Sulfur Smells Bad, but Is a Useful Aid in the Treatment of Acne, Especially When Combined With Other Medications
The Essential Info
Sulfur is a time-tested topical treatment for acne that people have been using since the 5th century BC for its ability to:
- Shed the outer layer of skin cells. This helps pores from becoming clogged.
- Inhibiting the growth of acne bacteria.
However, due to the unpleasant odor of sulfur and the temporary skin-discoloration that it can impart, topical treatments containing only sulfur are unpopular. This is why you’ll usually find it combined with benzoyl peroxide or sodium sulfacetamide (a prescription medication). Combining sulfur with these other medications cuts down on the unpleasant odor and also increases effectiveness. Caution: You should not use sulfur combined with sulfacetamide if you are allergic to sulfa drugs.
Side effects of topical sulfur include:
- Peeling of the skin
- Occasional cracking/splitting of the skin around the mouth
The higher the percentage of sulfur you use the more side effects you can expect.
Topical application of sulfur has been used to treat various skin conditions since the time of Hippocrates (5thcentury BC). Since the 1960s, modern science has validated its effectiveness in treating acne, particularly when combined with other ingredients such as benzoyl peroxide.
Sulfur is used to treat a variety of conditions, including:
- Seborrheic dermatitis (scaly patches and red skin, usually on the scalp)
- Fungal infections
In nature, sulfur is a yellow, nonmetallic element found in the Earth’s crust. A particular type of sulfur called colloidal sulfur is the most commonly used and most potent form of sulfur due to the smaller size of its particles, which makes it work better when applied to the skin.
How Sulfur Works on Acne
Sulfur helps with acne in two ways:
- Promoting the shedding of the outer layer of skin cells, helping pores from becoming clogged.
- Inhibiting the growth of acne bacteria.
Expand to read the deeper science of how sulfur works
When combined with other medications, sulfur may work in these ways:
Combined with benzoyl peroxide:
- Benzoyl peroxide may increase the skin shedding effect of sulfur.
Combined with sodium sulfacetamide (a prescription medication):
- Sulfur combined with sodium sulfacetamide demonstrates anti-inflammatory properties.1 Since acne is at its root an inflammatory disease, anything that reduces inflammation may reduce acne.
How Well Sulfur Works – Study Results
Because sulfur alone isn’t as effective as it is when combined with other medications, and because sulfur alone can produce skin discoloration and has a bad odor, it normally is not used on its own.
However, when combined with ingredients such as benzoyl peroxide8 and sodium sulfacetamide7 in the form of lotions, creams, soaps, and ointments that contain sulfur from 1 – 10%, it shows increased effectiveness.
A few sulfur-only products, such as Vleminckx’s solution and Ress’ solution, are infrequently used.4
When it comes to using sulfur together with benzoyl peroxide, one study found that this combination treatment successfully controlled mild-to-moderate acne within three or four months, and very severe acne within six to nine months.5 Another study found that a 3-month course of treatment with sulfur together with sodium sulfacetamide reduced the number of acne lesions by 78%.8
Expand to read details of studies
While uncommon, adverse effects of topical sulfur products include:
- Unpleasant odor
- Temporary discoloration of skin
- Drying, peeling, and swelling of the skin2,5,6,9-11
Pregnancy: Sulfur is a category C drug, which means there are no adequate studies performed on humans but potential benefits may warrant its use in pregnant women despite the potential risks.6 It is always important to speak with your doctor before using any medications, topical or otherwise, during pregnancy.
While preparations containing sulfur alone normally are well tolerated, preparations combined with sodium sulfacetamide are not recommended for patients with a sulfa allergy.10 Sulfa allergies can cause a number of symptoms varying in severity. The most common symptoms are skin reactions such as:
- Maculopapular rash (a rash that contains both a discolored area of skin and small, raised bumps)
- Morbilliform rash (small lesions that may combine to form larger lesions and hives and itching)12
These reactions occur generally within a few days of treatment and cease promptly after discontinuation. Although uncommon, patients with sulfa allergies can experience anaphylaxis (a life-threatening allergic reaction). Symptoms of anaphylaxis include hives, swelling of the lips and around the eyes, swelling of the windpipe, constriction of respiratory pathways, gastrointestinal disturbances, and low blood-pressure.12
- Keri, J. & Shiman, M. An update on the management of acne vulgaris. Clin Cosmet Investig Dermatol 2, 105 – 110 (2009). https://www.ncbi.nlm.nih.gov/pubmed/21436973
- Lin, A. N., Reimer, R. J. & Carter, D. M. Sulfur revisited. J Am Acad Dermatol 18, 553 – 558 (1988). https://www.ncbi.nlm.nih.gov/pubmed/2450900
- Abramovits, W. & Kennedy, A. J. Sulfur/sodium sulfacetamide preparations. Skinmed 3, 95 – 101 (2004). https://www.ncbi.nlm.nih.gov/pubmed/15010636
- Kaminsky, A. Less common methods to treat acne. Dermatology 206, 68 – 73 (2003). https://www.ncbi.nlm.nih.gov/pubmed/12566807
- Pace, W. E. A Benzoyl Peroxide-Sulfur Cream for Acne Vulgaris. Can Med Assoc J 93, 252 – 254 (1965). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1928665/
- Akhavan, A. & Bershad, S. Topical acne drugs: review of clinical properties, systemic exposure, and safety. Am J Clin Dermatol 4, 473 – 492 (2003). https://www.ncbi.nlm.nih.gov/pubmed/12814337
- Davis, S. Topical treatment of acne: skin care. SA Pharmacist’s Assistant 13, 42 – 44 (2013). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3997205/
- Breneman, D. L. & Ariano, M. C. Successful treatment of acne vulgaris in women with a new topical sodium sulfacetamide/sulfur lotion. Int J Dermatol 32, 365 – 367 (1993). https://www.ncbi.nlm.nih.gov/pubmed/8505165
- Del Rosso, J. Q. The use of sodium sulfacetamide 10%-sulfur 5% emollient foam in the treatment of acne vulgaris. J Clin Aesthet Dermatol 2, 26 – 29 (2009). https://pubmed.ncbi.nlm.nih.gov/20729951/
- Feldman, S., Careccia, R. E., Barham, K. L. & Hancox, J. Diagnosis and treatment of acne. Am Fam Physician 69, 2123 – 2130 (2004). https://www.ncbi.nlm.nih.gov/pubmed/15152959
- Russell, J. J. Topical therapy for acne. Am Fam Physician 61, 357 – 366 (2000). https://www.ncbi.nlm.nih.gov/pubmed/10670502
- Kelly, T. E. & Hackett, P. H. Acetazolamide and sulfonamide allergy: a not so simple story. High Alt Med Biol 11, 319 – 323 (2010). https://www.ncbi.nlm.nih.gov/pubmed/21190500