Pharmacology: Pharmacodynamics: Ketoconazole is an imidazole antifungal agent which interferes with ergosterol synthesis and therefore alters the permeability of the cell membrane of sensitive fungi.
Pharmacokinetics: Ketoconazole is a broad-spectrum synthetic antifungal agent which inhibits the growth of the following common dermatophytes and yeasts by altering the permeability of the cell membrane: Dermatophytes-Trichophyton rubrum, T. mentagrophytes, T. tonsurans, Microsporum canis, M. audouini, M. gypseum and Epidermophyton floccosum; Yeasts-Candida albicans and C. tropicalis and the organism responsible for tinea versicolor, Malassezia furfur (Pityrosporum orbiculare).
Cream: Development of resistance to Ketoconazole has not been established. In vitro studies suggest that Ketoconazole impairs the synthesis for ergosterol which is a vital component of fungal cell membranes. The mechanism of therapeutic effect of Ketoconazole in seborrhoeic dermatitis has not been established.
Shampoo: Ketoconazole 2.0% shampoo may be effective in seborrhoeic dermatitis where yeast Pityrosporum is involved. A double-blind study in 50 patients with seborrhoeic dermatitis has shown Ketoconazole 2% cream/shampoo to be as effective as hydrocortisone 1% cream in providing symptomic improvement and to be more effective in reducing the number of yeast cells.