Nizoral A-D Shampoo Review
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Addendum 7May2012: [1] I received commentary from Marco Asteriti on the percentage calculation for ketoconazole. I assumed it was a percent of volume but Marco suggest it is percent of mass. Thus I have increased the number of ketoconazole pills from 11 to 19. Thanks Marco! [2] I've been looking for ways to reduce overall sebum production and my son has had improvement with Zinc for Acne (oral) tablets ($7.75 on amazon). The zinc doesn't know if it's meant for your face or your scalp anyhow. My "eyeball" estimate is that greasy/sebhorreic scalp flakes and facial acne reduced by half.
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I decided to make my own ketoconazole shampoo because I refuse to pay the price gougers on Amazon. ($109, really?!) My son has severe scalp seborrheic dermatitis due to the rampant hormones of puberty, and our pediatrician recommended Nizoral. I did a literature search to learn the chemistry. See Useful Articles below if you need some juicy bedtime reading ;-)
First, if helpful, here's my layman's understanding of how various anti-dandruff shampoos work (since I had to do all that legwork anyway):
Dandruff in general is accelerated skin cell maturation/shedding cycles (keratinization) and the "disorganized" attachment of lipid droplets to skin cells as they migrate to the outer layer of the scalp, thereby forming itchy flakes. Seborrheic dermatitis is the population explosion of opportunistic Malassezia fungus feasting on increased scalp sebum in addition to the above conditions. There are 7 species of Malassezia, and one in particular loves scalp sebum because it's rich in the saturated hard fats: triglycerides and cholesterol.
Ketoconazole is a broad spectrum antifungal that directly attacks Malassezia by causing their cell membranes to break down. It's also anti-inflammatory and reduces sebum. The mechanisms of action of selenium sulfide and zinc pyrithione are less well understood. Both reduce Malassezia count and scalp sebum, but basically tackle dandruff by other routes. Zinc pyrithione normalizes the abnormal keratin structure of the stratum corneum resulting in fewer lipid inclusions between skin cells, and therefore fewer flakes. Selenium sulfide reduces the cell turnover rate, which is normally 28-30 days but has been observed to be a week or less in cases of dandruff. Salicylic acid breaks down skin cell-sebum plaques or flakes; in other words, it's symptom management and can be useful in combination with other active ingredients. I passed over tar and sulfur shampoos as my son won't use them. Tea tree oil is out for us; it's a phytoestrogen that's documented to be feminizing if used regularly by boys.
Making ketoconazole shampoo:
In summary, antifungal medications are lipophilic, so you need a fat solvent -- or so I thought until I tried fish pills--- followed by an emulsifier to keep ketoconazole dispersed evenly in your shampoo.
The important issue is formulating ketoconazole at one percent. That begs the question: one percent of what? At one point in the shortage, we had been able to get the 2% Nizoral from the UK thru Amazon, and I saved the leaflet which stated: "The active ingredient in 1 g of Nizoral Dandruff Shampoo is ketoconazole 20mg." I had original posted with the assumption that this was 1% of volume, but a more learned commenter suggested that the ketoconazole concentration was a percentage of mass -- i.e., density x volume ---and suggested using the known density of water as a close-enough approximation of the density of shampoo. If you're feelin' geeky, you can research "percent composition by mass."
This shampoo has worked beautifully. Materials needed:
(1) Aqua Fungus 200mg ketoconazole tablets. 30 tablets, for fish, from Amazon $19.99 + $5 shipping. I figured fish pills just might be water soluable. Indeed they are, and simplifies the process of making the ketoconazole solvent.
(2) Polysorbate-80, 2 ounces, $2. It's a safe, low toxicity solvent/emulsifier commonly found in food and shampoo. It's inexpensive and readily available from DIY cosmetics websites such as Making Cosmetics, Lotion Crafter, Garden of Wisdom, etc.
(3) A bottle of shampoo with a refillable opening. I used Organix Morocco Argan Oil Shampoo, 385 ml or 13 fluid ounces. I chose argan oil because it's a lipid and a known hair softener that eliminates the need for a conditioner.
(4) A food scale. If you don't have one, you can just use as much shampoo as I did.
(5) A long clean stick for stirring. I used a stainless steel escargot fork because it's easy to sterilize.
(6) A sterile pyrex measuring cup large enough to hold most of your shampoo.
Kitchen friendly procedure:
(1) I bought a 385 ml bottle of shampoo. I used 19 pills. The formula for calculating 1% ketoconazole using the mass of water as an approximation for the unknowable mass of any particular shampoo:
.975g/ml x 385ml = total mass = 3850mg
3850mg/200mg tablets=19.25 tablets
(2) Fold a thick piece of paper in half. You don't want it to tear. The crease in the paper will help you transfer the crushed pills very neatly. I used a new Papyrus notecard. Put the pills along the fold and crush them as fine as possible with a small hammer or similar.
(3) Put the powder in a small, sterile cup, such as a shotglass. Add just enough distilled or boiled/cooled water to mix it thoroughly. Add a couple of teaspoons of polysorbate 80 and stir.
(4) Pour your shampoo into the pyrex cup first and then add the crushed pill mixture. Stir well and pour back into bottle.
If your shampoo separates from using too much water, shake the bottle before use. It's easier than a do-over.
Useful Articles:
Drug delivery strategies for improved azole antifungal action, W.Yang, et al, November, 2008. informahealthcare.com
Design and Development of Topical Microemulsion for Poorly Water-Soluble Antifungal Agents, P. Paranajoti, et al, Journal of Applied Research,2002
An Overview of Medicated Shampoos used in Dandruff Treatment, A. Sanfilippo & J. English. ptcommunity.com
Dandruff has an Altered Stratum Corneum Ultrastructure that is Improved with Zinc Pyrithione Shampoo, R.R. Warner, et al., Journal of the American Academy of Dermatology, Vol 45, Number 6
Prepubertal Gynecomastia Linked to Lavender and Tea Tree Oils, Henley,D. et al. [...]
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Nizoral A-D Shampoo Price
| Price: | $24.00 ($4.17 / oz) |
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Nizoral A-D Shampoo Overview
A-D Ketoconazole Shampoo 1%. Non-prescription strength. Controls flaking, scaling and itching. The freedom will go to your head. Made in Italy.
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Nizoral A-D Shampoo Features
- Helps to prevent recurrence of flaking and itching associated with dandruff.
- Protect from light and freezing.
- Non-prescription strength.
- freedom will go to your head.
Size: 4 oz.
Product Detail
- Product Dimensions: 2.5 x 1.1 x 6.1 inches ; 5.6 ounces
- Shipping Weight: 6.4 ounces (View shipping rates and policies)
- ASIN: B0000Y3CRY
- UPC: 300450895042
- Average Customer Review: 4.6 out of 5 stars See all reviews (47 customer reviews)
- Amazon Best Sellers Rank: #5,737 in Beauty (See Top 100 in Beauty)
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