Final answer:
Ketoconazole is an antifungal medication effective against various dermatophyte infections and off label for androgenic alopecia in combination with other drugs. Spironolactone is used off label to treat female androgenic alopecia, but has feminizing side effects and other risks, making it unsuitable for men and pregnant women.
Step-by-step explanation:
Ketoconazole is an antifungal medication used in the treatment of various fungal infections. Its applications include treating conditions caused by dermatophytes, such as tinea pedis (athlete's foot), tinea cruris (jock itch), tinea corporis, and tinea versicolor. In addition to these uses, ketoconazole shampoo is often paired with an oral 5α-reductase inhibitor like finasteride or dutasteride off label to treat androgenic alopecia. When used in combination with other medications such as finasteride and minoxidil, it has been found more effective than when used individually for this purpose.
Spironolactone, on the other hand, is a medication with anti-androgenic properties that has been used off label to treat female androgenic alopecia, particularly when hair loss is progressive. It functions as a diuretic and has been useful in various conditions, but due to its feminizing side effects, it is not commonly used by men. Spironolactone can also cause several side effects, including low blood pressure, high blood potassium, and abnormal heart rhythms. It is teratogenic and therefore contraindicated in pregnant women or those trying to become pregnant.