Clinical Review

The Use of Sodium Sulfacetamide in Dermatology

Cutis. 2015 August;96(2):128-130

Sodium sulfacetamide is effective in the management of a variety of inflammatory facial dermatoses and often is used in combination with sulfur for a synergistic effect. Adverse effects from sodium sulfacetamide are rare and generally are limited to mild application-site reactions. This agent is contraindicated in any patient with known hypersensitivity to sulfonamides.

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Practice Points

Sodium sulfacetamide is a useful agent in the management of papulopustular rosacea, acne vulgaris, seborrheic dermatitis, and perioral dermatitis.
Adverse effects are rare and generally are limited to dryness, erythema, pruritus, and discomfort.

References

1. Akhavan A, Bershad S. Topical acne drugs: review of clinical properties, systemic exposure, and safety. Am J Clin Dermatol. 2003;4:473-492.

2. Gupta AK, Nicol K. The use of sulfur in dermatology. J Drugs Dermatol. 2004;3:427-431.

3. Motaparthi K, Hsu S. Topical antibacterial agents. In: Wolverton SE, ed. Comprehensive Dermatologic Drug Therapy. 3rd ed. Philadelphia, PA: Saunders; 2012:445-459.

4. Duemling WM. Sodium sulfacetamide in topical therapy. AMA Arch Derm Syphilol. 1954;69:75-82.

5. Sodium sulfacetamide. Drugs.com Web site. https://drugs.com/pro/sodium-sulfacetamide.html. Revised December 2012. Accessed June 16, 2015.

6. Sauder DN, Miller R, Gratton D, et al. The treatment of rosacea: the safety and efficacy of sodium sulfacetamide 10% and sulfur 5% lotion (Novacet) is demonstrated in a double-blind study. J Dermatol Treat. 1997;8:79-85.

7. Trumbore MW, Goldstein JA, Gurge RM. Treatment of papulopustular rosacea with sodium sulfacetamide 10%/sulfur 5% emollient foam. J Drugs Dermatol. 2009;8:299-304.

8. Lebwohl MG, Medansky RS, Russo CL, et al. The comparative efficacy of sodium sulfacetamide 10%/sulfur 5% lotion and metronidazole 0.75% gel in the treatment of rosacea. J Geriatr Dermatol. 1995;3:183-185.

9. Nally JB, Berson DS. Topical therapies for rosacea. J Drugs Dermatol. 2006;5:23-26.

10. Pelle MT, Crawford GH, James WD. Rosacea II: therapy. J Am Acad Dermatol. 2004;51:499-512.

11. Tarimci N, Sener S, Kilinç T. Topical sodium sulfacetamide/sulfur lotion. J Clin Pharm Ther. 1997;22:301.

12. Breneman DL, Ariano MC. Successful treatment of acne vulgaris in women with a new topical sodium sulfacetamide/sulfur lotion. Int J Dermatol. 1993;32:365-367.

13. Whelan ST. Sodium sulfacetamide for seborrheic dermatitis. AMA Arch Derm. 1955;71:724.

14. Bendl BJ. Perioral dermatitis: etiology and treatment. Cutis. 1976;17:903-908.

15. Olansky S. Old drug—in a new system—revisited. Cutis. 1977;19:852-854.

16. Genvert GI, Cohen EJ, Donnenfeld ED, et al. Erythema multiforme after use of topical sulfacetamide. Am J Ophthalmol. 1985;99:465-468.

17. Rubin Z. Ophthalmic sulfonamide-induced Stevens-Johnson syndrome. Arch Dermatol. 1977;113:235-236.

18. Draelos ZD. The multifunctionality of 10% sodium sulfacetamide, 5% sulfur emollient foam in the treatment of inflammatory facial dermatoses. J Drugs Dermatol. 2010;9:234-246.

19. Dubina MI, Fleischer AB. Interaction of topical sulfacetamide and topical dapsone with benzoyl peroxide. Arch Dermatol. 2009;145:1027-1029.

20. Sodium sulfacetamide – sulfacetamide sodium liquid. DailyMed Web site. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0d92c55b-5b54-4f5d-8921-24e4e877ae50. Accessed June 17, 2015.

21. Spes CH, Angermann CE, Stempfle HU, et al. Sulfadiazine therapy for toxoplasmosis in heart transplant recipients decreases cyclosporine concentration. Clin Investig. 1992;70:752-754.

22. Hansen JM, Kampmann JP, Siersbaek-Nielsen K, et al. The effect of different sulfonamides on phenytoin metabolism in man. Acta Med Scand Suppl. 1979;624:106-110.

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Sodium sulfacetamide has various uses in the field of dermatology due to its anti-inflammatory and antibacterial properties. It has been shown to be effective in the management of a variety of inflammatory facial dermatoses, including papulopustular rosacea, acne vulgaris, seborrheic dermatitis, and perioral dermatitis. We review the mechanism of action, pharmacology and formulations, clinical uses, and adverse effects of sodium sulfacetamide as a dermatologic treatment.

Mechanism of Action

Sodium sulfacetamide is a sulfonamide-type antibacterial agent. Its mechanism of action is the inhibition of bacterial dihydropteroate synthetase, which prevents the conversion of p-aminobenzoic acid to folic acid. This process causes a bacteriostatic effect on the growth of several gram-negative and gram-positive organisms, including Propionibacterium acnes.^1,2

The effectiveness of sodium sulfacetamide is increased when used in combination with sulfur, which has keratolytic, antibacterial, antifungal, and antiparasitic effects. The addition of hydrocortisone has been reported to increase the effectiveness of both agents.³

Pharmacology

Sodium sulfacetamide is highly soluble at the physiologic pH of 7.4, which contributes to its high level of penetration and absorption.⁴ An in vitro study showed percutaneous absorption of sodium sulfacetamide to be around 4%.⁵ Sulfonamides are metabolized mainly by the liver and are excreted by the kidneys.

Formulations

The most common concentrations of sodium sulfacetamide and sulfur are 10% and 5%, respectively. A wide variety of sulfacetamide-containing products are available, many of which are marketed to treat specific conditions depending on additional ingredients or the type of delivery system.

Clinical Uses

Topical formulations of sodium sulfacetamide and sulfur have proven to be efficacious in the management of rosacea, with a typical regimen consisting of twice-daily application for 8 weeks.⁶ The sulfur in the formulation has the additional benefit of targeting Demodex mites, which are implicated as a contributing factor in some cases of rosacea.⁷ Sodium sulfacetamide 10%–sulfur 5% lotion was more effective in improving the erythema, papulopustules, and overall severity of rosacea as compared to metronidazole gel 0.75%.⁸ Other studies have reported increased efficacy when sodium sulfacetamide and topical sulfur are used along with metronidazole.^9,10

Sodium sulfacetamide also has shown efficacy against acne. Its antibacterial and drying properties have been shown to decrease the number of inflammatory lesions and comedones, and in the treatment of acne vulgaris, no sensitivity reactions have been observed.² Also, unlike topical antibiotics, cases of P acnes resistance to topical sulfur products have not been widely reported. Studies have demonstrated that twice-daily use of sodium sulfacetamide 10%–sulfur 5% for 12 weeks decreases inflammatory acne lesions by 80.4% to 83%.^11,12

Seborrheic dermatitis is a common chronic infection of the skin caused by Malassezia species. One study investigated the use of sodium sulfacetamide ointment and soap to treat seborrheic dermatitis and found that the condition was either improved or completely controlled in 93% (71/76) of cases.⁴ Sodium sulfacetamide lotion was an effective treatment of seborrheic dermatitis in 89% (54/61) of patients with scalp involvement and 68% (30/44) of patients with glabrous skin involvement.¹³

Perioral dermatitis is characterized by groups of erythematous papules and pustules localized around the mouth. The use of topical sodium sulfacetamide along with oral tetracyclines has been demonstrated to consistently clear lesions in most patients with perioral dermatitis.¹⁴ Sodium sulfacetamide is unique in that it is not associated with the excessive erythema and irritation often found with retinoic acid and benzoyl peroxide.¹⁵ Unfortunately, however, there have been no well-controlled trials to compare the efficacy of sodium sulfacetamide to other topical therapies for this condition.

Adverse Effects

Adverse effects from sodium sulfacetamide are rare and generally are limited to cutaneous reactions including dryness, erythema, pruritus, and discomfort.¹ Periocular use of sodium sulfacetamide can cause conjunctival irritation. One study reported that 19% (6/31) of patients experienced local reactions but most were considered mild.⁹ Rare but serious reactions including erythema multiforme and Stevens-Johnson syndrome have been reported from ophthalmic use.^16,17

A common limiting factor to sodium sulfacetamide preparations that include elemental sulfur is the offensive smell, which has hindered patient compliance in the past; however, pharmaceutical companies have attempted to create more tolerable products without the odor.¹⁰ One study found that the tolerability of a sodium sulfacetamide 10%–sulfur 5% foam using a rinse-off method of application was excellent, with only 33% (8/24) of participants commenting on the smell.¹⁸ Another limiting factor of sodium sulfacetamide preparations containing sulfur is orange-brown discoloration when combined with benzoyl peroxide, which does not affect the skin but may stain clothing.¹⁹

Sodium sulfacetamide is rendered less effective when combined with silver-containing products.²⁰ No other notable drug interactions are known; however, oral sulfonamides are known to interact with several drugs, including cyclosporine and phenytoin.^21,22