Alcohol and Sulfur (Topical)


VA CLASSIFICATION
Primary: DE752
Secondary: DE500

Commonly used brand name(s): Acne Lotion 10; Liquimat Light; Liquimat Medium; Postacne.

Note: For a listing of dosage forms and brand names by country availability, see Dosage Forms section(s).



Category:


Antiacne agent (topical)—

cleansing agent (astringent; defatting)-keratolytic—

Indications

Accepted

Acne vulgaris (treatment) or
Oily skin (treatment)—Topical alcohol and sulfur combination is indicated as an aid in the treatment of acne vulgaris and oily skin. {01} {05} {07}


Pharmacology/Pharmacokinetics

Physicochemical characteristics:
Molecular weight—
    Alcohol: 46.07 {02}
    Sulfur: 32.06 {02}

Mechanism of action/Effect:

Alcohol—Aids in the removal of sebum (oil) from the surface of the skin. {05}

Sulfur—Acts as a keratolytic and promotes drying and peeling of the skin. Sulfur also has germicidal action, which results from its conversion to pentathionic acid presumably by epidermal cells or certain microorganisms. {04}


Precautions to Consider

Pregnancy/Reproduction

Problems in humans have not been documented.

Breast-feeding

Problems in humans have not been documented.

Pediatrics

Appropriate studies on the relationship of age to the effect of alcohol and sulfur have not been performed in the pediatric population. However, it is recommended that alcohol and sulfur combination not be used on children up to 8 years of age. {06} In older children, pediatrics-specific problems that would limit the usefulness of this medication are not expected.


Geriatrics


Appropriate studies on the relationship of age to the effect of alcohol and sulfur have not been performed in the geriatric population. However, geriatrics-specific problems that would limit the usefulness of this medication in the elderly are not expected.

Drug interactions and/or related problems
The following drug interactions and/or related problems have been selected on the basis of their potential clinical significance (possible mechanism in parentheses where appropriate)—not necessarily inclusive (» = major clinical significance):


Note: Combinations containing any of the following medications, depending on the amount present, may also interact with this medication. {05}

Abrasive or medicated soaps or cleansers or
Acne preparations or preparations containing a peeling agent such as
Benzoyl peroxide
Resorcinol
Salicylic acid
Tretinoin or
Acne preparations, topical, other or
Alcohol-containing preparations, topical such as
After-shave lotions
Astringents
Perfumed toiletries
Shaving creams or lotions or
Cosmetics or soaps with a strong drying effect or
Isotretinoin or
Medicated cosmetics or ``cover-ups''    (concurrent use with alcohol and sulfur combination may cause a cumulative irritant or drying effect, especially with the application of peeling, desquamating, or abrasive agents, resulting in excessive irritation of the skin)


Mercury compounds, topical    (concurrent use with sulfur may result in a chemical reaction releasing hydrogen sulfide, which has a foul odor, may be irritating, and may stain the skin black)


Medical considerations/Contraindications
The medical considerations/contraindications included have been selected on the basis of their potential clinical significance (reasons given in parentheses where appropriate)— not necessarily inclusive (» = major clinical significance).


Risk-benefit should be considered when the following medical problem exists
Sensitivity to this medication    (may cause allergic contact dermatitis, contact urticaria syndrome, sensitive skin [i.e., easily irritated], or subjective irritation [i.e., burning, stinging, or itching without objective signs] {11})




Side/Adverse Effects
The following side/adverse effects have been selected on the basis of their potential clinical significance (possible signs and symptoms in parentheses where appropriate)—not necessarily inclusive:

Those indicating need for medical attention
    
Hypersensitivity (skin irritation not present before therapy)


Those indicating need for medical attention only if they continue or are bothersome
    
Burning or stinging of skin
    
dryness or peeling of skin —may occur after a few days{03}




Patient Consultation
As an aid to patient consultation, refer to Advice for the Patient, Alcohol and Sulfur (Topical).

In providing consultation, consider emphasizing the following selected information (» = major clinical significance):

Before using this medication
»   Conditions affecting use, especially:
Sensitivity to alcohol or sulfur





Use in children—Not using on children up to 8 years of age


Proper use of this medication
Proper administration: Before using, washing or cleansing affected areas thoroughly and patting dry; applying small amount of medication to affected area(s) of skin and rubbing in gently

» Avoiding contact with the eyes, nostrils, and lips {05}; flushing thoroughly with water if medication accidentally gets into eyes or nostrils or on lips

Medication is flammable; not using near heat or open flame or while smoking

» Using only as directed; importance of not using more medication than the amount recommended

» Proper dosing
Missed dose: Applying as soon as possible

» Proper storage

Precautions while using this medication
» Avoiding simultaneous use with other topical acne preparations or preparations containing peeling agents, other alcohol-containing preparations, abrasive soaps or cleansers, cosmetics or soaps with drying effect, medicated cosmetics, or other topical skin medications, unless prescribed by physician

» Avoiding concurrent use with topical mercury-containing preparations


Side/adverse effects
Signs of potential side effects, especially hypersensitivity


General Dosing Information
Some alcohol and sulfur combination products are tinted a flesh color and can be used as a makeup or cover-up. {01} {05} {10}

Since this medication is an effective drying agent, it should be used sparingly when therapy is initiated, especially for those patients with sensitive skin. {14}

The frequency of applications may be increased gradually up to three times a day as tolerated. {14}

In dry or cold climates, the skin may be more sensitive to this medication, and the frequency of use should be reduced. During warm, humid weather, frequency of use may be increased. {14}

For treatment of adverse effects
If the medication comes in contact with the eyes, flush the eyes with water. {05}


Topical Dosage Forms

ALCOHOL AND SULFUR LOTION

Usual adult and adolescent dose
Acne vulgaris (treatment) or
Oily skin (treatment)


Topical, to the skin, one or two times a day. {05}


Usual pediatric dose
Acne vulgaris (treatment) or
Oily skin (treatment)
Children up to 8 years of age: Use is not recommended. {13}

Children 8 years of age and older: See Usual adult and adolescent dose.{05}


Strength(s) usually available
U.S.—


22% alcohol and 5% sulfur (OTC) [Liquimat Light] [Liquimat Medium{01}{08}{09}{12}]


22.5% alcohol and 10% sulfur (OTC) [Acne Lotion 10{15}]

Canada—


20% alcohol and 2% colloidal sulfur (OTC) [Postacne (butylparaben) (methylparaben) (sodium metabisulfite){03}{07}{10}{11}{13}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), in a well-closed container, unless otherwise specified by manufacturer. Protect from freezing.

Auxiliary labeling:
   • Shake well. {01} {03} {07} {10}
   • For external use only.



Revised: 08/02/1995



References
  1. Liquimat package insert (Owen—US), Rec 1/83, 6/86, 2/89; Rev 5/88, Rec 5/89.
  1. The United States pharmacopeia. The national formulary. USP 22nd revision (January 1, 1990). NF 17th ed (January 1, 1990). Rockville, MD: The United States Pharmacopeial Convention, Inc., 1990: 34, 1303, 1807.
  1. Postacne (Rorer). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 24th ed. Ottawa: Canadian Pharmaceutical Association, 1989: 824.
  1. Gilman AG, Goodman LS, Rall TW, Murad F, editors. Goodman and Gilman's the pharmocological basis of therapeutics. 7th ed. New York: Macmillan, 1985: 972.
  1. Reviewer comment, 6/84,
  1. Reviewers' comments, 4/84.
  1. Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 25th ed. Ottawa: Canadian Pharmaceutical Association, 1990: 881.
  1. Red book 1993. Montvale, NJ: Medical Economics Data, 1993: 338.
  1. Olin BR, editor. Drug facts and comparisons. St. Louis: Facts and Comparisons Inc, 1989: 545a.
  1. Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 26th ed. Ottawa: Canadian Pharmaceutical Association, 1991: 959.
  1. Panel comment, 3/91.
  1. Liquimat bottle label (Galderma—US), Rec 6/95.
  1. Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 29th ed. Ottawa: Canadian Pharmaceutical Association, 1994: 1046.
  1. Transect package insert (Westwood—US), Rec 4/86, 6/87.
  1. Olin BR, editor. Drug facts and comparisons. St. Louis: Facts and Comparisons Inc., 1994: 546.
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