Effects and Use of Sulfur in Dermatology

The use of sulfur compounds in Dermatology and Rheumatology has been known for centuries, but in recent decades it has fallen into oblivion.  This fascinating chemical element provides a number of application options including the latest, in particular in the form of bath treatments (tub and spray baths), which are preferred in the dermatological area.  Here, the positive effect on psoriasis vulgaris is particularly noteworthy and its fundamentals are set out in this article.

Inorganic sulfur can be used in a variety of chemical states – as its elementary state as well as sulfur sulfide and sulfur sulfate.
The main effect of the sulfur baths – also known as sulfide baths – is a result of their content of hydrogen sulfide (sulfur sulfide), which penetrates injured or diseased skin much better than healthy skin. 
The skin now has the ability to oxidize the sulfur compounds.  These chemical reactions are recognized as responsible among other things for the immunological effect of the sulfur, including the anti-inflammatory properties, and for the cell-protection offered by it.  Cell-damaging free oxygen radicals are at the same time detoxified by chemical reduction and can no longer harm the cells.
After bathing in sulfide water the rapid oxidization pathway was established in the skin.

Examination of the penetration of radioactively labelled sulfur sulfide (S-35) into the skin of healthy people and those suffering from skin diseases showed that it penetrates the cell membranes 100 times faster than oxygen and S-35 is distributed in all the layers of the epidermis after 8 hours. 
Here, the sulfur can be found both outside the cells (in normal skin and chronic eczema) as well as inside them (with seborrheic eczema and psoriasis).  The accumulation of hydrogen sulfide directly in the cells of the middle and lower layer of the epidermis established the efficacy of sulfur treatment in psoriasis.  The red and scaly plaques of the disease area are caused by chronic inflammation and high cell division activity in the area of the basal cell regions, which can be described on the basis of our present study results as the primary target of the effect of sulfur in the skin. 
Sulfur baths thus cause inflammation inhibition and cell division regulation.  The overproduction of skin cells encountered in psoriasis is reduced. 

Sulfur baths also have a desquamative (keratolysis) photosensitizing potency.  Under simultaneous irradiation with narrow-spectrum UVB light (SUP) after sulfur baths subsidence of the psoriasis skin changes could be observed in 82% of the patients after a treatment interval of 4 weeks.  Furthermore, it provides itching and pain relief, improves circulation and inactivates microoranisms, in particular bacteria, and could thus positively influence infections of the skin.

In various examinations at the cellular level an inhibition could be detected of local immune cells of the skin (Lagerhans cells), whose activity is responsible among other things for the creation and preservation of the underlying inflammation in psoriasis. 
It also disrupts the contact mechanism of these cells with other immune cells – lymphocytes, a type of white blood cells – thus preventing the progression of the inflammatory processes.  The simultaneously obtained clinical findings and the results of blood tests show a stable immune status and give no indication of a resulting systemic immune deficiency. 

Sulfur is – partly essential – involved in the reconstruction of cell membranes, the formation of numerous endogenous substances and various biochemical processes in the human body.  Examples are sulfur-containing amino acids (methionine and cysteine), which are necessary for the construction of protein structures and lead to basic substances of connective tissue (glycoproteins such as chondroitin, dermatan and heparan).  Sulfur groups – the so-called thiol groups – are chemically oxidized in the bottom cell layer of the skin and contribute to its stabilization and cell strength.  In cases of psoriasis, the remaining thiol groups are also evident in the upper layers of the skin, which the existing cornification disorder – clinically visible as scaling – illustrates. 

In summary, responsible for the effect of sulfur baths are mechanical (desquamative), disinfecting as well as, after the penetration of the sulfur into the skin, inflammation-inhibiting, cell division regulating and antioxidant effects.  Based on this, still true today is the saying, “Vel mirabilis natura sulfuris – The sulfur effect is a great miracle.“ (Pliny)

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