Androgenetic alopecia (AGA) causes significant psychosocial distress and deteriorates the patients quality of life. It is essential to explore more treatment options for patients unresponsive to first-line treatments of finasteride or minoxidil. Topical ketoconazole has been proposed as a promising therapy. A systematic review that evaluated the efficacy of topical ketoconazole in the treatment of AGA found:

• A marked increase in the mean ratio of hair regrowth to denuded area in the ketoconazole groups than controls in Murine studies.
• Increased hair shaft diameter after ketoconazole use in Human studies.
• A significant increase in the pilary index (percent anagen phase × diameter) post-treatment with ketoconazole.
• Clinical improvement of AGA as per photographic assessment and subjective evaluation. 

This study proves that topical ketoconazole is a promising adjunctive or alternative therapy for managing AGA.

Source:Fields JR, Vonu PM, Monir RL, Schoch JJ. Dermatol Ther. 2019;33(1):e13202.