Sulfur in pharmacy

Sulfur is used in pharmaceutical skin preparations for the treatment of acne and other conditions. It acts as a keratolytic agent and also kills bacteria, fungi, scabies mites and other parasites.

Sulfur in pharmacy

Clinical data
AHFS/Drugs.com	Multum Consumer Information
Routes of administration	Topical, rarely oral
ATC code	D10AB02 (WHO)
Legal status
Legal status	US: OTC In general: Over-the-counter (OTC)
Identifiers
IUPAC name Octathiocane
CAS Number	10544-50-0 Y 7704-34-9 (elemental sulfur)
PubChem CID	66348
ChemSpider	59726
UNII	70FD1KFU70
ChEBI	CHEBI:29385
Chemical and physical data
Formula	S8
Molar mass	256.48 g·mol−1
3D model (JSmol)	Interactive image
SMILES S1SSSSSSS1
InChI InChI=1S/S8/c1-2-4-6-8-7-5-3-1 Key:JLQNHALFVCURHW-UHFFFAOYSA-N

Chemically, it is the naturally occurring octasulfur (S₈).

Forms and uses

Pulverised sulfur

• Flowers of sulfur or sublimed sulfur (Latin: sulfur sublimatum) is the naturally occurring, unpurified form.^[1] It comes in yellow flakes and has been used in traditional and alternative medicine for humans and animals, as well as in alchemy and sulfuring fruit before drying.
• Purified sulfur (sulfur depuratum) is prepared by washing sublimed sulfur with ammonia. It is a fine yellow powder. It was formerly used as a laxative, but this application is rare today.^[1]
• Precipitated sulfur (sulfur praecipitatum) is prepared by boiling sulfur and calcium oxide in water and then precipitating with hydrochloric acid. It, too, is a fine yellow powder.^[1]
• Colloidal sulfur (sulfur colloidale) is an extremely fine sulfur powder prepared by repeated precipitation, first from polysulfides with protein and then from a slightly alkaline solution with ethanol or acetone. It has a greyish-white colour. Colloidal solutions in water are milky, and bluish when viewed against the light due to the Tyndall effect.^[1]

Topical uses

Precipitated sulfur and colloidal sulfur are used, in form of lotions, creams, powders, soaps, and bath additives, for the treatment of acne vulgaris, acne rosacea, and seborrhoeic dermatitis.^[1][2][3] Other topical uses included the treatment of superficial mycoses (infections with fungi) and scabies, but this is largely obsolete now.

Sulfur soap found in Shanghai, China

Adverse effects

Common adverse effects include irritation of the skin at the application site, such as dryness, stinging, itching and peeling.^[4] Generalised allergic reactions are rare; they include hives as well as swelling of lips, tongue, and throat, potentially closing up the respiratory tract.^[4]

Overdose

Ingesting more than a few grams can lead to poisoning by hydrogen sulfide (H₂S), which the gut flora produces from sulfur. H₂S is also generated on the skin, but topical formulations do not induce toxic concentrations, except when large quantities are used for small children.^[1]

Mechanism of action

Sulfur is converted to hydrogen sulfide through reduction, partly by bacteria. H₂S kills bacteria (possibly including Propionibacterium acnes which plays a role in acne^[2]), fungi, and parasites such as scabies mites. In the gut, H₂S increases motility, acting as a laxative.^[1] Sulfur's keratolytic action is also mediated by H₂S; in this case, the hydrogen sulfide is produced by direct interaction with the target keratinocytes themselves.^[5]

See also

• Sulfur (general information about this chemical element)

References

1. Hagers Handbuch der Pharmazeutischen Praxis (in German). Vol. 6B (4th ed.). Berlin–Heidelberg–New York: Springer. 1978. pp. 672–9. ISBN 3-540-07738-3.
2. FDA Professional Drug Information: Perrigo Sodium Sulfacetamide and Sulfur.
3. Arzneibuch-Kommentar. Wissenschaftliche Erläuterungen zum Europäischen Arzneibuch und zum Deutschen Arzneibuch [Pharmacopoeia Commentary. Scientific annotations to the European Pharmacopoeia and the German Pharmacopoeia] (in German) (23rd ed.). Stuttgart: Wissenschaftliche Verlagsgesellschaft. 2004. Monographie Schwefel zum äußerlichen Gebrauch [Monograph Sulfur for external use]. ISBN 978-3-8047-2575-1.
4. Multum Consumer Information: Sulfur topical.
5. Lin AN, Reimer RJ, Carter DM (March 1988). "Sulfur revisited". Journal of the American Academy of Dermatology. 18 (3): 553–8. doi:10.1016/S0190-9622(88)70079-1. PMID 2450900.