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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 [email protected].

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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