Is Sulfur the Answer to Your Acne?
There are so many things that people recommend as a topical to clear up acne: benzoyl peroxide, salicylic acid, turmeric, tea tree oil, coconut oil - you name it. The list goes on. Sometimes it's hard to determine what is right for everyone, so I find it useful to go ingredient-by-ingredient to weigh the pros and cons of each item - that way everyone can make an informed decision.
Sulfur is one such ingredient that people often recommend for acne.
What is Sulfur?
Sulfur is a naturally-occurring mineral that is found mostly near hot springs and volcanic craters. It has a distinct "rotten egg" smell, caused by sulfur dioxide gas escaping into the air.
Sulfur and Skin Care
Sulfur has been used on the skin for thousands of years. As early as 5,000 years ago, the ancient Egyptians used a salve made with sulfur to treat both acne and eczema, and Traditional Chinese Medicine was using sulfur in skin care, some 2,200 years ago. But just because it's something that has been done for a long time doesn't mean we should keep doing it, or that there's any premise to it.
So let's delve in a little more before we draw any conclusions.
Modern Use of Sulfur for Skin Care
Since the 1950’s, sulfur has been available in the form of a 5% sulfur foam that is applied directly to broken skin. The foam also contains 10% sodium sulfacetamide to make the product emollient without clogging pores, and moisturizing to the skin.
Sulfur creams, lotions, sprays, soap bars and ointments have come to the market since, although it is still not as popular as other treatments, such as benzoyl peroxide.
The Science Behind Sulfur
Sulfur is an inhibitor of growth of the P. acnes bacterium - it is a mild "antimicrobial." However, its precise mechanism of action is unknown. It is thought that the sulfur may interfere with and cause inactivation of sulfhydryl groups on the proteins involved in specific enzymatic pathways in the bacteria. For acne treatment, the sulfur is almost always combined with another antimicrobial called sodium sulfacetamide. This compound acts as a competitive antagonist to paraaminobenzoic acid (PABA), an essential component for bacterial growth.
Since most people who have acne do have some degree of inflammation due to the P. acnes bacterium, sulfur and sodium sulfacetamide are almost always included in the products to treat acne. One advantage of the topical application of antimicrobials such as sulfur is that they have very few side effects and do not lead to microbial resistance.
Sulfur also has both comedolytic and keratolytic properties by helping dry out problem areas while pushing to promote quicker shedding and exfoliation of pore-clogging dead skin cells, dirt, and oil, respectively. Sulfur works by making your very top layers of skin dry and peel off. This can unclog the pores, reduce oil, and acne.
Generally, sulfur-containing products are used as alternatives to antibiotics - they provide a similar action, and so anyone who benefits from antibiotics would likely also benefit from sulfur, although without the added risk of resistance.
Several studies have been done on patients with acne and use of sulfur as a monotherapy or in conjunction with other treatments, and although the majority of the evidence rides on case studies, the response is almost always positive.
Is Sulfur Suitable for My Acne?
Sulfur works best if you have mild to moderate acne characterized by pustules and small pimples, but case studies have shown that even people with severe or cystic/hormonal acne may also benefit from its anti-inflammatory properties. It is perfect for both inflammatory and comedonal acne. So, if you have pustules, blackheads, or a combination of the two, sulfur may help to improve your skin.
Sulfur can also be useful when treating patients who may have acne as well as rosacea and/or seborrheic dermatitis, as these conditions can also respond to this medication. This is doubly exciting for those of us with concurrent skin conditions.
Which Sulfur Products Should I Use?
Some sulfur-containing products have a heavy fragrance to cover the icky sulfur smell - but opting for these types of products is more likely to irritate the skin. There are certain sulfur-containing products that are better than others. Here's a few I like:
Grandpa's Thylox Acne Treatment - a gentle cleanser
Mario Badescu Drying Lotion - this is a great spot treatment
Keep in mind that you won't want to use all three of these products at the same time - the results would likely be dry, irritated skin and we don't want that. Opt for whichever product you feel will help you the most - if you feel your cleanser is sub-par, try the soap bar. If you feel like you like your skin care routine just the way it is but want to treat and prevent pimples even more, try the De La Cruz Sulfur Ointment (my personal preference). Or, if you just want a gentle but effective way to get rid of pimples when they do pop up, opt for the Drying Lotion spot treatment.
While sulfur is generally recognized as safe, please note that mild irritation at the site of application may occur. Discontinue use if this issue persists.