazole in FPHL. Patients were randomly assigned into Group A with 20 patients who received 2% topical minoxidil solution and Group B involving 20 patients who were treated by 2% topical ketoconazole preparation. All patients were treated for 6 months and evaluated clinically plus via trichoscopy. Side effects were recorded, and patients’ satisfaction was measured. Results Regarding hair growth, a significant difference was detected between baseline and at 4th and 6th months in Group A. While in Group B, the improvement was delayed until the 6th month. Only 10% of Group B reported side effects. Patients’ satisfaction did not differ between the two groups. Conclusions Topical ketoconazole mediates a trichogenic effect in FPHL with few side effects. However, ketoconazole showed a delayed improvement versus minoxidil at similar concentrations. Further studies should evaluate the efficacy of higher concentrations of ketoconazole solutions for FPHL which is a promising therapy. Trial registration IRB approval status: reviewed and approved by IRB of Faculty of Medicine, Zagazig University; approval no. #3642