Nizoral 2% Ketoconazole Cream

The CIR Expert Panel has confirmed this ingredient to be nontoxic and clinical studies show no sensitization at cosmetic use concentrations.

True allergic reactions are quite rare: a 15-year retrospective study of 6,751 patients found only 0.31% had a positive reaction (and less than half were considered clinically relevant).

It seemed that when sensitization does occur, it's most commonly linked to topical medication (like corticosteroids) and not cosmetics. Allergic contact dermatitis also appears largely limited to individuals with underlying skin conditions.

Overall, propylene glycol is a well-studied ingredient that most people can tolerate without issue.

Though it has "alcohol" in the name, it is not related to denatured alcohol or ethyl alcohol.

The FDA allows products labeled "alcohol-free" to have fatty alcohols.

This ingredient may not be fungal acne safe. It is a primary fatty alcohol with a chain length above 12 carbons. A study from 2019 show Malassezia can feed on fatty alcohols in this range, so it may trigger fungal acne in those prone to it.

Fatty alcohols are usually derived from natural fats and oils and therefore do not have the same drying or irritating effect as solvent (ethanol) alcohols.

The FDA allows products labeled "alcohol-free" to have fatty alcohols.

This ingredient may not be fungal acne safe. It is a primary fatty alcohol with a chain length above 12 carbons. A study from 2019 show Malassezia can feed on fatty alcohols in this range, so it may trigger fungal acne in those prone to it.

The Cosmetic Ingredient Review has found 4% of this ingredient in repeat-insult patch tests on humans to be non-sensitizing. There is a caveat that some reactions have shown up in patients with damaged or diseased skin.

Because it is an ester of a C18 fatty acid, it falls into the C11-24 range that the Malassezia yeast can metabolize. This means this ingredient may not be fungal acne safe.

In this case, the 60 comes from reacting 60 units of ethylene oxide with sorbitan.

Polysorbates are commonly used in medicine and foods.

The CIR Expert Panel has evaluated the scientific data and found this ingredient to be safe, non-irritating, and non-sensitizing at concentrations up to 5% (it's even approved by the FDA as an OTC eye drop ingredient).

This ingredient is generally considered non-toxic, non-irritating, and has low absorption potential.

You might have heard that this ingredient clogs pores. This reputation comes from the older rabbit ear studies which are more sensitive than human skin to clogging.

Dermatologist Dr. Zoe Draelos has also confirmed in a peer-reviewed paper that products containing comedogenic ingredients are not necessarily comedogenic themselves.

A small subset of people (~2%) may experience contact sensitivity so patch testing is a reasonable idea if you have reactive skin.

Since this ingredient is an ester of myristic acid (a C14 fatty acid), it falls within the carbon chain range that is known to feed Malassezia. This ingredient may not be fungal acne safe.