How to Use Nizoral Shampoo for Dandruff
How often to use Nizoral Anti-Dandruff Shampoo, how long to leave it on, how to switch to prevention, and what to do if you also use a steroid scalp treatment.
Part of the Dandruff & Psoriasis Health Guide.
When to get urgent help: Call 999 or go to A&E if you have signs of a serious allergic reaction after using the shampoo, such as swelling of the face, lips, tongue or throat, or difficulty breathing. Speak to a GP or call NHS 111 if your scalp becomes hot, swollen, painful or weeping, if you notice patches of hair loss, or if red, scaly skin spreads to your face or body.
Key fact: Nizoral Anti-Dandruff Shampoo contains ketoconazole 2%, an antifungal that targets the Malassezia yeast linked to dandruff. It works best when it is left on the scalp for 3–5 minutes and used every 3–4 days, not every day.
Get Nizoral Anti-Dandruff Shampoo Online
Access Doctor supplies Nizoral Anti-Dandruff Shampoo from our GPhC-registered UK pharmacy. Our pharmacist team can advise if you are unsure whether it suits your scalp.
View Nizoral →How Nizoral works on dandruff
Dandruff is linked to Malassezia, a yeast that lives on everyone’s scalp. In some people it triggers irritation and faster shedding of skin cells, which shows up as white or yellow flakes and an itchy scalp. Nizoral’s active ingredient, ketoconazole, is an azole antifungal: it blocks the yeast from making ergosterol, a building block of its cell membrane, so the yeast cannot grow properly.
That is why Nizoral is used differently from an everyday cosmetic shampoo. It needs contact time on the scalp to work, and it only needs to be used every few days. Ketoconazole applied to the scalp as a shampoo is not detectable in the blood, so the cautions that apply to ketoconazole tablets do not apply here.
For a wider look at the active ingredient, including other ketoconazole shampoos, see our ketoconazole shampoo guide.
2%
Ketoconazole in UK Nizoral Anti-Dandruff Shampoo
3–5 min
Contact time before rinsing
3–4 days
Gap between washes during treatment
What strength is Nizoral in the UK?
Nizoral Anti-Dandruff Shampoo sold in the UK contains ketoconazole 2%. You may see references online to a 1% Nizoral shampoo — that is a product sold in the United States, not a UK medicine, so advice comparing “1% over the counter” with “2% on prescription” does not apply here.
In the UK, the same 2% strength comes in packs with different legal categories. Nizoral Anti-Dandruff Shampoo is a general sales list (GSL) medicine licensed for dandruff in adults and children over 12. Other ketoconazole 2% shampoo packs are pharmacy (P) medicines licensed for both dandruff and seborrhoeic dermatitis, and some are prescription-only. The strength is the same; what differs is the licensed use and where it can be supplied.
| Product type | Strength | Licensed for | Where supplied |
|---|---|---|---|
| Nizoral Anti-Dandruff Shampoo | Ketoconazole 2% | Dandruff (adults and children over 12) | General sale (GSL) |
| Ketoconazole 2% shampoo (pharmacy packs) | Ketoconazole 2% | Dandruff and seborrhoeic dermatitis | Pharmacy (P), with pharmacist advice |
| Ketoconazole 2% shampoo (prescription packs) | Ketoconazole 2% | Dandruff, seborrhoeic dermatitis and pityriasis versicolor | Prescription only (POM) |
How to use Nizoral step by step
1
Wet your hair and scalp
Wet your hair thoroughly with warm water.
2
Lather into the scalp
Apply the shampoo and massage it into the scalp, not just the lengths of the hair, so it reaches the skin where the yeast lives.
3
Leave it on for 3–5 minutes
This contact time is what lets the ketoconazole work. Rinsing straight away reduces the effect.
4
Rinse thoroughly
Rinse the scalp and hair well. Keep the shampoo out of your eyes; if it gets in, rinse them with water.
5
Use your normal shampoo in between
On the days you are not using Nizoral, you can wash with your usual shampoo if you need to.
How often and for how long
| Phase | How often | How long |
|---|---|---|
| Treating dandruff | Every 3–4 days | 2–4 weeks |
| Preventing it coming back | Once every 1–2 weeks | As long as needed |
Using Nizoral more often than this does not clear dandruff faster and can make the scalp drier or more irritated. Once flaking is under control, dropping to once every one to two weeks helps keep the yeast in check. If dandruff has not improved after 4 weeks of correct use, see a GP or pharmacist, because another condition such as psoriasis or seborrhoeic dermatitis may be involved.
If you also use a steroid scalp treatment
Some people use a steroid scalp lotion, such as Betacap or Betnovate Scalp Application, for an inflamed scalp. If you have been using a steroid on your scalp for a while, the Nizoral leaflet advises that it should be reduced gradually over 2–3 weeks while you start Nizoral, rather than stopped suddenly, to avoid a rebound flare.
If both are being used, wash with Nizoral first, dry the hair, then apply the steroid lotion to the dry scalp as directed. Tell your pharmacist or prescriber about every scalp product you use.
Nizoral and seborrhoeic dermatitis
Seborrhoeic dermatitis is a more inflamed form of the same problem: red, greasy-looking scale on the scalp, eyebrows, sides of the nose or behind the ears. NICE CKS recommends ketoconazole 2% shampoo as a first treatment for seborrhoeic dermatitis of the scalp.
Nizoral Anti-Dandruff Shampoo itself is licensed for dandruff only. For seborrhoeic dermatitis, a pharmacist can supply a ketoconazole 2% shampoo licensed for that use. If the scalp is also very inflamed, a prescriber may add a short course of a steroid scalp application. Nizoral is not a treatment for scalp psoriasis or hair loss.
Not sure it is dandruff? Thick, silvery, well-defined plaques that extend past the hairline are more typical of scalp psoriasis. Round, smooth bald patches suggest alopecia areata. Both need a different approach, so check with a GP or pharmacist.
Side effects
Most people use Nizoral without problems. The leaflet lists these side effects:
- Uncommon (up to 1 in 100 people): burning, itching, redness or irritation where it is applied, dry skin, rash, inflamed hair follicles, watery eyes, hair loss, and changes to how your hair feels.
- Rare (up to 1 in 1,000 people): a change in taste, eye irritation, acne, skin inflammation (dermatitis), flaking skin, blistering or over-sensitivity where applied, and general allergic reactions.
- Frequency not known: hives, swelling of the face or throat (angioedema) and changes in hair colour.
Stop using it and get help straight away if you have signs of an allergic reaction. If irritation or hair shedding bothers you, stop and speak to a pharmacist.
When to see a GP
The NHS advises seeing a GP if:
- Dandruff has not improved after using an anti-dandruff shampoo for 4 weeks.
- Your dandruff is bad or your scalp is very itchy.
- Your scalp is red or swollen.
- You have flaky patches on your face or body.
We would also suggest getting advice if you have thick plaques, crusting, weeping or patches of hair loss, or if you have a weakened immune system.
UK safety and prescribing information
- Legal status: Nizoral Anti-Dandruff Shampoo (ketoconazole 2%) is a general sales list medicine licensed for dandruff in adults and children over 12. Other ketoconazole 2% shampoo packs are pharmacy or prescription-only medicines.
- Children: Nizoral Anti-Dandruff Shampoo is for children over 12. For younger children with a flaky scalp, speak to a pharmacist or GP.
- Pregnancy and breastfeeding: the leaflet states it can be used. Ketoconazole is not detectable in the blood after use on the scalp. Ask a pharmacist if you are unsure.
- Steroid scalp treatments: if you have been using one, reduce it gradually over 2–3 weeks rather than stopping suddenly.
- Reporting side effects: you can report suspected side effects to the MHRA through the Yellow Card scheme website or the Yellow Card app.
Need advice on a flaky or itchy scalp?
Our GPhC-registered pharmacy team can help you choose between an antifungal shampoo and a prescription scalp treatment.
See scalp treatments →Frequently asked questions
Is Nizoral 1% or 2% in the UK?
Nizoral Anti-Dandruff Shampoo sold in the UK contains ketoconazole 2%. A 1% Nizoral shampoo is sold in the United States, but it is not a UK product.
How often should I use Nizoral shampoo?
Use it every 3 to 4 days for 2 to 4 weeks to treat dandruff. Once it is under control, use it once every 1 to 2 weeks to help stop dandruff coming back.
How long should I leave Nizoral on my scalp?
Leave it on for 3 to 5 minutes before rinsing. The contact time is what lets the ketoconazole work, so rinsing straight away makes it less effective.
Can I use Nizoral every day?
No. Daily use does not clear dandruff faster and can dry or irritate the scalp. Use your normal shampoo in between Nizoral washes if you need to.
Does Nizoral help seborrhoeic dermatitis?
Ketoconazole 2% shampoo is recommended by NICE CKS for seborrhoeic dermatitis of the scalp. Nizoral Anti-Dandruff Shampoo is licensed for dandruff only, so a pharmacist may suggest a ketoconazole 2% shampoo licensed for seborrhoeic dermatitis instead.
Can Nizoral cause hair loss?
Hair loss is an uncommon side effect, affecting up to 1 in 100 people. If you notice more hair loss than usual, stop using it and speak to a pharmacist or GP.
Can I use Nizoral when pregnant or breastfeeding?
The Nizoral leaflet states that it can be used during pregnancy and breastfeeding. Ketoconazole is not detectable in the blood after use on the scalp. Ask a pharmacist if you have any concerns.
Can I use Nizoral with a steroid scalp lotion?
Yes, if advised. If you have been using a steroid on your scalp for some time, reduce it gradually over 2 to 3 weeks while starting Nizoral, rather than stopping suddenly. Wash with Nizoral first and apply the steroid to dry hair afterwards.
Can Nizoral change my hair colour?
Changes in hair colour have been reported, but how often this happens is not known. If you colour or treat your hair, keep an eye on it and stop if you notice a change.
References
- electronic Medicines Compendium. Nizoral Anti-Dandruff Shampoo — Summary of Product Characteristics. medicines.org.uk
- NICE CKS. Seborrhoeic dermatitis. cks.nice.org.uk
- NHS. Dandruff. nhs.uk
- MHRA. Yellow Card scheme. yellowcard.mhra.gov.uk
Medical disclaimer: This article is for information only and does not replace advice from your GP, pharmacist or prescriber. Always read the leaflet that comes with your medicine. In a medical emergency, call 999.