Version May 2024
Acne vulgaris, acne rosacea, seborrheic dermatitis:
Cream, lotion, emollient cream: Apply a thin film to affected area 1 to 3 times daily.
Cleanser, cleansing cloth/pads: Wash affected area 1 to 2 times daily.
Emollient foam: Apply to affected area 1 to 2 times daily; foam may remain on skin or may be rinsed off after 1 to 2 minutes.
Suspension: Apply to affected area 1 to 2 times daily.
Use is contraindicated.
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
Acne vulgaris, acne rosacea, seborrheic dermatitis: Children ≥12 years and Adolescents: Refer to adult dosing.
Use is contraindicated.
There are no dosage adjustments provided in the manufacturer’s labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Also see Sulfacetamide (Topical).
Frequency not defined: Dermatologic: Desquamation, erythema of skin, pruritus, skin irritation, xeroderma
Hypersensitivity to sulfur, sulfonamides, or any component of the formulation; renal disease
Note: Although the FDA-approved product labeling states this medication is contraindicated in patients with hypersensitivity to sulfonamide-containing drugs, the scientific basis of this cross-sensitivity has been challenged. See “Warnings/Precautions” for more detail.
Concerns related to adverse effects:
• Autoimmune diseases: Fatalities associated with severe reactions, including drug-induced systemic lupus erythematosus, have occurred with sulfonamides (regardless of administration route).
• Blood dyscrasias: Fatalities associated with severe reactions, including agranulocytosis, acute hemolytic anemia, aplastic anemia, purpura hemorrhagica, and other blood dyscrasias, have occurred with sulfonamides (regardless of route).
• Dermatologic reactions: Fatalities associated with severe reactions, including Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug fever, have occurred with sulfonamides (regardless of route). In addition, contact dermatitis, reddening, and scaling of the skin may occur.
• Hepatic effects: Fatalities associated with severe reactions, including fulminant hepatic necrosis and jaundice, have occurred with sulfonamides (regardless of route).
• Hypersensitivity reactions: Skin rash or other reactions have occurred in patients with no prior history of sulfonamide hypersensitivity. Discontinue use at the first sign of hypersensitivity or rash.
• Sulfonamide ("sulfa") allergy: Traditionally, concerns for cross-reactivity have extended to all compounds containing the sulfonamide structure (SO2NH2). An expanded understanding of allergic mechanisms indicates cross-reactivity between antibiotic sulfonamides and nonantibiotic sulfonamides may not occur, or at the very least this potential is extremely low (Brackett 2004; Johnson 2005; Slatore 2004; Tornero 2004). In particular, mechanisms of cross-reaction due to antibody production (anaphylaxis) are unlikely to occur with nonantibiotic sulfonamides and antibiotic sulfonamides. A nonantibiotic sulfonamide compound which contains the arylamine structure and therefore may cross-react with antibiotic sulfonamides is sulfasalazine (Zawodniak 2010). T-cell-mediated (type IV) reactions (eg, maculopapular rash) are less understood and it is not possible to completely exclude this potential based on current insights. In cases where prior reactions were severe (Stevens-Johnson syndrome/TEN), some clinicians choose to avoid exposure to these classes.
• Systemic effects: Systemic absorption is increased with application to large, infected, abraded, denuded, or burned skin.
Dosage form specific issues:
• Benzyl alcohol and derivatives: Some dosage forms may contain benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity ("gasping syndrome") in neonates; the "gasping syndrome" consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggest that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol with caution in neonates. See manufacturer's labeling.
Other warnings/precautions:
• Appropriate use: For external use only; avoid contact with eyes, eyelids, lips, and mucous membranes. Use with caution if areas of denuded or abraded skin are involved. Discontinue use if irritation, rash, or signs of hypersensitivity occur.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Cleanser, topical:
AVAR: Sulfur 5% and sulfacetamide sodium 10% (227 g) [contains benzyl alcohol]
AVAR LS: Sulfur 2% and sulfacetamide sodium 10% (227 g) [contains benzyl alcohol]
Plexion: Sulfur 4.8% and sulfacetamide sodium 9.8% (285 g) [contains benzyl alcohol]
Prascion: Sulfur 5% and sulfacetamide sodium 10% (170 g [DSC])
Rosanil: Sulfur 5% and sulfacetamide sodium 10% (170 g [DSC])
Generic: Sulfur 2% and sulfacetamide sodium 10% (227 g); Sulfur 4.8% and sulfacetamide sodium 9.8% (285 g); Sulfur 5% and sulfacetamide sodium 10% (170 g, 227 g, 340 g)
Cream, topical:
AVAR-e: Sulfur 5% and sulfacetamide sodium 10% (45 g [DSC], 57 g) [contains benzyl alcohol]
AVAR-e Green: Sulfur 5% and sulfacetamide sodium 10% (45 g [DSC], 57 g) [contains benzyl alcohol; color corrective cream]
AVAR-e LS: Sulfur 2% and sulfacetamide sodium 10% (45 g [DSC], 57 g) [contains benzyl alcohol]
Clenia: Sulfur 5% and sulfacetamide sodium 10% (28 g) [DSC]
Plexion: Sulfur 4.8% and sulfacetamide sodium 9.8% (57 g) [contains benzyl alcohol]
SSS 10-5: Sulfur 5% and sulfacetamide sodium 10% (28 g)
Virti-sulf: Sulfur 5% and sulfacetamide sodium 10% (28 g) [DSC]
Generic: Sulfur 2% and sulfacetamide sodium 10% (57 g); Sulfur 4.8% and sulfacetamide sodium 9.8% (57 g); Sulfur 5% and sulfacetamide sodium 10% (28 g, 57 g)
Foam, topical:
Clarifoam EF: Sulfur 5% and sulfacetamide sodium 10% (60 g [DSC], 100 g [DSC])
SSS 10-5: Sulfur 5% and sulfacetamide sodium 10% (60 g, 100 g)
Generic: Sulfur 5% and sulfacetamide sodium 10% (60 g)
Lotion, topical:
Plexion: Sulfur 4.8% and sulfacetamide sodium 9.8% (57 g) [contains benzyl alcohol]
Generic: Sulfur 4.8% and sulfacetamide sodium 9.8% (57 g)
Pad, topical [cleansing cloth]:
Plexion: Sulfur 4.8% and sulfacetamide sodium 9.8% (60s) [contains benzyl alcohol]
Rosula: Sulfur 5% and sulfacetamide sodium 10% (30s [DSC], 60s [DSC])
Sumaxin: Sulfur 4% and sulfacetamide sodium 10% (60s) [contains aloe]
Generic: Sulfur 4.8% and sulfacetamide sodium 9.8% (60s), Sulfur 4% and sulfacetamide sodium 10% (60s [DSC])
Suspension, topical:
Clenia Plus: Sulfur 4.25% and sulfacetamide sodium 9% (30 mL, 237 mL) [contains aloe]
SulfaCleanse 8/4: Sulfur 4% and sulfacetamide sodium 8% (473 mL) [contains aloe]
Zma Clear: Sulfur 4.5% and sulfacetamide sodium 9% (237 mL) [contains aloe]
Generic: Sulfur 4% and sulfacetamide sodium 8% (473 mL); Sulfur 5% and sulfacetamide sodium10% (30 g)
Wash, topical:
BP 10-1: Sulfur 1% and sulfacetamide sodium 10% (170 g)
BP Cleansing Wash: Sulfur 5% and sulfacetamide sodium 10% (480 mL) [contains urea]
Rosula Wash: Sulfur 4.5% and sulfacetamide sodium 10% (340.2 g [DSC])
Sulfamez Wash: Sulfur 1% and sulfacetamide sodium 10% (177 mL)
Sumaxin: Sulfur 4% and sulfacetamide sodium 9% (473 mL) [contains aloe]
Generic: Sulfur 4% and sulfacetamide sodium 9% (480 mL)
Wash, topical [emulsion-based]:
BP Cleansing Wash: Sulfur 4% and sulfacetamide sodium 10% (473 mL) [contains urea]
Sumadan: Sulfur 4.5% and sulfacetamide sodium 9% (454 g)
Sumadan XLT: Sulfur 4.5% and sulfacetamide sodium 9% (454 g) [packaged in a kit with Niseko sunscreen SPF 25]
Generic: Sulfur 4.5% and sulfacetamide sodium 9% (454 g); Sulfur 5% and sulfacetamide sodium 10% (170.3 g, 227 g)
Yes: Excludes emulsion-based wash
Cream (Avar-e Emollient External)
10-5% (per gram): $14.02
Cream (Avar-e Green External)
10-5% (per gram): $13.20
Cream (Avar-e LS External)
10-2% (per gram): $13.41
Cream (Plexion External)
9.8-4.8% (per gram): $13.49
Cream (Sulfacetamide Sodium-Sulfur External)
9.8-4.8% (per gram): $9.31
10-2% (per gram): $7.79 - $11.49
10-5% (per gram): $7.79 - $12.01
Emulsion (Sulfacetamide-Sulfur in Urea External)
10-5% (per mL): $0.70
Kit (Sumadan External)
9-4.5% (per each): $1,072.99
Kit (Sumaxin CP External)
10-4% (per each): $1,100.02
Liquid (Avar Cleanser External)
10-5% (per gram): $3.23
Liquid (Avar LS Cleanser External)
10-2% (per gram): $3.28
Liquid (Plexion Cleanser External)
9.8-4.8% (per gram): $2.92
Liquid (Sulfacetamide Sodium-Sulfur External)
9-4% (per mL): $1.34
9-4.5% (per gram): $0.36 - $0.41
9.8-4.8% (per gram): $0.91 - $2.50
10-2% (per gram): $1.90
10-5% (per gram): $0.62
Liquid (Sumadan Wash External)
9-4.5% (per gram): $2.36
Lotion (Plexion External)
9.8-4.8% (per gram): $14.72
Lotion (Sulfacetamide Sodium-Sulfur External)
9.8-4.8% (per gram): $9.31
10-5% (per gram): $9.39
Pads (Plexion Cleansing Cloth External)
9.8-4.8% (per each): $15.04
Pads (Sulfacetamide Sodium-Sulfur External)
9.8-4.8% (per each): $7.79
Pads (Sumaxin External)
10-4% (per each): $18.33
Suspension (Clenia Plus External)
9-4.25% (per mL): $3.29
Suspension (Sulfacetamide Sodium-Sulfur External)
8-4% (per mL): $1.04
9-4.25% (per mL): $2.96
10-5% (per gram): $9.32
Suspension (SulfaCleanse 8/4 External)
8-4% (per mL): $1.37
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Topical: For external use only. Wash hands prior to use. Avoid contact with eyes, eyelids, lips, and mucous membranes.
Cleanser: Shake well prior to use. Apply to wet skin and massage gently into skin working into full lather for 10 to 20 seconds; rinse skin completely and pat dry skin.
Cleansing cloths/cleansing pads: Moisten skin and cloth/pad with water, work cloth/pad into lather, and massage into skin for 10 to 20 seconds; rinse skin completely and pat dry skin. Dispose in trash; do not flush.
Cream, lotion: Apply to clean, dry skin; massage into skin completely.
Emollient cream: Shake well prior to use (Avar-e). Apply to clean, dry skin; massage into skin completely.
Emollient foam: Wash affected area before use. Shake can vigorously and tap bottom of can onto palm of other hand or a hard surface at least 1 to 2 times, then shake and tap again prior to each use. Foam may remain on skin or may be rinsed off after 1 to 2 minutes.
Suspension: Shake well prior to use. Wet skin and apply to affected area, work into full lather and massage into skin for 10 to 20 seconds, then rinse thoroughly and pat skin dry.
Topical: For external use only. Avoid contact with eyes, eyelids, lips, and mucous membranes. Wash hands prior to use.
Cleanser: Apply to wet skin and massage gently into skin working into full lather for 10 to 20 seconds; rinse thoroughly and pat dry.
Cleansing cloths/cleansing pads: Moisten skin and cloth/pad with water, work cloth/pad into lather, and massage into skin for 10 to 20 seconds; rinse skin completely and pat dry skin. Dispose in trash; do not flush.
Emollient foam: Apply to clean, dry skin. Consult product-specific labeling for details regarding priming and preparation of product prior to use. Dispense foam onto fingertip and massage into affected areas; foam may remain on skin or may be rinsed off after 1 to 10 minutes.
Acne rosacea, acne vulgaris, seborrheic dermatitis: Treatment of acne vulgaris, acne rosacea, and seborrheic dermatitis.
None known.
There are no known significant interactions.
Animal reproduction studies have not been conducted with this combination. Refer to the Sulfacetamide monograph for additional information.
Small amounts of sulfonamides administered orally are excreted in breast milk; it is not known if sulfur and sulfacetamide administered topically is excreted in breast milk. The manufacturer recommends that caution be exercised when administering sulfur and sulfacetamide to breast-feeding women.
Signs of local irritation and/or sensitization, especially during long-term therapy.
Sulfacetamide interferes with bacterial growth by inhibiting bacterial folic acid synthesis through competitive antagonism of para-aminobenzoic acid (PABA). Sulfur is a keratolytic. Used in combination to inhibit the growth of acne-causing bacteria.
Refer to the Sulfacetamide monograph for additional information.
Absorption: Sulfur, topical: ~1%
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