Sulfur the saga continues

[Guest guest]

An interesting abstract to follow. I have noted that several web

sites mention sulfur as being non comedogenic if it is precipitated

sulfur. Perhaps, there are too many impurities in the production of

sulfur by other methods besides precipitation. Sulfur is very useful

against yeasts and fungi, whatever you want to call them. It is also

a good anti-inflammatory without the baggage anti-inflammatories

usually carry.

Comedogenicity of current therapeutic products, cosmetics, and

ingredients in the rabbit ear.

Fulton JE Jr, Pay SR, Fulton JE 3rd.

Cosmetics continue to be used by acne-prone individuals. Often as

more acne develops, more cosmetics are applied. In order to protect

against this natural tendency, physicians should provide more patient

information on the currently available products and ingredients. This

presentation is designed to help in that effort. The data presented

were gleaned from the rabbit ear assay, which is not an ideal animal

model but is the best we have. If an ingredient is negative in the

rabbit ear assay, we feel it is safe on the acne-prone skin. A

strong, positive ingredient or cosmetic should be avoided. Ingredient

offenders include isopropyl myristate and its analogs, such as

isopropyl palmitate, isopropyl isostearate, butyl stearate,

isostearyl neopentanoate, myristyl myristate, decyl oleate, octyl

stearate, octyl palmitate or isocetyl stearate, and new introductions

by the cosmetic industry, such as propylene glycol-2 (PPG-2) myristyl

propionate. Lanolins continue to be a problem, especially derivatives

such as acetylated or ethoxylated lanolins. Our most troublesome

recent finding is the comedogenic potential of the D & C Red dyes.

They are universally used in the cosmetic industry, especially in

blushers. This may explain the predominance of cosmetic acne in the

cheekbone area. All of these D & C Red dyes tested to date, the

xanthenes, monoazoanilines, fluorans, and indigoids, are comedogenic.

Actually, this is not surprising as they are coal tar derivatives.

The natural red pigment, carmine, is noncomedogenic and can serve as

a substitute for D & C dyes in blushers. Many finished products are

comedogenic. Most troublesome to the dermatologists are the

therapeutic tools that we use, such as Liquimat, Retin-A cream,

Hytone, Staticin, Sulfoxl, Desquam-X, and Persadox HP cream. These

should be reformulated. We have been unable to confirm that

precipitated sulfur (U.S.P.) is a potent comedogen in the rabbit ear

assay. Clinically, we still find sulfur quite effective as an

adjuvant to the benzoyl peroxide therapy for the treatment of acne

vulgaris. We would suggest that the bias against sulfur be

reconsidered.

[Guest guest]

Thanks for this, 007! Where did this come from? I don't know anything

about sulfur, but it would be nice to create a comprehensive list of

comedogenic ingredients, and common skin irritants, somewhere for

everyone to contribute to and access. Maybe in association with

's wonderful (and hopefully legal ) idea about posting

product ingredients?

When you say yeast and fungi in a dermatologic context, you're

referring to both candida and non-candida dermatophytes (fungi that

cause skin infections in humans). In medical usage, unless you're

specifically referring to candida vaginitis which is commonly

referred to as a yeast infection, everything else is usually just

called a fungal infection.

Marjorie

Marjorie Lazoff, MD

> An interesting abstract to follow. I have noted that several web

> sites mention sulfur as being non comedogenic if it is precipitated

> sulfur. Perhaps, there are too many impurities in the production

of

> sulfur by other methods besides precipitation. Sulfur is very

useful

> against yeasts and fungi, whatever you want to call them. It is

also

> a good anti-inflammatory without the baggage anti-inflammatories

> usually carry.

>

>

> Comedogenicity of current therapeutic products, cosmetics, and

> ingredients in the rabbit ear.

>

> Fulton JE Jr, Pay SR, Fulton JE 3rd.

>

> Cosmetics continue to be used by acne-prone individuals. Often as

> more acne develops, more cosmetics are applied. In order to protect

> against this natural tendency, physicians should provide more

patient

> information on the currently available products and ingredients.

This

> presentation is designed to help in that effort. The data presented

> were gleaned from the rabbit ear assay, which is not an ideal

animal

> model but is the best we have. If an ingredient is negative in the

> rabbit ear assay, we feel it is safe on the acne-prone skin. A

> strong, positive ingredient or cosmetic should be avoided.

Ingredient

> offenders include isopropyl myristate and its analogs, such as

> isopropyl palmitate, isopropyl isostearate, butyl stearate,

> isostearyl neopentanoate, myristyl myristate, decyl oleate, octyl

> stearate, octyl palmitate or isocetyl stearate, and new

introductions

> by the cosmetic industry, such as propylene glycol-2 (PPG-2)

myristyl

> propionate. Lanolins continue to be a problem, especially

derivatives

> such as acetylated or ethoxylated lanolins. Our most troublesome

> recent finding is the comedogenic potential of the D & C Red dyes.

> They are universally used in the cosmetic industry, especially in

> blushers. This may explain the predominance of cosmetic acne in the

> cheekbone area. All of these D & C Red dyes tested to date, the

> xanthenes, monoazoanilines, fluorans, and indigoids, are

comedogenic.

> Actually, this is not surprising as they are coal tar derivatives.

> The natural red pigment, carmine, is noncomedogenic and can serve

as

> a substitute for D & C dyes in blushers. Many finished products are

> comedogenic. Most troublesome to the dermatologists are the

> therapeutic tools that we use, such as Liquimat, Retin-A cream,

> Hytone, Staticin, Sulfoxl, Desquam-X, and Persadox HP cream. These

> should be reformulated. We have been unable to confirm that

> precipitated sulfur (U.S.P.) is a potent comedogen in the rabbit

ear

> assay. Clinically, we still find sulfur quite effective as an

> adjuvant to the benzoyl peroxide therapy for the treatment of acne

> vulgaris. We would suggest that the bias against sulfur be

> reconsidered.

[Guest guest]

> Here's the full cite:

> J Am Acad Dermatol. 1984 Jan;10(1):96-105.

> PMID: 6229554 [PubMed - indexed for MEDLINE

>

> Many other similar on medline.

Thanks, 007. Old reference, though I don't know it matters much in

stuff like this. Many dermatologists don't put as large an emphasis

on comedogenic ingredients as they did in the 1980s. For that reason

I wouldn't instinctively prioritize it as you do, but I do think it's

useful information (esp selfishly, for my skin. )

> It's legal to look at the label, it should be legal to write the

> contents of a label down and we should.

With respect to ingredients, it's something to consider for those

sites that do not publicize their ingredients. (Sites such as CVS,

drugstore.com, and dermstore.com may have made special arrangements

with the companies who products they sell.) What if someone started

listing recipes from restaurants from sources other than the public

postings from the restaurants themselves?

> My hope is that we can post

> reviews and suggestions and forward them to the manufacturers to

> get them to reformulate their products in a non comedogenic manner.

I wouldn't support that. Most ingredients that are comedogenic are so

because they transverse the top layer of the skin; they are excellent

carrier agents, or serve another useful function. Plus, most people

have no problem with so-called comedogenic ingredients. Those

relatively few that do, like me and I gather you, will just have to

look around for products we can use.

Also, I suspect comedogenicity is relatively more important in

products that are applied thickly and all over the face -- such as

sunscreens and foundations -- rather than applied thinly to active

areas only, such as the topical antibiotics.

> One of the interesting things about sulfur is that it is active

> against pityrosporum ovale. a lot of people have concerns about

> this commensal in rosacea. another thing is that it also should

have some

> activity against facial candida dermatitis, which can mimic rosacea

> (rarely). The vehicle is everything, it seems, sulfur is not the

> problem when it comes to comedogenicity... it is the vehicle.

None of these are major concerns, though -- I'd argue that they

aren't even minor concerns, and unless I'm missing something, not a

reason to advocate sulfur for everyone.

It's obviously important not to confuse acne vulgaris with acne

rosacea (the inflammatory component of rosacea). It's not uncommon

for both types of acne to co-exist, and it makes intellectual sense

that some of the (relatively rare) long term complications from using

antibiotics in pts with acne vulgaris be considered in those using

antibiotics in rosacea patients who have ongoing inflammation

involving pores. But the etiologies of both types of acne are

completely different, and inflammation plays a different role in

each. Unless I'm missing something, I would think that considering

the principles behind acne rosacea as if acne vulgaris seems to be a

step back, it's confusing rather than enlightening to me.

Marjorie

Marjorie Lazoff, MD

[Guest guest]

> Here's the full cite:

> J Am Acad Dermatol. 1984 Jan;10(1):96-105.

> PMID: 6229554 [PubMed - indexed for MEDLINE

>

> Many other similar on medline.

Thanks, 007. Old reference, though I don't know it matters much in

stuff like this. Many dermatologists don't put as large an emphasis

on comedogenic ingredients as they did in the 1980s. For that reason

I wouldn't instinctively prioritize it as you do, but I do think it's

useful information (esp selfishly, for my skin. )

> It's legal to look at the label, it should be legal to write the

> contents of a label down and we should.

With respect to ingredients, it's something to consider for those

sites that do not publicize their ingredients. (Sites such as CVS,

drugstore.com, and dermstore.com may have made special arrangements

with the companies who products they sell.) What if someone started

listing recipes from restaurants from sources other than the public

postings from the restaurants themselves?

> My hope is that we can post

> reviews and suggestions and forward them to the manufacturers to

> get them to reformulate their products in a non comedogenic manner.

I wouldn't support that. Most ingredients that are comedogenic are so

because they transverse the top layer of the skin; they are excellent

carrier agents, or serve another useful function. Plus, most people

have no problem with so-called comedogenic ingredients. Those

relatively few that do, like me and I gather you, will just have to

look around for products we can use.

Also, I suspect comedogenicity is relatively more important in

products that are applied thickly and all over the face -- such as

sunscreens and foundations -- rather than applied thinly to active

areas only, such as the topical antibiotics.

> One of the interesting things about sulfur is that it is active

> against pityrosporum ovale. a lot of people have concerns about

> this commensal in rosacea. another thing is that it also should

have some

> activity against facial candida dermatitis, which can mimic rosacea

> (rarely). The vehicle is everything, it seems, sulfur is not the

> problem when it comes to comedogenicity... it is the vehicle.

None of these are major concerns, though -- I'd argue that they

aren't even minor concerns, and unless I'm missing something, not a

reason to advocate sulfur for everyone.

It's obviously important not to confuse acne vulgaris with acne

rosacea (the inflammatory component of rosacea). It's not uncommon

for both types of acne to co-exist, and it makes intellectual sense

that some of the (relatively rare) long term complications from using

antibiotics in pts with acne vulgaris be considered in those using

antibiotics in rosacea patients who have ongoing inflammation

involving pores. But the etiologies of both types of acne are

completely different, and inflammation plays a different role in

each. Unless I'm missing something, I would think that considering

the principles behind acne rosacea as if acne vulgaris seems to be a

step back, it's confusing rather than enlightening to me.

Marjorie

Marjorie Lazoff, MD