Ionic Minerals Sulfur Liquid Concentrate by Eidon Inc.

POSSIBLY EFFECTIVE

• Dandruff. Sulfur is an FDA-permitted ingredient of over-the-counter (OTC) topical products to treat dandruff (88107). However, efficacy data from clinical trials is limited. In a study of 48 adults using shampoos containing sulfur 2%, salicylic acid 2%, or both ingredients twice weekly for 5 weeks, reductions in scaling and the number of desquamating cells per square centimeter were greater with any of the active treatments compared with the shampoo base alone. However, the combination of both ingredients produced significantly greater and earlier reductions than either active ingredient alone (88108).
• Scabies. Applying topical preparations of 5% to 20% precipitated sulfur in petrolatum appears to be effective for the treatment of scabies in some patients. Response occurs in 24% to 97% of patients, but is unpleasant due to the smell. Sulfur preparations are applied overnight (10-12 hours) for between 3 and 6 nights, with reduced efficacy when used for only 24 hours (27846,27847,88124,98205,98207). Concentrations should be limited to between 2% and 6% for infants, children, adolescents, and pregnant women (27846,27847,98207). Sulfur ointments have also been compared with other treatments for scabies. Clinical research and a meta-analysis of the available research show that topical sulfur is less effective and has a higher risk of adverse effects when compared with topical permethrin or topical or oral ivermectin (98205,100735). Sulfur ointment also seems to be more expensive when compared with topical permethrin or oral ivermectin (98207). Preliminary clinical trials and a meta-analysis have reported similar efficacy rates for topical sulfur and lindane, and for topical sulfur and benzyl benzoate (27848,100735).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Acne. Sulfur in concentrations of 3% to 10% is an FDA-permitted ingredient in over-the-counter (OTC) topical products to treat acne (88107,88123). However, efficacy data is mainly anecdotal (88122). Creams and ointments containing 1% to 10% sulfur have been used to treat acne for many decades, but sulfur is now generally found in combination with benzoyl peroxide, salicylic acid, or sodium sulfacetamide (88120,88121).
• Allergic rhinitis (hay fever). A preliminary clinical study suggests that using a homeopathic nasal spray containing sulfur, luffa, Galphimia glauca, and histamine for 42 days has similar efficacy to cromolyn sodium nasal spray for relief of symptoms of allergic rhinitis (60080).
• Chronic obstructive pulmonary disease (COPD). Preliminary clinical research shows that inhalation of aerosolized sulfurous water (Acqua Breta, Terme di Riolo) 5 mL once daily for 12 days does not improve lung function when compared with baseline in patients with COPD (98206).
• Common cold. A preliminary clinical study suggests that taking a homeopathic product containing sulfur and German ipecac (Engystol, Heel GmbH) orally for up to 2 weeks during a cold provides similar symptomatic relief to conventional over-the-counter remedies such as antihistamines, antitussives, and NSAIDs (27849).
• Hyperlipidemia. A preliminary clinical study suggests that drinking 50 mL of water from a sulfurous spring three times daily for 4 weeks reduces total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride levels, and decreases platelet aggregability. However, the study has methodological problems, including the lack of a control group, and does not address the effects of sulfur alone (91101).
• Rosacea. Preliminary clinical research shows that applying sulfur 10% in an emollient base (Diprobase, Merck Sharp and Dohme) once daily for 4 weeks is as effective as oral tetracycline (300 mg twice daily for 1 week, then 150 mg twice daily for 3 weeks) for reducing rosacea papules and pustules (88113). Using a combination of sulfur 5% and sodium sulfacetamide 10% in a topical emollient foam (Clarifoam EF, Onset Dermatologics) twice daily also seems to reduce the severity of rosacea (88111,88112). Other clinical research shows that using this same product for 8 weeks reduces inflammatory lesions by an additional 42% and erythema by an additional 52% when compared with placebo (88112). In another study, using foam containing sulfur 5% and sodium sulfacetamide 10% for 8 weeks reduced papules, pustules, and overall severity of rosacea more than topical metronidazole 0.75% gel (88112). More evidence is needed to rate sulfur for these uses.

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POSSIBLY SAFE ...when used topically and appropriately, short-term. Topical products containing sulfur in concentrations up to 10% have been used safely in clinical research for up to 8 weeks (27846,27847,88107,88112,88123,88124,98205,98207,100735). There is insufficient reliable information available about the safety of using sulfur orally.

CHILDREN: POSSIBLY SAFE
when used topically and appropriately, short-term. Topical products containing sulfur in concentrations up to 6% have been used safely when applied nightly in children and adolescents for up to 6 nights (27846,27847). In infants, topical products containing sulfur in concentrations up to 2% have been safely applied for 3 hours daily for up to 6 days (27847).

PREGNANCY AND LACTATION: POSSIBLY SAFE
when applied topically and appropriately, short-term. Topical products containing sulfur in concentrations up to 6% have been safely applied nightly for up to 6 nights (27846,27847). There is insufficient reliable information available about the safety of sulfur when used orally; avoid using.

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General ...Topically, sulfur is generally well tolerated when used in concentrations of up to 10%. Adverse effects include skin dryness, irritation, and pruritus (27846,88112,88120,88121,88126). Orally, sulfur has been reported to cause diarrhea and metabolic acidosis (27845).

Dermatologic ...Topically, application of sulfur preparations can cause dryness, leading to local irritation and pruritus in up to 28% of patients (27846,88112,88120,88121,88126).

Gastrointestinal ...Orally, sulfur is converted to sulfide in the gastrointestinal tract, causing intestinal irritation which can lead to diarrhea (27845).

Renal ...There is one case report of metabolic acidosis occurring in a 57-year-old woman who had consumed approximately 250 grams of flowers of sulfur, a form of sulfur prepared by sublimation, over a 6-day period (27845). Underlying conditions, including diabetes and renal failure, may have contributed to the acidosis. Sulfur is converted to sulfide by colonic bacteria and then to sulfate in various tissues, generating hydrogen ions which can lead to acidosis when clearance mechanisms are overwhelmed (27845).

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