As I understand, most popular anti fungal soap/shampoo has Ketoconazole as an active ingredient. Ketoconazole stops the growth of fungi, but as it does not kill it, but halts division, how can soap/shampoo stop fungal infections? Not all fungus will reproduce at the same time during 5 minutes after soap/shampoo is applied on the skin, so is soap just pseudo medicine?
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Ketoconazole is a antifungal drug. How I understand many antifungal drugs, specifically ketoconazole, work, is through inhibition of the sterol biosynthesis pathway which forms ergosterol. Similar to how cholesterol is necessary for the stabilization or regulation of a mammalian lipid membrane, ergosterol works similarly in the cell membranes of fungi. Without ergosterol, it is most likely true that the fungi are incapable of survival.
The sterol biosynthesis pathway is incredibly long and complex, but ketoconazole works specifically to inhibit a key enzyme in the pathway known as CYP51A1. This inhibits the synthesis of ergosterol, as previously noted, which is necessary for most fungi for cell survival - so I do believe that ketoconazole does work to directly kill the fungus. As such, it is an appropriate treatment for fungal infections - the proof of which can be found in the fact that it was clinically approved to do so.
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