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Nizoral, Ketoconazole & Pregnancy

By Amalah

Dear wise and venerated Amalah,

When I was pregnant with my first child, about halfway through I developed incredibly dry skin, accompanied by the all-embarrassing dandruff.  After she was born, it didn’t go away completely, but did subside. (By the way, I did see a dermatologist and it is dandruff and not dry scalp.)  After much experimentation, I landed on Nizoral, which cured me completely. Now I am 3 months pregnant, and it has gotten unbearable. I can’t use the Nizoral while pregnant, and the baking soda / apple cider vinegar doesn’t  work for me. I’m beside myself and nearly too mortified to leave my house.  What can I try?

Please help!
Itchy and Flaky

Advice Smackdown ArchivesSo…we all know that I am not a doctor, correct? But instead am simply a voracious web-surfer/reader and almost-spooky remember-er of everything I read? Right? Good.

I’m wondering why you think you can’t use Nizoral shampoo while you’re pregnant. Because…you can. There are warnings/cautions against pregnant woman INGESTING the main ingredient (ketoconazole) in TABLET FORM (which are dosed at 200mg), so perhaps you or your doctor misunderstood that the low-ketoconazole levels in the topical shampoo are generally considered safe for pregnancy and breastfeeding, because it’s not enough to get absorbed into your bloodstream — and definitely not enough to then travel through your circulatory system and past the placenta.  If you’re using the prescription version of Nizoral, it’s 2% ketoconazole. If you’re buying it over-the-counter at the supermarket, it’s only 1% ketoconazale. That’s nothing, frankly. And either way, if you’re following the package instructions, you’re only coming in contact with the stuff once or twice a week.

Ketoconazole is a Category C drug for pregnancy. This means: Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks. But note that the “adverse effects” occurred in HIGH INGESTED DOSES of the stuff, not the 1% or 2% topical versions. (Also, while the human studies on ketoconazole have been very small, NO problems were found for the subjects or their babies.)

I know, I know. These “topical” things are sticky, and I admit my own advice has probably been a bit all over the place about them, depending on the product. (Teensy dabs of 2% salicylic acid zit cream = totally okay; daily use shampoos loaded with a dozen suspect essential oil/herbal blends = ehhhhhhhh, maybe you could shop around a bit for an alternative?) So I get there’s a personal comfort layer to this stuff and what I personally might feel okay using might not be the same for you.

But for what it’s worth: Like the Category C description states, it all comes down to benefit to the mother compared to potential risk to the fetus. For you, the benefits are indisputable: dandruff is nasty, irritating stuff and it’s a problem that goes deeper than vanity or just wanting “pretty hair.” Your SCALP, dude. It’s flaking and itching and it can become terribly painful. Plus, the flakes. Nobody wants the flakes.

As for the potential risk to your baby: Minimal, if it exists at all. No, you should not take ketoconazole tablets during pregnancy, much like you shouldn’t ingest salicylic acid or tea tree oil or any number of things. Basically: If you’re pregnant and swallowing any sort of pill or supplement beyond a prenatal, STOP and call your doctor, or do some web research. But there’s no reason to get hopped up over every.single.ingredient. in products that you maybe only have a passing exposure to. Lots of things are good for us in moderation but bad for us in excess. Pregnancy, more or less, is the same way.

(Plus, you know, I’ve been watching a lot of Mad Men reruns and jeeeeeeeeeeebus lord. The smoking/drinking/God-knows-what-else of that period certainly puts our current heightened expectations on the “perfect pregnancy” into perspective, you know?)


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About the Author

Amy Corbett Storch


Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy’s daily mothering adventures at Ama...

Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy’s daily mothering adventures at Amalah. Also, it’s pronounced AIM-ah-lah.

If there is a question you would like answered on the Advice Smackdown, please submit it to

Amy also documented her second pregnancy (with Ezra) in our wildly popular Weekly Pregnancy Calendar, Zero to Forty.

Amy is mother to rising first-grader Noah, preschooler Ezra, and toddler Ike.

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  • Christy

    July 7, 2010 at 3:42 pm

    You know, I wonder if pregnant people 50 or 100 years from now will say the same things about us that we say about the “Mad Men” era pregnant women! “How could they DO that? Didn’t they know what if could do their babies?!”

  • Cledbo

    July 7, 2010 at 7:24 pm

    Yeah, Christy, but at the same time the human race keeps making new ones of itself regardless. While paying attention to all the good and bad stuff that affects the most vulnerable versions of ourselves is an important and excellent thing for us to do, in the huge long run we’ve been doing questionable to unspeakable things as pregnant ladies and babies, and we’ve still managed to over-populate the planet – some of that population are smart and funny too!
    Health is important, but freaking out over every.tiny.thing is kind of counter-productive.
    And in 50-100 years, I would rather everyone was focussing on getting the rest of the planet up to speed with things like women’s rights and education, rather than stressing that people used dandruff shampoo when there was a 0.00001% chance that maybe it was dangerous.

    This wasn’t an attack on you, btw, I’m just venting because developed-world dwellers like ourselves often forget that all this stress is a luxury only we can afford, plus I could care less what people in 100 years think because they’ll have 100 years worth of technological innovation we don’t have! 🙂

  • Abi

    July 7, 2010 at 11:21 pm

    My husband has really horrid dandruff/flaky skin in his scalp, face, ears, beard, sideburns, which I’ve actually been considering writing in about, but we seem to have found an effective solution for now: he worked olive oil into his scalp, and let it sit for probably an hour or two? (when he tried to wash it out initially we realized our water had been turned off, so he had to wait to go to work to wash it out) we used the hemp/tea tree oil dr. bronner’s instead of shampoo.
    He didn’t use it on his face, in his ears, or beard, but his scalp feels great, and I haven’t seen a single flake in a week or more. He’s also started washing his face with olive oil soap almost every day, and it is making a difference, but not nearly as much. I’d just go with straight olive oil.

  • Trish

    July 8, 2010 at 8:42 am

    Try Head and Shoulders Intensive Care: that is my daily shampoo and keeps the worst at bay. (I use Nizoral when my scalp flares up.) I used the Head and Shoulders throughout my pregnancy with no problems.

  • Kari weber

    July 9, 2010 at 12:19 pm

    Another important consideration for the OP “itchy and flaky” is that she says she doesn’t want to leave her house, she is so embarrassed… I see potential problems developing from that.  If the use of the Nizoral clears up the dandruff, and allows her to have a pregnancy free of self- consciousness (at a time when we are already OVER self- conscious as it is!) than I think it is worth the emotional health alone.  

  • Treeling

    July 9, 2010 at 6:15 pm

    I used Nizoral– my result is a healthy, live 2 month old baby thus far.  No word yet on whether he’s able to solve the Israeli-Palestinian crisis, but he seems ok and hitting his milestones.

    If it makes you feel any better about it– my baby’s pediatrician prescribed ketoconazole cream for my 2 week old son’s yeasty diaper rash with no hesitation.  Prescription strength. 

    So, if it’s safe to put straight on the baby, it’s probably safe to put it on the mommy, whose body is, after all, a giant Brita filter that does a pretty good job of protecting the growing offspring contained within and will filter the shampoo down to nothing.

    And as to the Mad Men thing– I think the takeaway is less “don’t they know what they were doing to their babies???” and more “Wait, I thought that X was supposed to cause horrible thing Y to happen to babies and yet clearly the vast majority of babies born in the 60’s turned out okay despite parents engaging in flagrant and frequent bouts of horrible thing Y!”   Perhaps we slightly oversell the dangers of just about EVERYTHING these days– particularly to pregnant and new moms.

    Best Mad Men parenting moment– Sally Draper playing moon man in the dry cleaning bag.  “Sally DRAPER!”…… “if the clothes that were in that bag are on the floor…!”

  • tasterspoon

    July 14, 2010 at 2:24 pm

    Tip for the OP and all pregnant ladies in re Mad Men: whatever you do, don’t tell your child that you engaged in thing X. At a family wedding this past weekend, my mom was surprised to learn that I (5 months preg) was not drinking and said, “Oh, well I drank the whole time I was pregnant with you and never thought anything of it.” Which led me to be pissed at her for several days, like, “Do you mean to say that ALL THIS TIME I could have been a GENIUS, and, while we’re on the topic, why didn’t you sign me up for ice skating lessons when I was four so I could have been in the OLYMPICS?!?”