Reversal of androgenetic alopecia by topical ketoconzole: relevance of anti-androgenic activity.

Ketoconazole (KCZ), an imidazole anti-fungal agent, is known to be effective for the treatment of seborrheic dermatitis and dandruff. In addition, 2% KCZ shampoo was found to improve hair density and the size and proportion of anagen follicles in androgenetic alopecia (AGA) [1] and, in combination with finasteride, to have an additive effect for AGA [2]. Recently, it has been reported that topical application of KCZ stimulates hair growth in C3H/HeN mice [3]. However, whether topical KCZ is effective enough to improve the clinical appearance of AGA is not yet clear. We therefore carried out an open trial of topical 2% KCZ lotion (Nizoral) in combination with shampoos. Furthermore, to identify the mechanism, which can explain the clinical effect of KCZ on AGA, we performed transient transfection assays using CV-1 cells transfected with androgen receptors (AR). The six Japanese males from 23 to 51 years old were enrolled in this study with their written informed consent. They presented with grade II vertex to IVa AGA according to the Hamilton—Norwood classification [4]. The subjects applied topical 2% KCZ lotion (Nizoral) almost every day during or immediately after hair washing with their own unmedicated shampoos. When they revisited our clinic every several months, clinical pictures were obtained to determine the efficacy of the treatment. Two of the men, one 23 years old with grade II vertex and the other 25 years old with Va AGA, showed remarkable hair regrowth after 6 and 10 months, respectively (Fig. 1). The 23-year-old male stopped using KCZ and 3 months later hair loss recurrence on the vertex was noted (Fig. 1c). When