How sulfur compounds can be used to treat acne

Sulfur (Sulphur in Europe) is a yellow, non-metallic natural element and one of the building blocks of life. Sulfur is present in many proteins, vitamins and hormones that are necessary for a healthy skin and is a major component of keratin present in the skin, hairs and nails.

Sulfur has antifungal, antibacterial and keratolytic properties besides being a good exfoliant for removing dead cells. Despite all these properties, sulfur has gone out of favor for treating acne simply because of the range of therapeutic agents available for acne treatment. It still however remains a good and reliable treatment option for treating acne either alone or in combination with compounds such as sodium sulfacetamide and salicylic acid.

Mechanism of action

How it works is not known. It is believed that when sulfur is applied topically it reacts with a substance called cysteine present in the skin and produces hydrogen sulfide. Hydrogen sulfide breaks down keratin a protein found in epithelial cell debris. It also produces pentathonic acid which is toxic to fungus and has an inhibitory effect on propionibacterium acne, the bacteria responsible for infections and scarring in severe acne.

Effectiveness

A study was done to compare the effectiveness of sulfur 10% cream with systemic tetracycline. The sulfur cream achieved a greater reduction in the number of inflamed lesions, with no difference in the relapse rate within 6 months.

Advantages

It has very mild side effects at the application site compared to other topical applications.

Sulfur is well absorbed by the body system. This was well demonstrated in a study where sulfur was detected in the epidermis two hours and throughout the skin within eight hours of application. Twenty four hours after application no sulfur could be detected in the skin.

Initially it was thought that that sulfur was comedogenic. However application of a 5% test solutions of sulfur on comedone free skins of healthy subjects with or without acne, showed no such correlation between comedone developments and the presence or absence of sulfur in the formulation applied.

Combination therapy

Sulfur has been used in combination with compounds such as sodium sulfacetamide and salicylic acid. Sodium sulfacetamide inhibits the action of paraaminobenzoic acid which is required for bacterial growth. It hence suppresses the growth of propionibacterium acne. Sodium sulfacetamide has several advantages, namely the absence of any major side effect, the consistent response to therapy and its cosmetically appealing formulation which leads to long term compliance.

Clinical trials, conducted with sulfur 5% and sodium sulfacetamide 10% formulations, were found to be quite effective in reducing the number of comedones and inflammatory lesions, by almost 70-80%. Formulations of sulfur and sodium sulfacetamide are available as lotions, topical suspensions and cleansers. Side effects such as dryness and itching were rare, mild and self-limiting.

Conclusions

Although the use of sulfur and its compounds in acne treatment has declined, it still remains a good treatment option, considering its safety, mild side effects and efficacy.