Ketoconazole (Topical)

Ketoconazole anti-fungal treatment is available in prescription strength and over-the-counter formulations and is used to kill fungal or yeast infections on the skin.


Ketoconazole is a topical treatment used to stop the growth of fungal or yeast infections on the surface of the human body. As there are many such types of infections, there are many types of Ketoconazole medication formulas including shampoo, cream, foam, gel and liquid solution.

Ketoconazole is used for the treatment of many infections including ringworm, athlete's foot, dandruff, jock itch, tinea versicolor, candidiasis and seborrheic dermatitis, to name but a few.

Ketoconazole suppresses the fungal infections found in the body by penetrating the fungus cell's outer layer, causing it to weaken and die off naturally or with help of the antibodies found in most people. As many people with fungal or yeast infections have autoimmune diseases, Ketoconazole topical formulations are useful in eradicating infections from those without the natural ability to do so.

Ketoconazole was first discovered in 1976 and used in an oral format, which is no longer prescribed in many countries due to the poor health effects this format had on liver function. The topical formulation, however, is still widely used and even has off-label uses for treating hair loss in combination with other medications.

This medication should be used on clean, dry skin and is typically applied once or twice per day. The duration of treatment application depends on what type of infection is found on the body. Patients are cautioned to apply at the same time every day and not to shorten the duration of their prescribed application, as this could cause a re-growth of the infection.

Conditions Treated

  • Blastomycosis
  • Chromomycosis
  • Candiduria
  • Dandruff
  • Coccidioidomycosis
  • Oral Candida
  • Histoplasmosis
  • Pityriasis versicolor
  • Paracoccidioidomycosis
  • Tinea corporis
  • Seborrheic dermatitis
  • Candidiasis infection
  • Tinea cruris
  • Recalcitrant cutaneous dermatophyte infection
  • Tinea pedis
  • Severe cutaneous dermatophyte infection
  • Cutaneous candidiasis

Type Of Medicine

  • Imidazole antifungal agent

Side Effects

Ketoconazole works at a cellular level to prevent yeast and fungal cells from using certain proteins and enzymes, which weakens them and stops their growth. In doing so, this medication could affect normal, healthy cells and cause unwanted symptoms. Should you experience any of the symptoms listed below, get in touch with your physician immediately to prevent any long-term health concerns:

  • Burning, stinging, irritation or itching sensations that weren't present before use
  • Acne
  • Bleeding sores in mouth
  • Red, crusted, blistered, irritated or itching skin
  • Needles and pins, tingling sensations
  • Dry, flaky, scaly or cracked skin or scalp
  • Nail discoloration on fingers or toes
  • Dizzy
  • Dry, irritated, swollen eyes
  • Skin rash that is red or has blisters filled with pus or yellow crusts
  • Painful, dry, red, swollen or skin with rash
  • Gum or mouth soreness
  • Swollen face
  • Hair loss or irritated scalp
  • Pain at application site
  • Hair discoloration
  • Scalp dryness, flaking, crusting, burning or blistering
  • Rapid heart rhythm
  • Elevated body temperature
  • Hives
  • Hoarse voice
  • Irritation
  • Severe redness, itching, scaling or soreness
  • Stiff, painful or swollen joints
  • Skin rash
  • Difficulty breathing
  • Swollen face, lips, eyes, feet or hands
  • Thinning or losing hair
  • Chest pain or tightness
  • Difficulty swallowing
  • Wheezing

Other symptoms may occur that don't require medical attention and disappear over time with use of the medication. Your doctor may know of ways to alleviate these symptoms in the short term, so report any signs of:

  • Scalp oiliness or dryness
  • Headache
  • Hair texture is abnormal
  • Skin dryness
  • Pustules on scalp

There may be other changes to your health that occur after your treatment with this medication, which should be reported to your physician as soon as they happen for the best opportunity of preventing any long-term issues.


Your physician will decide on the best format of treatment for your condition. This will depend on your overall health, the location of your infection and the type of infection that you have, among other factors. Do not apply more of the medication than you are instructed to use on your written prescription and do not change how often you are to apply it. Continue with your prescription until the amount you receive is gone or until your prescribed length of treatment is over, whichever comes first. Following your doctor's prescribed instructions or the manufacturer's written instructions exactly will ensure that you are safe in taking this medication and that it will be effective on your condition.

Ketoconazole topical formulations are for application on the skin's surface only. Avoid getting this medication in your eyes, mouth or nose and do not apply it to vaginal yeast infections. Skin that is abraded burned or cut should not have Ketoconazole applied to the broken area. Should you accidentally get this medication into a bodily orifice or on broken skin, rinse it with water immediately.

Ketoconazole cream should be applied in an amount that covers the infected area and into the surrounding skin for a small margin. Rub in the cream gently until it is absorbed. Do not cover the area with any bandages or plastics and wear loose clothing only over the treated area. Wash your hands before and after using the Ketoconazole cream. Continue with the treatment for the full time prescribed, even if your skin begins to clear up. Fungal and yeast infections are notoriously difficult to get rid of, so continuing the medication is critical to eradicating it. Stopping the use of Ketoconazole too quickly may prompt the return of your infection. Apply the cream at the same time every day and do not miss a dose.

Patients who have been prescribed the foam format of the medication should wash their hands before using it. As the foam instantly absorbs into skin, it is best not to apply it to your hand, but to use the cap of the foam can or another surface that is cool to the touch to spray a small amount. Touch the dispensed amount of foam to your fingers and apply to the affected area immediately. Massage gently until the foam soaks into your skin. To apply to areas that have hair, hold the hair away with one hand while you apply the foam with the other to be sure it reaches the skin surface. Wash your hands again after applying the foam to the infected area. The foam version of Ketoconazole contains a propellant that is flammable. Do not use this medication near someone who is smoking or near a heat or flame source. When disposing of the foam medicine container, do not puncture or burn it.

The gel format of Ketoconazole should be applied in the same way as the cream formula, remembering to wash your hands before and after application. Apply a sufficient amount to cover the affected area and a small margin surrounding it and rub in the gel with your fingers until it is absorbed. Avoid washing or getting this area wet for at least three hours after application. Apply Ketoconazole gel at the same time every day and finish the prescription duration indicated on your written instructions. Do not miss any doses of this medication and do not cover the treated area with any bandages, wraps or tight clothing. If necessary, makeup or sunscreen can be used on the treated area after waiting at least 20 minutes after applying the medication. The gel format may contain flammable substances and shouldn't be used while smoking or near a heat or flame source.

Patients using the 1% strength Ketoconazole shampoo should follow the instructions on the packaging, which typically indicate that after your hair is very wet, you should apply enough shampoo to work up a good lather and massage gently into the scalp for a certain period of time. Rinse the product out well with clear, warm water and repeat the application. After a final rinse, making sure that all of the product has been washed out, dry your hair and repeat as indicated.

If you are using the 2% strength Ketoconazole shampoo, after getting your scalp wet massage in an amount that is enough to give a good lather and leave the lather in place for five minutes. Rinse your scalp and hair well under clear, running water and proceed with drying your hair. Repeat as indicated.

Different conditions will require different formulations of Ketoconazole in order to reach the infection at the skin or scalp's surface remain there for an effective period of time and not cause any unwanted effects to the health skin. For this reason, each patient should follow what their doctor has prescribed for them, as it will be specific to their needs.

In general, for the treatment of tinea corporis, candidiasis, tinea cruris, pityriasis versicolor or tinea pedis, adults will be instructed to apply the cream once per day. For Seborrheic dermatitis, adults will typically receive a prescription to apply the cream twice daily. Children will have their dosage indicated on their prescription by their physician.

For the treatment of seborrheic dermatitis, the foam version of Ketoconazole will typically be given to adults, teenagers and children older than 12 years old for application once daily for 14 days. Patients who are less than 12 years old may or may not receive a dosage of Ketoconazole in the foam format, which will depend on their doctor.

For the treatment of dandruff, the 1% strength Ketoconazole shampoo will be prescribed for adults to use every three to four days for an eight week period of treatment time to control their symptoms. The 2% strength solution is for the treatment of pityriasis versicolor and is prescribed to be used one time in adult patients. Children will have their dosage written especially for them by their physician, depending on their condition.

Do your best to apply the medication at the same time of day if you are on a daily dose, without skipping a dose. If you accidentally miss a dose of your medication, skip it if it is nearly time for the next application. If, however, you are hours away from your next dose, apply the medication as soon as you remember. Any questions should be directed to your physician should you be unsure whether to apply or skip a missing dose.


Hypersensitivity to any medications including Ketoconazole that you've experienced in the past should be reported to your medical doctor before you are given a prescription of this medication. Also inform your doctor if you have reactions to animals, dyes, perfumes or preservatives. Ketoconazole medication comes with a patient information leaflet that you should read and understand prior to your treatment. Ask your doctor or pharmacist any questions that occur to you before you apply your first dose.

Pediatric patients who are over 12 years of age have been determined to be a group that benefits from treatment with Ketoconazole for certain infections without experiencing any unwanted health symptoms that are age-related. Children younger than 12, however, have not been studied for appropriate use; therefore this medication should only be used under doctor's supervision and with caution as to dosage size in this age group.

Some geriatric patients could be more sensitive to certain possible adverse health effects of Ketoconazole and their dosage should be adjusted accordingly. In general, this age group should not have any difficulty with unwanted symptoms or less effectiveness in any format of this medication.

With regard to use in pregnant women, as it has not been previously studied, it is unknown if Ketoconazole will cause harm in fetal development. Alert your physician if you are pregnant and require treatment with Ketoconazole.

Breastfeeding women should be aware that no studies have been undertaken to prove the safety of use of Ketoconazole topical medication with regard to passing it along via breast milk to infants. Discuss the safety aspect of breastfeeding with your physician prior to accepting treatment with Ketoconazole.

Some medicines work well together to combat certain health conditions, giving the patient a successful overall treatment of their issues. Others interact poorly with each other, causing unwanted health effects and possible long-term harm. Before taking any other medications or using anything on your infected area, check with your doctor to determine how it will interact with Ketoconazole topical treatment. Include any herbal or vitamin supplements and holistic remedies you use as well as over-the-counter treatments and medications.

It is usually permissible to use makeup and sunscreen treatments if you wait at least 20 minutes after applying Ketoconazole gel formulations. Check with your doctor if this is allowed for your treatment.

Avoid smoking while applying the foam or gel formulations of Ketoconazole, as these contain substances that can be flammable.

Discuss your diet and your consumption of alcoholic beverages with your physician prior to your treatment with Ketoconazole to determine if any adverse interactions could occur during your treatment. If you use tobacco products, make sure you discuss this with your physician as well.


Expect to make follow-up appointments with your doctor so that your condition can be monitored for the effectiveness of Ketoconazole on your infection. During your appointment, you will also be tested for any health effects that are occurring as the result of using this medication.

If, after you have completed the duration of your treatment indicated on your prescription, you still have medication left, do not use it to treat any skin problem without discussing it with your doctor first.

You should see an improvement in your symptoms within two weeks if you are being treated for cutaneous candidiasis, tinea corporis, pityriasis versicolor or tinea cruris. If you are under treatment for seborrheic dermatitis, you should see an improvement in your symptoms after four weeks of treatment. Finally, your tinea pedis condition should improve within four to six weeks with continued treatment of Ketoconazole. If your condition does not improve or gets worse, get in touch with your physician for further instructions.

Good health and hygiene habits are essential to the success of your Ketoconazole treatment and to make sure your condition does not reoccur. Your physician will most likely instruct you as follows:

Athlete's foot patients and foot ringworm patients:

  • Wear 100% cotton socks, changing them often if you have sweaty feet. Avoid synthetic or wool socks.
  • Wear shoes with holes or sandals.
  • Use absorbent, non-perfumed powder on feet during the times you aren't applying Ketoconazole.

Groin ringworm and jock itch patients:

  • Wear cotton undergarments that are loose fitting.
  • Use absorbent, non-perfumed powder when you are not applying Ketoconazole topical.

Ketoconazole foam formulations may make some patients more sensitive to the sun, tanning beds or sun lamps. Avoid artificial forms of sunlight and wear sunscreen when you go out to protect yourself. Wait at least 20 minutes after applying Ketoconazole before applying sunscreen treatments and check with your physician if you have questions about this.

A life-threatening sensitivity to Ketoconazole known as anaphylaxis is possible with use of this medication. Report the symptoms of anaphylaxis to your physician, which can include difficulty swallowing or breathing, itching, skin rashes and any swelling in your face, mouth or hands, should you experience them.

Discontinue the use of Ketoconazole topical and get in touch with your doctor right away if you get a rash on your skin where you have applied the medication or have sensations of stinging, burning or irritation and swelling.


Keep Ketoconazole out of sight and reach of children and pets, stored in the original container. Shampoo formulations of Ketoconazole should be removed from shared shower and bathing areas to prevent accidental dosing by others in your household. Avoid extreme heat or cold temperatures or exposure to light and moisture. Do not allow Ketoconazole to freeze and, if it does, dispose of it safely.

Any unused Ketoconazole should be disposed of as should any expired doses of this medication. Refer to your patient information leaflet on how to dispose of this medication safely or consult your doctor or pharmacist.


Ketoconazole topical treatments are formulated for the treatment of yeast and fungal infections including athlete's foot, jock itch, dandruff, ringworm and others. Available in gel, cream, liquid solution, shampoo and foam formats, Ketoconazole is used around the world for the treatment of many conditions in a safe, effective way.

Patients should apply only the amount indicated on their prescription, which is enough to cover the infected area and a small margin around it. Your prescription will also indicate how many times per day you should apply the medication, which should be followed exactly. You will also be instructed on how long to continue applying Ketoconazole treatment in order to keep your infection from returning. These instructions should be followed exactly. Any missing doses should be reported to your physician for further instruction.

Irritation, swelling and redness at the site of the infection could indicate sensitivity to the medication or something in the formulation. Discontinue use and notify your physician immediately if you have any of these symptoms.

Avoid tight clothing, bandages, dressings or wraps over the treated area unless your doctor has specifically instructed you to use them. Do not get Ketoconazole into any bodily orifice such as your eyes, mouth, nose or vagina. Children younger than 12 years old and women who are pregnant or breastfeeding should avoid using topical Ketoconazole, as it has not been proven safe for these groups. Geriatric patients may be sensitive to some of the known symptoms that can occur with use of this medication. Dosage adjustment in this group may be necessary depending on their health condition. The foam and gel formulations of Ketoconazole treatment are flammable and should not be used while smoking or near an open flame or heat source.

Apply the gel, cream or foam by first washing your hands. Gently massage in the correct amount of medication to cover your infected area of skin, moving aside hair if you applying it to a scalp area or other area where there is hair growth. Avoid any coverings or the use of other products after application. Apply foam to the cap or other cool surface to avoid too much absorption by your hands prior to application. Wash hands thoroughly after applying the medication to remove any residue.

Shampoo formulations come in different strengths and each has different instructions for proper use. Read and follow the instructions given to you by your physician or pharmacist or those that come with over-the-counter strengths of this medication.