VA Class: DE102
Chemical Name: cis-1-acetyl-4-[4-[[2-(2,4-dichlorophenyl)-2-(1H-imidazol-1-ylmethyl)-1,3-dioxolan-4-yl] methoxy]phenyl] piperazine
Molecular Formula: C26H28Cl2N4O4
CAS Number: 65277-42-1
Brands: Extina, Nizoral, Nizoral A-D, Xolegel
Uses for Ketoconazole
A drug of first choice for topical treatment of tinea corporis or tinea cruris.81 85 Oral antifungals preferred when tinea corporis or tinea cruris is extensive, dermatophyte folliculitis is present, infection is chronic or does not respond to topical therapy, or patient is immunocompromised or has coexisting disease.80 81 82 83 84
Pityriasis (Tinea) Versicolor
Seborrheic Dermatitis and Dandruff
Ketoconazole Dosage and Administration
When using the 2% foam, hold the can containing the foam upright and spray a small amount into the cap of the can or other cool surface.106 Do not dispense foam directly onto affected areas or onto hands since the foam will begin to melt immediately on contact with warm skin.106 If fingers are warm, rinse them in cold water and dry before handling the foam.106 Using the fingertips, gently massage small amounts of foam onto affected areas until the foam disappears and entire affected area has been treated.106
When using the 2% gel, do not apply sunscreen or cosmetics to the affected area until at least 20 minutes after application of the gel.105 Do not wash the affected area for at least 3 hours after application of the gel.105
Topical Seborrheic Dermatitis in Children ≥12 Years of Age
Dandruff in Children ≥12 Years of Age
1% shampoo: For self-medication, apply to wet hair, lather, and rinse thoroughly; then repeat application, lathering, and rinsing.104 Use every 3 or 4 days for up to 8 weeks as needed or as directed by a clinician.104 Thereafter, use as needed to control dandruff.104
Tinea Corporis or Tinea CrurisTopical
2% cream: Apply and rub gently into affected and surrounding area of skin once or twice daily for 2 weeks.1 2 25 58 59 62 110 There is some evidence that twice-daily regimen may occasionally be more effective than once-daily regimen.25 62 If clinical improvement does not occur after treatment, reevaluate diagnosis.1 110
2% cream: Apply and rub gently into affected and surrounding area of skin once or twice daily for 6 weeks.1 2 60 66 79 110 If clinical improvement does not occur after treatment, reevaluate diagnosis.1 110
2% cream: Apply and rub gently into affected and surrounding area of skin once or twice daily for 2 weeks.1 2 25 58 59 110 If clinical improvement does not occur after treatment, reevaluate diagnosis.1 110
Pityriasis (Tinea) Versicolor
2% shampoo: Apply to damp skin of the affected area and a wide margin surrounding this area and lather; after 5 minutes, rinse with water.72 A single application should be sufficient,72 97 although once-daily application for 3 days also has been used.97
2% shampoo: For seborrheic dermatitis of the scalp†, has been used to wash the hair and scalp 2 or 3 times weekly for 2–4 weeks.76 98 99 101 After a response was obtained, has been used once weekly every other week to prevent relapse.98
1% shampoo: For self-medication to control flaking, scaling, and itching associated with dandruff, apply to thoroughly wet hair, lather and rinse thoroughly; then repeat application, lathering, and rinsing.104 Use every 3 or 4 days for up to 8 weeks as needed or as directed by a clinician.104 Thereafter, use as needed to control dandruff.104
2% shampoo: For treatment of dandruff†, has been used to wash the hair and scalp 2 or 3 times weekly for 2–4 weeks.76 98 99 101 After a response was obtained, has been used once weekly every other week to prevent relapse.98
Cautions for Ketoconazole
Some formulations of the 2% cream contain sodium sulfite, which may cause allergic-type reactions (including anaphylaxis and life-threatening or less severe asthmatic episodes) in certain susceptible individuals.110 Overall prevalence of sulfite sensitivity in the general population is unknown, but probably low; such sensitivity appears to occur more frequently in asthmatic than in nonasthmatic individuals.110
Systemic Adverse Effects
Although hepatotoxicity, decreased testosterone concentrations, and decreased ACTH-induced corticosteroid concentrations have been reported with oral ketoconazole,32 105 110 these adverse effects have not been reported with topical ketoconazole105 110 and are unlikely since the drug does not appear to be appreciably absorbed following topical application to skin.2 56 57
1% shampoo: Pregnant women considering self-medication should consult a clinician before using the preparation.104
1% shampoo: Nursing women considering self-medication should consult clinician before using the preparation.104
2% foam: Safety and efficacy not established in children <12 years of age.106
2% gel: Safety and efficacy not established in children <12 years of age.105
1% shampoo: Safety and efficacy for self-medication not established in children <12 years of age.104
2% shampoo: Safety and efficacy not established in children.72
Common Adverse Effects
2% shampoo: When applied to the skin, pruritus, application site reaction, dry skin.72 When applied to scalp, increased hair loss, irritation, abnormal hair texture, loss of hair curl in patients with permanently waved (“permed”) hair, scalp pustules, dry skin, pruritus, oiliness or dryness of the hair and scalp.72
Interactions for Ketoconazole
No formal drug interaction studies to date.105
2% cream: Topical application to chest, back, and arms of healthy adults with intact skin does not result in detectable blood concentrations.1 2 24 110 Following topical application in vitro in a skin model, ketoconazole was retained in the stratum corneum and the boundary of the stratum corneum and stratum granulosum for up to 16 hours.56 63
2% foam: Topical application of 3 g twice daily for 4 weeks in patients with moderate to severe seborrheic dermatitis resulted in plasma ketoconazole concentrations <6 ng/mL in 75% of patients; maximum plasma concentration was 11 ng/mL.106
2% gel: Topical application once daily for 2 weeks (0.05-3.47 g daily) in patients with severe seborrheic dermatitis (1–14% of body surface area) resulted in mean peak plasma concentrations of 1.35 ng/mL on day 7 and 0.8 ng/mL on day 14.105
2% shampoo: Chronic use of 2% shampoo (4–10 times weekly for 6 months, 2–3 times weekly for 3–26 months) did not result in detectable plasma concentrations.72
Small amounts of ketoconazole are absorbed systemically when the drug is administered intravaginally.24
20–25°C; do not refrigerate or freeze.106
25°C (may be exposed to 15–30°C).105
2–30°C; protect from light and freezing.104
≤25°C; protect from light.72
Actions and Spectrum
Presumably exerts its antifungal activity by altering cellular membranes, resulting in increased membrane permeability, secondary metabolic effects, and growth inhibition.1 21 23 32 48 49 50 51 52 55 105 106 110 Fungistatic activity may result from interference with ergosterol synthesis.1 21 34 49 50 51 55 105 106 110 Fungicidal activity at high concentrations may result from a direct physiochemical effect on the fungal cell membrane.3 55
Mechanism(s) of action in the treatment of dandruff not fully determined.72
Dermatophytes: Active against Epidermophyton floccosum,1 4 6 10 22 32 40 72 110 Microsporum audouini,1 10 22 32 40 72 110 M. canis,1 4 10 22 32 40 72 110 M. gypseum,1 4 10 22 32 40 72 110 Trichophyton mentagrophytes,1 4 10 22 32 40 72 110 T. rubrum,1 4 10 22 32 40 72 110 and T. tonsurans.1 4 10 22 32 40 72 110
Advice to Patients
Importance of using the medication for the full, prescribed treatment period, even if symptoms improve; importance of consulting with clinician if the skin condition does not improve after a full course of therapy.56 57 104 106
If using 2% foam or gel, importance of avoiding fire, flame, and/or smoking during and immediately following application.105 106 Importance of not throwing foam container into a fire, even if can is empty.106
Importance of not using the 1% shampoo for self-medication of dandruff if the scalp is broken or inflamed.104 Importance of discontinuing use and contacting a clinician if rash occurs or the condition worsens or does not improve within 2–4 weeks.104
Importance of informing patients of other important precautionary information. (See Cautions.)
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 02/2015. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.
Extina 2% Foam (GLAXO SMITH KLINE): 50/$198.99 or 150/$563.95
Extina 2% Foam (GLAXO SMITH KLINE): 100/$369.99 or 300/$1,042.02
Ketoconazole 2% Cream (TARO): 15/$19.99 or 45/$45.99
Ketoconazole 2% Cream (TARO): 30/$26.99 or 90/$76.97
Ketoconazole 2% Cream (TARO): 60/$35.99 or 180/$99.99
Ketoconazole 2% Foam (PERRIGO PHARMACEUTICALS): 50/$175.99 or 150/$499.95
Ketoconazole 2% Foam (PERRIGO PHARMACEUTICALS): 100/$326.00 or 300/$925.93
Ketoconazole 2% Shampoo (PERRIGO PHARMACEUTICALS): 120/$27.99 or 240/$49.97
Kuric 2% Cream (JSJ PHARMACEUTICALS): 75/$113.65 or 225/$311.47
Nizoral 2% Shampoo (JANSSEN): 120/$53.99 or 240/$96.97
Xolegel 2% Gel (AQUA PHARMACEUTICALS): 45/$365.98 or 135/$1,040.01
AHFS DI Essentials. © Copyright, 2004-2015, Selected Revisions July 1, 2009. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.
1. Taro Pharmaceuticals. Ketoconazole cream, 2% prescribing information. Brampton, Ontario; 2002 Nov.
2. Cauwenbergh GF, Degreef H, Verhoeve LS. Topical ketoconazole in dermatology: a pharmacological and clinical review. Mykosen. 1984; 27:395-401. [PubMed 6090895]
3. Van den Bossche H, Ruysschaert JM, Defrise-Quertain F et al. The interaction of miconazole and ketoconazole with lipids. Biochem Pharmacol. 1982; 31:2609-17. [PubMed 6291539]
4. Shadomy S, Espinel-Ingroff A, Kerkering TM. In-vitro studies with four new antifungal agents: BAY n 7133, bifonazole (BAY h 4502), ICI 153,066 and Ro 14-4767/002. Sabouraudia. 1984; 22:7-15. [PubMed 6322364]
5. Lefler E, Stevens DA. Inhibition and killing of Candida albicans in vitro by five imidazoles in clinical use. Antimicrob Agents Chemother. 1984; 25:450-4. [IDIS 184277] [PubMed 6375555]
6. Espinel-Ingroff A, Shadomy S, Gebhart RJ. In vitro studies with R 51,211 (itraconazole). Antimicrob Agents Chemother. 1984; 26:5-9. [IDIS 187623] [PubMed 6089654]
7. Bergan T, Vangdal M. In vitro activity of antifungal agents against yeast species. Chemotherapy. 1983; 29:104-10. [IDIS 169053] [PubMed 6301773]
8. Gebhart RJ, Espinel-Ingroff A, Shadomy S. In vitro susceptibility studies with oxiconazole (Ro 13-8996). Chemotherapy. 1984; 30:244-7. [IDIS 187989] [PubMed 6086246]
9. Cohen J. Antifungal chemotherapy. Lancet. 1982; 2:532-7. [IDIS 155949] [PubMed 6125688]
10. Dixon D, Shadomy S, Shadomy HJ et al. Comparison of the in vitro antifungal activities of miconazole and a new imidazole, R41,400. J Infect Dis. 1978; 138:245-8. [PubMed 681800]
11. Graybill JR, Craven PC. Antifungal agents used in systemic mycoses: activity and therapeutic use. Drugs. 1983; 25:41-62. [IDIS 165275] [PubMed 6297871]
12. Farr PM, Shuster S. Treatment of seborrhoeic dermatitis with topical ketoconazole. Lancet. 1984; 2:1271-2. [IDIS 193282] [PubMed 6150296]
13. Donadini A. The combination of an anti-inflammatory steroid, an antibacterial agent, and an antifungal in the treatment of outpatients with skin diseases of uncertain aetiology. Curr Ther Res Clin Exp. 1985; 37:478-84.
14. Cristiani T. Experience with the combination of an anti-inflammatory steroid, an antibacterial agent and an antimycotic agent in the topical treatment of skin diseases of various origins. Curr Ther Res Clin Exp. 1985; 37:225-31.
15. Minak G, Beverini S. Treatment of forms of infantile dermatitis with a multi-purpose drug combination. Curr Ther Res Clin Exp. 1984; 36:1198-1202.
16. Berardesca E. Combination treatment of skin diseases of mixed aetiology with an anti-inflammatory steroid, an antibacterial agent, and an antifunal. Curr Ther Res Clin Exp. 1985; 37:791-6.
17. Trabacco M. Treatment of dermatological manifestations in infants with a multivalent combination. Curr Ther Res Clin Exp. 1985; 37:784-9.
18. Pazzaglia A. Clinical results obtained with a combination of an anti-inflammatory steroid, an antibacterial agent and an antifungal in dermatological outpatient practice. Int J Clin Pharmacol Ther Toxicol. 1985; 23:367-72. [PubMed 4030166]
19. Gini M. Use of a combination of an anti-inflammatory corticosteroid, an antibacterial agent and an antifungal in the local post-operative treatment of cutaneo-mucosal diseases following cryosurgery. Int J Clin Pharmacol Ther Toxicol. 1985; 23:373-5. [PubMed 4030167]
20. Pellerano S. Use of a combination of an anti-inflammatory steroid, an antibacterial agent and an antifungal in dermatological practice. Int J Clin Pharmacol Ther Toxicol. 1985; 23:215-8. [PubMed 3888858]
21. Borgers M, Van den Bossche H, De Brabander M. The mechanism of action of the new antimycotic ketoconazole. Am J Med. 1983; 74(Suppl 1B):2-8. [IDIS 165048] [PubMed 6295147]
22. Heel RC. In vitro and in vivo activity. In: Levine HB, ed. Ketoconazole in the management of fungal disease. New York: Adis Press; 1982:57-66.
23. Janssen Pharmaceutica. Product information form for ketoconazole. Piscataway, NJ; 1986 Feb.
24. Rawlins M. Systemic absorption of ketoconazole 2% cream. Janssen clinical research report N 31403. Piscataway, NJ; 1982 Sep.
25. Janssen Pharmaceutica. Ketoconazole 2% cream: systemic absorption, skin irritancy, and therapeutic effectiveness in animals and man. A review of the available data up to April 1983. Research report No. N 31597. Piscataway, NJ; 1983 Apr.
26. Savin RC. Double-blind comparison of 2% ketoconazole cream (R 41,400) and placebo in the treatment of tinea versicolor: Janssen Pharmaceutica clinical research report N 31513. Piscataway, NJ; 1983 Mar.
27. Taplin D, Carmargo G. Double-blind comparison of 2% ketoconazole cream (R 41,400) and placebo in the treatment of tinea corporis and tinea cruris. Janssen Pharmaceutica clinical research report No. N 31514. Piscataway, NJ; 1983 Mar.
28. Taplin D, Carmargo G. Double-blind comparison of 2% ketoconazole cream (R 41,400/98) and placebo in the treatment of fungal infections of the feet. Janssen Pharmaceutica clinical research report No. N 31511. Piscataway, NJ; 1983 Mar.
29. Torres MA, Mohamed J, Cavazos-Adame H et al. Topical ketoconazole for fungal keratitis. Am J Ophthalmol. 1985; 100:293-8. [IDIS 204217] [PubMed 4025470]
30. Komadina TG, Wilkes DI, Shock JP et al. Treatment of Aspergillus fumigatus keratitis in rabbits with oral and topical ketoconazole. Am J Ophthalmol. 1985; 99:476-9. [PubMed 3872596]
31. O’Day DM, Ray WA, Head WS et al. Influence of the corneal epithelium on the efficacy of topical antifungal agents. Invest Ophthalmol Vis Sci. 1984; 25:855-9. [PubMed 6329991]
32. Teva Pharmaceuticals. Ketoconazole tablets prescribing information. Sellersville, PA; 2003 Nov.
34. Pye GW, Marriott MS. Inhibition of sterol C14 demethylation by imidazole-containing antifungals. Sabouraudia. 1982; 20:325-9. [PubMed 6760419]
35. Odds FC, Webster CE, Abbott AB. Antifungal relative inhibition factors: BAY 1-9139, bifonazole, butoconazole, isoconazole, itraconazole (R 51211), oxiconazole, Ro 14-4767/002, sulconazole, terconazole and vibunazole (BAY n-7133) compared in vitro with nine established antifungal agents. J Antimicrob Chemother. 1984; 14:105-14. [PubMed 6094418]
36. Odds FC. Laboratory evaluation of antifungal agents: a comparative study of five imidazole derivatives of clinical importance. J Antimicrob Chemother. 1980; 6:749-61. [PubMed 7440468]
37. Clissold SP, Heel RC. Tioconazole: a review of its antimicrobial activity and therapeutic use in superficial mycoses. Drugs. 1986; 31:29-51. [IDIS 210402] [PubMed 3510114]
38. Pottage JC Jr, Kessler HA, Goodrich JM et al. In vitro activity of ketoconazole against herpes simplex virus. Antimicrob Agents Chemother. 1986; 30:215-9. [IDIS 220405] [PubMed 3021048]
39. Ford GP, Ive FA, Midgley G. Pityrosporum folliculitis and ketoconazole. Br J Dermatol. 1982; 107:691-5. [IDIS 161628] [PubMed 6293529]
40. Van Cutsem J. The antifungal activity of ketoconazole. Am J Med. 1982; 74(Suppl 1B):9-15.
41. Anon. Boxed warning added to ketoconazole label. FDA Drug Bull. 1983; 13:15-6. [PubMed 6311655]
42. Skinner RB Jr, Zanolli MD, Noah PW et al. Seborrheic dermatitis and acquired immunodeficiency syndrome. J Am Acad Dermatol. 1986; 14:147-8. [PubMed 2936769]
43. Skinner RB Jr, Noah PW, Taylor RM et al. Double-blind treatment of seborrheic dermatitis with 2% ketoconazole cream. J Am Acad Dermatol. 1985; 12(15 Part 1):852-6. [PubMed 3159759]
44. Skinner RB Jr, Noah PW, Zanolli MD et al. The pathogenic role of microbes in seborrheic dermatitis. Arch Dermatol. 1986; 122:16-7. [PubMed 2935085]
45. Faergemann J. In vitro and in vivo activities of ketoconazole and itraconazole against Pityrosporum orbiculare. Antimicrob Agents Chemother. 1984; 26:773-4.
46. Ryley JF, Wilson RG, Barrett-Bee KJ. Azole resistance in Candida albicans. Sabouraudia. 1984; 22:53-63. [PubMed 6322363]
47. Tavitian A, Raufman JP, Rosenthal LE et al. Ketoconazole-resistant Candida esophagitis in patients with acquired immunodeficiency syndrome. Gastroenterology. 1986; 90:443-5. [IDIS 210426] [PubMed 3510145]
48. Thomas AH. Suggested mechanisms for the antimycotic activity of the polyene antibiotics and the N-substituted imidazoles. J Antimicrob Chemother. 1986; 17:269-79. [PubMed 3516967]
49. Beggs WH, Andrews FA, Sarosi GA. Minireview: action of imidazole-containing antifungal drugs. Life Sci. 1981; 28:111-8. [PubMed 7019609]
50. Borgers M. Mechanism of action of antifungal drugs, with special reference to the imidazole derivatives. Rev Infect Dis. 1980; 2:520-34. [IDIS 124096] [PubMed 7003674]
51. Sud IJ, Feingold DS. Mechanisms of action of the antimycotic imidazoles. J Invest Dermatol. 1981; 76:438-41. [IDIS 133194] [PubMed 7017013]
52. Beggs WH. Growth phase in relation to ketoconazole and miconazole susceptibilities of Candida albicans. Antimicrob Agents Chemother. 1984; 25:316-8.
53. Beggs WH. Influence of growth phase on the susceptibility of Candida albicans to butoconazole, oxiconazole, and sulconazole. J Antimicrob Chemother. 1985; 16:397-9. [PubMed 3902762]
54. Minagawa H, Kitaura K, Nakamizo N. Effects of pH on the activity of ketoconazole against Candida albicans. Antimicrob Agents Chemother. 1983; 23:105-7.
55. Sud IJ, Feingold DS. Heterogeneity of action among antimycotic imidazoles. Antimicrob Agents Chemother. 1981; 20:71-4. [IDIS 135352] [PubMed 6269485]
56. Janssen Pharmaceutica, Titusville, NJ: Personal communication.
57. Reviewers’ comments (personal observations); 1986 Sep.
58. Meisel C. Single-blind, side-to-side comparison of ketoconazole 2% cream and clotrimazole 1% cream in 8 patients with superficial mycotic infections. Janssen Pharmaceutica clinical research report No. N 31398. Piscataway, NJ; 1983 Mar.
59. Qadripur SA, Hellgren L, Gjertsen BT et al. Double-blind comparison of ketoconazole 2% cream and clotrimazole 1% cream in the treatment of superficial fungal infections: an international multicenter study. Janssen Pharmaceutica clinical research report No. N 31402. Piscataway, NJ; 1983 Mar.
60. Swanson NA. A double-blind randomized comparative trial of once- and twice-daily ketoconazole 2% cream and placebo in the treatment of tinea pedis. Janssen Pharmaceutica clinical research report. Piscataway, NJ; 1984 Sep.
61. Jolly HW, Greer D. Double-blind comparison of two doses of 2% ketoconazole cream (R41,400) in the treatment of chronic and acute tinea pedis. Janssen Pharmaceutica clinical research report No. N 31512. Piscataway, NJ; 1983 Mar.
62. Satriano RC. Ketoconazole 2% cream: an open comparison between one and two daily applications in patients with dermatophyte infections of the skin. Janssen Pharmaceutica clinical research report No. N 31400. Piscataway, NJ; 1983 Feb.
63. Savin RC, Horwitz SN. Double-blind comparison of 2% ketoconazole cream and placebo in the treatment of tinea versicolor. J Am Acad Dermatol. 1986; 15:500-3. [PubMed 3760275]
64. Smith KJ, Warnock DW, Kennedy CT et al. Azole resistance in Candida albicans. J Med Vet Mycol. 1986; 24:133-44.
65. Food and Drug Administration. Sulfiting agents; labeling in drugs for human use; warning statements. [21 CFR Part 201] Fed Regist. 1986; 51:43900-5.
66. Greer D, Jolly HW. Comparative trial of a two-dosage schedule of ketoconazole 2% cream for the treatment of tinea pedis. J Am Acad Dermatol. 1987; 17:53-6. [PubMed 3301923]
67. Smith EB. Ketoconazole 2% cream. Semin Dermatol. 1987; 6:62-5.
68. Greer D, Jolly HW. Topical ketoconazole treatment of cutaneous candidiasis. J Am Acad Dermatol. 1988; 4(Part 1):748-50.
69. Janssen Pharmaceutica. Ketoconazole 2% cream once daily in the treatment of cutaneous candidiasis: a summary of four double-blind placebo-controlled studies. Clinical summary report R 41400. Piscataway, NJ; 1986 Jul.
70. Carr MM, Pryce DM, Ive FA. Treatment of seborrhoeic dermatitis with ketoconazole: I. Response of seborrhoeic dermatitis of the scalp to topical ketoconazole. Br J Dermatol. 1987; 116:213-6. [IDIS 226412] [PubMed 2950914]
71. Wishner AJ, Teplitz ED, Goodman DS. Pityrosporum, ketoconazole, and seborrheic dermatitis. J Am Acad Dermatol. 1987; 17:140-1. [PubMed 2956294]
72. McNeil. Nizoral (ketoconazole) 2% shampoo prescribing information. Fort Washington, PA; 2003 Oct.
73. Faergemann J. Treatment of serborrhoeic dermatitis of the scalp with ketoconazole shampoo. A double blind study. Acta Derm Venereol. 1990; 70:171-2. [PubMed 1969208]
74. Farr PM, Krause LB, Marks JM et al. Response of scalp psoriasis to ketoconazole. Lancet. 1985; 2:921-2. [IDIS 206752] [PubMed 2865422]
75. Ford GP, Farr PM, Ire FA et al. The response of seborrhoeic dermatitis to ketoconazole. Br J Dermatol. 1984; 111:603-7. [IDIS 192376] [PubMed 6093845]
76. Green CA, Farr PM, Shusters. Treatment of seborrhoeic dermatitis with ketoconazole: II. Response of seborrhoeic dermatitis of the face, scalp and trunk to topical ketoconazole. Br J Dermatol. 1987; 116:217-21. [IDIS 226413] [PubMed 2950915]
77. Cavwenbergh G, DeDoncker P, Schrootea P et al. Treatment of dandruff with a 2% ketoconazole scalp gel. A double-blind placebo-controlled study. Int J Dermatol. 1986; 25:541. [PubMed 3533805]
78. Lester M. Ketoconazole 2 percent cream in the treatment of tinea pedis, tinea cruris, and tinea corporis. Cutis. 1995; 55:181-3. [PubMed 7634851]
79. Greer DL. Topical treatment for moccasin-type tinea pedis. J Am Acad Dermatol. 1987; 16:554-6. [PubMed 3546420]
80. Gupta AK, Einarson TR, Summerbell RC et al. An overview of topical antifungal therapy in dermatomycoses: a North American perspective. Drugs. 1998; 55:645-74. [PubMed 9585862]
81. Piérard GE, Arrese JE, Piérard-Franchimont C. Treatment and prophylaxis of tinea infections. Drugs. 1996; 52:209-24. [PubMed 8841739]
82. Lesher JL. Recent developments in antifungal therapy. Dermatol Clin. 1996; 14:163-9. [PubMed 8821170]
83. Hay RJ. Dermatophytosis and other superficial mycoses. In: Mandel GL, Douglas RG Jr, Bennett JE, eds. Principles and practices of infectious disease. 4th ed. New York: Churchill Livingston; 1995: 2375-86.
84. Drake LA, Dincehart SM, Farmer ER et al. Guidelines of care for superficial mycotic infections of the skin: tinea corporis, tinea cruris, tinea faciei, tinea manuum, and tinea pedis. J Am Acad Dermatol. 1996; 34:282-6. [IDIS 363962] [PubMed 8642094]
85. Reviewers’ comments (personal observations) on Sulconazole 84:04.08.
86. Sunenshine PJ, Schwartz RA, Janniger CK. Tinea versicolor: an update. Cutis. 1998; 61:65-72. [PubMed 9515210]
87. Assaf RR, Weil ML. The superficial mycoses. Dermatol Clin. 1996; 14:57-67. [PubMed 8821158]
88. Drake LA, Dinehart SM, Farmer ER et al. Guidelines of care for superficial mycotic infections of the skin: pityriasis (tinea) versicolor. J Am Acad Dermatol. 1996; 34:287-9. [IDIS 363963] [PubMed 8642095]
89. Bigardi AS, Pigatto PD, Altomare G. Allergic contact dermatitis due to sulconazole. Contact Dermatitis. 1992; 26:281-2. [PubMed 1395584]
90. Machet L, Vaillant L, Muller C et al. Contact dermatitis and cross-sensitivity from sulconazole nitrate. Contact Dermatitis. 1992; 26:352-3. [PubMed 1395603]
91. Jones SK, Kennedy CTC. Contact dermatitis from tioconazole. Contact Dermatitis. 1990; 22:122-3. [PubMed 2138969]
92. Baes H. Contact sensitivity to miconazole with ortho-chloro cross-sensitivity to other imidazoles. Contact Dermatitis. 1991; 24:89-93. [PubMed 1828223]
93. Marren P, Powell S. Contact sensitivity to tioconazole and other imidazoles. Contact Dermatitis. 1992; 27:129-30. [PubMed 1395626]
94. Stubb S, Heikkila H, Reitamo S et al. Contact allergy to tioconazole. Contact Dermatitis. 1992; 26:155-8. [PubMed 1387056]
97. Lange DS, Richards HM, Guarnieri J et al. Ketoconazole 2% shampoo in the treatment of tinea versicolor: a multicenter, randomized, double-blind, placebo-controlled trial. J Am Acad Dermatol. 1998; 39:944-50. [IDIS 419629] [PubMed 9843006]
98. Peter RU, Richarz-Barthauer U. Successful treatment and prophylaxis of scalp seborrhoeic dermatitis and dandruff with 2% ketoconazole shampoo: results of a multicentre, double-blind, placebo-controlled trial. Br J Dermatol. 1995; 132:441-5. [IDIS 343683] [PubMed 7718463]
99. Danby FW, Maddin WS, Margesson LJ et al. A randomized, double-blind, placebo-controlled trial of ketoconazole 2% shampoo versus selenium sulfide 2.5% shampoo in the treatment of moderate to severe dandruff. J Am Acad Dermatol. 1993; 29:1008-12. [PubMed 8245236]
100. Go IH, Wientjens DP, Koster M. A double-blind trial of 1% ketoconazole shampoo versus placebo in the treatment of dandruff. Mycoses. 1992; 35:103-5. [PubMed 1435847]
101. Anon. Ketoconazole shampoo for dandruff. Med Lett Drugs Ther. 1994; 36:68. [PubMed 8022364]
102. Bulmer AC, Bulmer GS. The antifungal action of dandruff shampoos. Mycopathologia. 1999; 147:63-65. [PubMed 10967964]
103. Janssen Pharmaceutica. Nizoral (ketoconazole) 2% shampoo prescribing information. Piscataway, NJ; 1990 Jun.
104. McNeil Consumer Healthcare. Nizoral A-D (ketoconazole) 1% shampoo patient information. Fort Washington, PA; 2002 Dec 18.
105. Barrier Therapeutics, Inc. Xolegel (ketoconazole) 2% gel prescribing information. Princeton, NJ; 2006 Jul.
106. Stiefel Laboratories, Inc. Extina (ketoconazole) 2% foam prescribing information. Coral Gables, FL; 2007 Jun.
107. Elewski B, Ling MR, Phillips TJ. Efficacy and safety of a new once-daily topical ketoconazole 2% gel in the treatment of seborrheic dermatitis: a phase III trial. J Drugs Dermatol. 2006; 5:646-50. [PubMed 16865870]
108. Swinyer LJ, Decroix J, Langner A et al. Ketoconazole gel 2% in the treatment of moderate to severe seborrheic dermatitis. Cutis. 2007; 79:475-82. [PubMed 17713152]
109. Elewski BE, Abramovits W, Kempers S et al. A novel foam formulation of ketoconazole 2% for the treatment of seborrheic dermatitis on multiple body regions. J Drugs Dermatol. 2007; 6:1001-8. [PubMed 17966177]
110. Teva Pharmaceuticals. Ketoconazole cream, 2% prescribing information. Sellersville, PA; 2005 Mar.