Sulfur & Acne
Sulfur (aka "sulphur") is one of the longest-standing acne treatments currently being used. Sulfur is sometimes touted as a natural, less abrasive alternative to ingredients in other acne treatments.
The exact mechanism by which sulfur effects acne is unknown.[3] It is generally believed to have "keratolytic" action, meaning it acts on keratin cells in the skin.[3, 4] Keratin is a tough, protien-rich substance that is also found in fingernails, and the overproduction of keratin (hyperkeratinization) is believed to be a factor in acne. Sulfur is believed create hydrogen sulfide upon coming into contact with the skin, which inhibits keratin cells' ability to bond together, thereby disrupting hyperkeratonization.[3]
Sulfur also has antibacterial and antifungal properties, including action against proprionibacterium acnes (aka "P.acnes"), which is the bacteria most associated with acne.[4] Sulfur's antibacterial action is believed to result from sulfur interfering with bacterial ecosystems within the skin.[4]
In its natural form, sulfur is a yellow, nonmetallic powder. One study suggested that sulfur is mildly comedogenic, meaning it could clog pores.[5] This study suggested that sulfur could negatively affect acne treatment.[5] However, the suggestion that sulfur is comedogenic has not been confirmed by other studies. Any inference that sulfur does more harm than good would be unwarranted, given the overall evidence of sulfur's effectiveness in improving acne symptoms.
Sulfur is deemed safe and effective for the over-the-counter treatment of acne by the United States Food and Drug Administration, either alone or in combination with resorcinal.[1] Resorcinal, by contrast, is only deemed effective for treating acne when used with sulfur.[2]
Sulfur is also found in prescription acne treatments, typically in combination with other medications, such as sodium sulfacetimide and benzoyl peroxide. Sulfur's use with benzoyl peroxide may enhance its effectiveness, with the benzoyl peroxide possibly facilitating the effects of sulfur-produced sulfides on keratin.(3) Sodium sulfacetamide and sulfur also appear to have synergistic effects.[6]
As with many acne medications, it takes time for sulfur to exert its full effects. While studies show that patients taking sulfur often have some improvement after only one month, it may take three months or longer for sulfur to have its full effect on acne.[7]
References:- 21 C.F.R. §§ 333.301-333.310 (2007).
- 21 C.F.R. § 333.310-333.320 (2007).
- Pace, WE. A Benzoyl Peroxide-Sulfur Cream for Acne Vulgaris. Canad. Med. Ass. J. 1965;93(Aug.):252-54.
- Gupta AK, Karyn N. The use of sulfur in dermatology. Journal of Drugs in Dermatology. 2005;3(4);427-31
- Mills, OH, Kligman, AM. Is Sulphur Helpful or Harmful in Acne Vulgaris? Br. J. Derm. 1972;86:620-27.
- Akhaven A, Bershad, S. Topical Acne Drugs: Review of Clinical Properties, Systemic Exposure, and Safety. Am J Clin Dermatol. 2003; 4(7):473-92
- Wrong NM, Treatment of Acne with Sulphur Lotion. Br. J Derm. 1950;62(12):491-94.