Elemental sulfur (S)

Elemental sulfur is a naturally occurring non-metallic element that has been utilized for centuries in the treatment of various dermatological conditions. In modern medicine, it is employed as a versatile therapeutic agent in topical preparations, where it undergoes chemical conversion upon contact with the skin. Its medicinal action is largely mediated by its reduction to hydrogen sulfide (H2S) by keratinocytes and its oxidation by cutaneous bacteria to pentathionic acid. These metabolites exert keratolytic effects by breaking down the stratum corneum and demonstrate broad-spectrum antimicrobial activity against bacteria, fungi, and parasites. Sulfur is particularly effective in managing inflammatory skin diseases such as acne vulgaris, seborrheic dermatitis, and rosacea, as well as parasitic infestations like scabies. Despite its long history of use, it remains a staple in dermatology due to its efficacy and relatively low risk of systemic toxicity, although its characteristic odor and potential for localized skin irritation are common drawbacks.

Other names

SulfurBrimstoneFlowers of sulfurSublimed sulfurPrecipitated sulfurColloidal sulfurOctasulfur

Elemental sulfur acts as a prodrug that is topically converted into hydrogen sulfide (H2S) through interaction with cysteine in keratinocytes and by cutaneous bacteria; H2S subsequently breaks down keratin to provide keratolytic effects [1][4]. It is also converted into pentathionic acid by skin flora, which is toxic to fungi and parasites such as Sarcoptes scabiei [2][4]. Additionally, sulfur exerts antibacterial effects by inactivating sulfhydryl groups in essential microbial enzyme systems [4].