Topical Ketoconazole: A Systematic Review of Current Dermatological Applications and Future Developments

The 2019 systematic review analyzed the efficacy and safety of topical ketoconazole (KTZ) across 40 randomized controlled trials involving 4566 patients for various dermatological conditions. KTZ was highly effective for Malassezia-related conditions, with efficacy rates of 63-90% for seborrheic dermatitis and 71-89% for pityriasis versicolor. It was also effective for tinea pedis, Candida infections, and other superficial dermatomycoses. Off-label uses included androgenetic alopecia, where KTZ shampoo increased hair shaft diameter and improved outcomes when combined with oral finasteride, cutaneous leishmaniasis, blepharitis, and onychomycosis, with varying results. Adverse events were generally mild to moderate. The review highlighted KTZ's potential for treating acne, atopic dermatitis, psoriasis, and rosacea due to its anti-inflammatory, anti-bacterial, anti-parasitic, anti-androgen, sebum-lowering, and barrier-restoring effects, but emphasized the need for further clinical trials.