Related Terms

• Balneotherapy, brimstone, Dead Sea, mineral water, shiliuhuang (Chinese), sulfur water, sulphur, sulpur, thion, Toto.

• Combination products: BHI Cold (sulfur and pulsatilla); Luffa comp-Heel™ nasal spray (Luffa operculata, Galphimia glauca, histamine, sulfur); Engystol® (swallow-wort, sulfur); Zeel comp® (Rhus toxicodendron, sulphur, radix Arnica montana, Sanguinaria canadensis, and dulcamara).

• Note: This monograph focuses on elemental sulfur used to treat human medical conditions. The following items were excluded from this monograph: sulfur mustard, iron-sulfur clusters, sulfur dioxide, sulfur accumulation in plants, sulfur-containing antioxidants, sulfur-containing amino acids, volatile sulfur compounds, sulfur nutrition in plants, sulfur-containing compounds in garlic, and organosulfur compounds.

Background

• Sulfur is a tasteless, yellow crystalline solid. In nature, it can be found as the pure element or in sulfide and sulfate minerals. Sulfur is a constituent of petroleum, sulfuric acid, and natural gas. Its commercial uses are primarily in fertilizers, but it is also widely used in gunpowder, matches, insecticides, and fungicides.

• Elemental sulfur is present in all living tissues. After calcium and phosphorus, it is the third most abundant mineral element in the human body. It is essential for life and is found in two amino acids, cysteine and methionine. Sulfur is found in foods such as meat, garlic, onion, dates, and broccoli. Dietary sulfur supplementation may be indicated for vegan athletes, children, the elderly, or patients with HIV, as these populations are at an increased risk for sulfur deficiency.

• Sulfur is commonly used in homeopathic medicine to treat acne, rosacea (facial inflammation), scabies, seborrheic dermatitis (skin inflammation), tinea versicolor (fungal skin infection), recurrent upper respiratory tract infection, and dandruff. Sulfur, used alone or in combination with other agents, has demonstrated efficacy in the treatment of many skin conditions.

• Balneotherapy (mineral baths) is one of the oldest forms of therapy for patients with arthritis. There is evidence supporting the use of sulfur baths for the treatment of rheumatism and rheumatoid arthritis. While is not enough clinical evidence to recommend sulfur baths in replacement of standard modes of therapy for osteoarthritis, it may be safely added to standard regimens.

• Sulfur preparations have been studied for use in allergic rhinitis, ankylosing spondylitis (a form of arthritis), arthritis (psoriatic), atherosclerosis (hardening of the arteries), the common cold, dandruff, deafness (rhinogenic), fibromyalgia (muscle and soft tissue pain), inflammation (rhinopharyngotubaric phlogoses), pain (rheumatic disease), rheumatoid arthritis, rosacea (facial inflammation), scabies, and skin disorders. High-quality human trials supporting the use of sulfur for conditions other than osteoarthritis are lacking at this time.

Scientific Evidence

Tradition/Theory

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.

• Acne, AIDS, allergies, antibacterial, antifungal, antiparasitic, athletic injuries, bladder disorders, bronchitis (chronic), cancer, chronic pain, cleanser (dentures), congestive heart failure, constipation, depression, diabetes, eczema (itchy skin), high cholesterol, interstitial cystitis (inflammation of the bladder wall), itchiness, laxative, menopausal symptoms, pharyngitis (sore throat), psoriasis (red and irritated skin), rashes, seborrheic dermatitis (skin inflammation), tinea versicolor (skin infection), upper respiratory tract infection, warts.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (18 years and older)

• For acne, lotions, ointments, creams, or soaps containing 1-10% sulfur have been applied to affected areas. Manufacturers usually recommend applying creams or ointments to the entire affected area, 1-3 times daily.

• For atherosclerosis (hardening of the arteries), 50 milliliters of undiluted sulfur spring water has been taken by mouth three times daily for four weeks.

• For chronic lichen simplex (long-term itching and thickening of the skin), 200 milliliters of a homeopathic preparation has been taken by mouth once daily for one year.

• For dandruff, a shampoo containing 2% sulfur has been used. Manufacturers recommend shampooing as often as once daily until flakes are under control.

• For fibromyalgia (muscle and soft tissue pain), sulfur baths have been used for 10 days.

• For osteoarthritis, bathing in a sulfur pool for 2-3 weeks or twice weekly for six consecutive weeks has been used.

• For rheumatoid arthritis, daily sulfur baths for 12-14 days have been used.

• For rosacea (facial inflammation), the manufacturer of Rosula® recommends using an ointment containing 10% sulfur applied every night for three weeks or a lotion containing 10% sulfacetamide with 5% sulfur applied 1-3 times daily.

• For scabies, an ointment containing 2-8% precipitated sulfur in petrolatum has been applied once daily for six days, followed by a one-week rest period, application for two days, thoroughly washing off with neutral soap, and application of lubricant cream.

• For seborrheic dermatitis, a manufacturer recommends using a shampoo containing 2% sulfur and salicylic acid daily or every other day until noticeable improvement, then once or twice per week. Alternatively, a lotion containing 10% sulfacetamide with 5% sulfur may be applied 1-3 times daily.

Children (under 18 years old)

• For deafness (rhinogenic), sulfur inhalation therapy (aerosol + Politzer) have been used for 12 consecutive days.

• For scabies, an ointment containing 2-8% precipitated sulfur in petrolatum has been applied once daily for six days, followed by a one-week rest period, application for two days, thoroughly washing off with neutral soap, and application of lubricant cream. Concentrations have been 2% for children up to six years old, and 2-5% for adolescents and pregnant women. Children under two years old have worn the ointment for three hours, while all others have worn it overnight.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

• Avoid in individuals with a known allergy or sensitivity to sulfur. Rare hypersensitivity reactions from sodium sulfacetamide in topical acne treatments have been reported.

Side Effects and Warnings

• Sulfur may cause application site reactions, eye irritation, gastrointestinal problems, kidney damage, hives, respiratory problems, metabolic acidosis (too much acid in body fluids), heat reactions, and mild skin inflammation.

• Sulfur may increase the risk of bleeding. Caution is advised in patients with bleeding disorders or those taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary.

• Use cautiously in infants. There are reports of deaths in infants after application of sulfur to large areas of the body for the treatment of scabies.

• Use heated sulfur baths cautiously, as serious adverse reactions to heat may be possible.

• Use cautiously in patients with kidney disease, as sulfur ingestion may cause kidney damage.

• Use concentrated sulfur products cautiously, as ingestion of elemental sulfur is known to be poisonous.

• Use cautiously in patients with sensitive skin.

• Use cautiously in patients with gastrointestinal sensitivities. Swallowing large amounts may cause nausea, vomiting, and diarrhea.

• Use caution with sulfur products taken by mouth, as ingestion of sulfur may cause sulfhemoglobinemia, a rare blood condition.

• Use cautiously in patients with an allergy or sensitivity to sulfonamides.

• Avoid using or storing sulfur products near a heat source or other chemicals.

• Avoid the use of topical sulfur on irritated skin.

• Avoid the use of concentrated sulfur on the skin.

• Avoid getting sulfur products near the eyes, as the U.S. Environmental Protection Agency (EPA) reports that it is an eye irritant. In case of contact with eyes, rinse immediately with plenty of water and seek medical advice.

• Avoid inhaling sulfur products, as overexposure to sulfur has caused respiratory disturbances, chronic bronchitis, chronic sinus effects, chest discomfort, asthma, difficulty breathing, and irritation of the respiratory tract. Breathing of dust may aggravate asthma and other pulmonary diseases. Local adverse effects were reported to be associated with a sulfur-containing nasal spray.

• Avoid use of sulfur preparations in pregnant or breastfeeding patients, due to a lack of safety information.

• Avoid in individuals with a known allergy or sensitivity to sulfur. Rare hypersensitivity reactions from sodium sulfacetamide in topical acne treatments have been reported.

Pregnancy and Breastfeeding

• Sulfur is likely safe when consumed by nonallergic women in amounts generally found in foods. It is not recommended for medicinal use in pregnant or breastfeeding patients, due to a lack of safety information.

Interactions

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

Interactions with Drugs

• Sulfur may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants (blood thinners) such as warfarin (Coumadin®) or heparin, antiplatelet drugs such as clopidogrel (Plavix®), and nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).

• Sulfur may also interact with anti-inflammatory drugs, cholesterol-lowering drugs, isotretinoin, laxatives, and retinoids.

Interactions with Herbs and Dietary Supplements

• Sulfur may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.

• Sulfur may also interact with anti-inflammatory herbs and supplements, cholesterol-lowering herbs and supplements, and laxatives.

Author Information

• This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

References

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

1. Bordet, M. F., Colas, A., Marijnen, P., et al. Treating hot flushes in menopausal women with homeopathic treatment--results of an observational study. Homeopathy. 2008;97(1):10-15. View Abstract

2. Colin, P. Homeopathy and respiratory allergies: a series of 147 cases. Homeopathy. 2006;95(2):68-72. View Abstract

3. de Souza, R. F., de Freitas Oliveira, Paranhos H., et al. Interventions for cleaning dentures in adults. Cochrane.Database.Syst.Rev 2009;(4):CD007395. View Abstract

4. Diaz, M., Cazorla, D., and Acosta, M. [Efficacy, safety and acceptability of precipitated sulphur petrolatum for topical treatment of scabies at the city of Coro, Falcon State, Venezuela]. Rev Invest Clin 2004;56(5):615-622. View Abstract

5. Dibbern, D. A., Jr. and Montanaro, A. Allergies to sulfonamide antibiotics and sulfur-containing drugs. Ann Allergy Asthma Immunol. 2008;100(2):91-100. View Abstract

6. Gupta, A. K. and Nicol, K. The use of sulfur in dermatology. J Drugs Dermatol. 2004;3(4):427-431. View Abstract

7. Gupta, R., Manchanda, R. K., and Arya, B. S. Homoeopathy for the treatment of lichen simplex chronicus: a case series. Homeopathy. 2006;95(4):245-247. View Abstract

8. Leibetseder, V., Strauss-Blasche, G., Holzer, F., et al. Improving homocysteine levels through balneotherapy: effects of sulphur baths. Clin Chim.Acta 2004;343(1-2):105-111. View Abstract

9. Leonard, T., Eady, A., and Leonardi-Bee, J. Complementary therapies for acne vulgaris. Cochrane Database of Systematic Reviews 2006;(4)

10. Nimni, M. E., Han, B., and Cordoba, F. Are we getting enough sulfur in our diet? Nutr Metab (Lond) 2007;4:24. View Abstract

11. Scheinfeld, N. Controlling scabies in institutional settings: a review of medications, treatment models, and implementation. Am J Clin Dermatol. 2004;5(1):31-37. View Abstract

12. Sherman, G., Zeller, L., Avriel, A., et al. Intermittent balneotherapy at the Dead Sea area for patients with knee osteoarthritis. Isr.Med Assoc.J 2009;11(2):88-93. View Abstract

13. Tiwari, N. L. Scope of homoeopathy in diabetic coma. National Journal of Homoeopathy 2006;8(6):420-421.

14. Trumbore, M. W., Goldstein, J. A., and Gurge, R. M. Treatment of papulopustular rosacea with sodium sulfacetamide 10%/sulfur 5% emollient foam. J Drugs Dermatol. 2009;8(3):299-304. View Abstract

15. Verhagen, A. P., Bierma-Zeinstra, S. M., Boers, M., et al. Balneotherapy for osteoarthritis. Cochrane.Database.Syst.Rev 2007;(4):CD006864. View Abstract