Sodium Sulfacetamide - Sulfur

[Guide]

Rosacea 101 page 54-5

by permission of the author

Sodium sulfacetamide-sulfur is an antibiotic and drying agent combination medicine and works by promoting the shedding of the top layer of skin (keratolysis).

“The combination of sodium sulfacetamide and sulfur is unique in the rosacea armamentarium because of its dual use as topical therapy and therapeutic cleanser. Several formulations of sulfacetamide 10% and sulfur 5% are now available as topical lotions and cleansers. The sulfacetamide/sulfur cleansers serve as adjunctive therapy by providing additive effects to other topical and oral therapies for rosacea with favorable tolerability and cosmetic appeal.” [279]

“After 12 weeks of treatment with sodium sulfacetamide 10% and sulfur 5% cream with sunscreens, there was a significantly greater percentage reduction (80%) in inflammatory lesions compared with metronidazole 0.75% cream (72%)(P = .04), as well as a significantly greater percentage of subjects with improved erythema (69% vs 45%, respectively; P = .0007). In addition, the sodium sulfacetamide 10% and sulfur 5% cream with sunscreens group had a significantly greater proportion of subjects with success in global improvement at week 12 compared with the metronidazole 0.75% cream group (79% vs 59%, respectively; P = .01).” [280]

“Sulfur has antifungal, antibacterial, and keratolytic activity. In the past, its use was widespread in dermatological disorders such as acne vulgaris, rosacea, seborrheic dermatitis, dandruff, pityriasis versicolor, scabies, and warts. Adverse events associated with topically applied sulfur are rare and mainly involve mild application site reactions. Sulfur, used alone or in combination with agents such as sodium sulfacetamide or salicylic acid, has demonstrated efficacy in the treatment of many dermatological conditions.” [281]

“Sulfur is a time-honored therapeutic agent useful in a variety of dermatologic disorders. Its keratolytic action is due to formation of hydrogen sulfide through a reaction that depends upon direct interaction between sulfur particles and keratinocytes. The smaller the particle size, the greater the degree of such interaction and the greater the therapeutic efficacy. When applied topically, sulfur induces various histologic changes, including hyperkeratosis, acanthosis, and dilatation of dermal vasculature.” [282]

Avar, Avar e Green, Plexion, Plexion SCT, Plexion TS, Rosanil, Rosac, Rosula, and Rosula NS are brand name sodium sulfacetamide-sulfur prescriptions.

Addendum

Sulphur has been used for a long time to treat rosacea. 283

The following warning is issued by Mission Pharmacal about using sulfacetamide: 

"Sulfonamides are known to cause Stevens-Johnson syndrome in hypersensitive individuals. Stevens-Johnson syndrome also has been reported following the use of sodium sulfacetamide topically. Cases of drug-induced systemic lupus erythematosus from topical sulfacetamide also have been reported." [1]

Etcetera

Sodium bituminosulfonate (derived from naturally occurring sulphur-rich oil shale) is now being considered in treating rosacea. 

Sulphur or Sulfur for Rosacea

End Notes

279 Evaluating the role of topical therapies in the management of rosacea: focus on combination sodium sulfacetamide and sulfur formulations.
Del Rosso JQ; Cutis. 2004 Jan;73(1 Suppl):29-33.

280 Combination sodium sulfacetamide 10% and sulfur 5% cream with sunscreens versus metronidazole 0.75% cream for rosacea.
Torok HM, Webster G, Dunlap FE, Egan N, Jarratt M, Stewart D.
Cutis. 2005 Jun;75(6):357-63.

281 The use of sulfur in dermatology.
Gupta AK, Nicol K; J Drugs Dermatol. 2004 Jul-Aug;3(4):427-31.

282 Sulfur revisited.
Lin AN, Reimer RJ, Carter DM; J Am Acad Dermatol. 1988 Mar;18(3):553-8.

283 http://www.artandmedicine.com/wood/images/Rosacea.jpg

PATIENT AT the Skin Clinic of the Women's Medical College. Rosacea is a chronic disease of the middle period of life. These "rosy drops" sometimes present a central point of a somewhat darker hue. In severe cases a fiery triangle may be seen on either cheek. In the most remarkable form of the disease the nose may attain the size of the fist. The eruption had troubled her more or less for six years and had been much worse than usual during the last month. She complained greatly of discomfort after eating and often vomited her food. The gastric irritability having subsided under a restricted diet, she was ordered Aug. 6, 1878, a mixture containing sulphate of iron and sulphate of magnesia, and for local application an ointment of sulphur, four parts, cosmoline, ninety-two parts. This was followed by rapid improvement, and when seen again on Sept. 17, all trace of the eruption had disappeared, and she felt much stronger and better. Source

[1]  Mission Pharmacal Contact Us page: 
WARNINGS
Sulfonamides are known to cause Stevens-Johnson syndrome in hypersensitive individuals. Stevens-Johnson syndrome also has been reported following the use of sodium sulfacetamide topically. Cases of drug-induced systemic lupus erythematosus from topical sulfacetamide also have been reported. In one of these cases, there was a fatal outcome. KEEP OUT OF THE REACH OF CHILDREN.