Can I Use Ketoconazole Shampoo if I Am Pregnant or Breastfeeding?

Ketoconazole shampoo is a common treatment for severe dandruff, seborrheic dermatitis, and even fungal-related hair loss on the scalp. However, when you're pregnant or breastfeeding, any product you use on your body deserves a second look.

Is it safe to continue using this shampoo? Let's break it down in detail.

What is ketoconazole and how does it work?

Ketoconazole is a powerful antifungal that fights fungal and yeast infections. Found in medicated shampoos like the popular Nizoral, it works by attacking the cell membrane of fungi, preventing them from growing and multiplying. This helps relieve itching, scaling, and scalp inflammation.

In shampoos, it's usually found in 1% (over-the-counter) and 2% (prescription) strengths. The lower-strength version is more affordable, but both have the same active ingredient.

Ketoconazole During Pregnancy: Is It Safe?

Pregnancy is a time when the safety of any medication or topical product is a primary concern. During this time, the mother's body undergoes many changes, and what is applied to the skin can, to some extent, be absorbed and potentially lead to pregnancy.

are based on available evidence, which in many cases can be limited when it comes to topical medications such as antifungal shampoos. Oral ketoconazole is classified as category C, meaning that animal studies have shown adverse effects on the fetus, but there are insufficient human studies. For this reason, it should only be used if the potential benefit justifies the risk.

However, ketoconazole shampoos are not absorbed in large amounts through the skin. According to PubMed, systemic absorption (i.e., the amount that enters the bloodstream) is minimal when applied topically to the scalp. This means it is very unlikely to reach the fetus in significant amounts.

Still, experts recommend using it only if absolutely necessary and under medical supervision. That is, if dandruff or dermatitis is unbearable and hasn't improved with milder treatments, your doctor might consider the benefits outweigh the risks.

What about breastfeeding?

During breastfeeding, the main concern is whether ketoconazole can pass into breast milk and affect the baby.

Again, studies on topical absorption indicate that it is highly unlikely that significant amounts will reach the bloodstream and, therefore, the milk.

According to the NIH (National Institutes of Health), there is no evidence that topical ketoconazole causes adverse effects in breastfed infants. Still, they recommend avoiding applying it directly to skin where the baby may come into direct contact, such as the breast.

Are there safer alternatives?

If you prefer to be extra cautious, there are milder options you could consider during pregnancy and breastfeeding*. Shampoos containing zinc pyrithione or selenium sulfide, both approved for topical use, are generally effective for treating mild to moderate dandruff and have fewer restrictions.

In addition, natural ingredients such as tea tree oil or aloe vera can help soothe an irritated scalp. However, their effectiveness is more limited and they may take longer to show results.

Conclusion: Should you use ketoconazole during pregnancy or breastfeeding?

Ketoconazole shampoo, used occasionally and in small amounts, appears to be safe based on current evidence, but always with your doctor's approval. Absorption is minimal, but as with any treatment during this stage, the decision should be individual and based on the actual need for treatment.

If your symptoms are mild, it may be better to opt for milder alternatives. However, if dermatitis or dandruff is affecting your quality of life, your doctor can help you find a balance between relief and safety.

References

FDA. (n.d.). Pregnancy and Lactation Labeling (Drugs) Final Rule. https://www.fda.gov

PubMed. (n.d.). Topical ketoconazole absorption and safety during pregnancy. https://pubmed.ncbi.nlm.nih.gov

National Institutes of Health (NIH). (n.d.). Drugs and Lactation Database (LactMed). https://www.nih.gov

Perfect Hair Health. (n.d.). Is ketoconazole shampoo safe for hair loss during pregnancy? https://perfecthairhealth.com

American Academy of Dermatology Association. (n.d.). Seborrheic Dermatitis: How to treat and manage. https://www.aad.org

Mayo Clinic. (n.d.). Dandruff: Diagnosis and treatment. https://www.mayoclinic.org