Comparison of the effect of topical triamcinolone 0.1% cream with sulfur 2.0% cream in the treatment of patients with hand eczema: A randomized controlled trial.

BACKGROUND: Hand eczema (HE) is a common and heterogeneous condition. It has a wide range of etiologies and clinical manifestations. In this study the efficacy of triamcinolone 0.1% cream and sulfur 2% creams was compared in treating patients with HE. METHODS: This randomized, triple-blind clinical trial was performed on 70 patients with HE (including 70 right and 70 left hands). In this study, two creams were used including triamcinolone 0.1% and sulfur 2.0%. Patients were treated with these creams twice a day (once in every 12 h) for 4 weeks. Follow-up was 4 weeks after treatment. Hand Eczema Severity Index (HECSI), itching, dryness, burning sensation, and erythema scores were collected three times during the study and compared between treatment regimens. RESULTS: Findings showed that both triamcinolone (0.1%) and sulfur (2.0%) creams could significantly reduce the scores of HECSI, itching, dryness, burning sensation, and erythema, and the therapeutic effects lasted for at least 4 weeks after cessation of topical treatment. CONCLUSION: Topical sulfur cream (2.0%) is as effective as triamcinolone (0.1%) cream in treatment of HE without any prominent adverse reactions.

Comparison of sulfur ointment and permethrin treatments in scabies.

Scabies is a contagious, parasitic skin disease that adversely affects the quality of life and, can cause systemic complications if it is not properly treated. Sulfur ointment and permethrin cream are among the most used topical agents in the treatment of scabies. In this study, we aimed to compare the efficacy of sulfur ointment and permethrin cream in the treatment of scabies. In this single-center study, patients who were diagnosed with scabies in the dermatology outpatient clinics of Karabuk University Training and Research Hospital between April, 2021 and September, 2021 were investigated retrospectively. Age, gender, date of diagnosis, topical agent used for scabies treatment, and response to the treatment at the control examination in the second week were recorded. The patients were divided into two groups those receiving 5% permethrin cream or 10% sulfur ointment, and the treatment efficacy of both agents was compared. This study showed that 10% sulfur ointment was significantly more effective in treating scabies than 5% permethrin cream (p < 0.001). Moreover, younger patients with scabies responded better to both treatments. 10% Sulfur ointment can be considered a safe and effective topical option in the treatment of scabies. The resistance to 5% permethrin cream, which is the most commonly used agent for scabies, can be a concern as an unexpected low success rate was obtained in this study.

Air Pollution and Pediatric Respiratory Hospitalizations: Effect Modification by Particle Constituents and Oxidative Potential.

Rationale: Outdoor particulate and gaseous air pollutants impair respiratory health in children, and these associations may be influenced by particle composition. Objectives: To examine whether associations between short-term variations in fine particulate air pollution, oxidant gases, and respiratory hospitalizations in children are modified by particle constituents (metals and sulfur) or oxidative potential. Methods: We conducted a case-crossover study of 10,500 children (0-17 years of age) across Canada. Daily fine particle mass concentrations and oxidant gases (nitrogen dioxide and ozone) were collected from ground monitors. Monthly estimates of fine particle constituents (metals and sulfur) and oxidative potential were also measured. Conditional logistic regression models were used to estimate associations between air pollutants and respiratory hospitalizations, above and below median values for particle constituents and oxidative potential. Measurements and Main Results: Lag-1 fine particulate matter mass concentrations were not associated with respiratory hospitalizations (odds ratio and 95% confidence interval per 10 µg/m3 increase in fine particulate matter: 1.004 [0.955-1.056]) in analyses ignoring particle constituents and oxidative potential. However, when models were examined above or below median metals, sulfur, and oxidative potential, positive associations were observed above the median. For example, the odds ratio and 95% confidence interval per 10 µg/m3 increase in fine particulate matter were 1.084 (1.007-1.167) when copper was above the median and 0.970 (0.929-1.014) when copper was below the median. Similar trends were observed for oxidant gases. Conclusions: Stronger associations were observed between outdoor fine particles, oxidant gases, and respiratory hospitalizations in children when metals, sulfur, and particle oxidative potential were elevated.

Excess sulfur and Fe elements drive changes in soil and vegetation at abandoned coal gangues, Guizhou China.

Coal gangue piles accumulate outside mines and can persist for years, negatively impacting the regional environment. To determine the main cause of soil pollution at coal gangues, several coal gangues in Guizhou Province, China that had undergone natural recovery via native plants for 8 years were investigated in summer 2019. Three plots (2 m × 2 m) from the coal gangue area were selected for the treatment (GP). Control plots that were 100 m away from GP were also investigated in contrast (CK-near). In addition, plots from forest, farmland and lake land that were far from GP and largely undisturbed were also investigated as more extreme contrasts (CK-far). A series of soil indicators that can be affected by coal-gangue, such as heavy metals (Mn, Cr, Cd, Ni, Zn, Cu, Pb), As, pH, cation exchange capacity (CEC), sulfur (S) and iron (Fe), were tested for in the plots. Plant species, coverage and height were also analyzed to uncover biodiversity and dominant species information. The results suggested that coal gangue significantly influences soil S, pH and plant species after 8 years of natural recovery. The CK-far plots contained relatively low soil sulfur content, normal pH (close to 7) and abundant plant biodiversity. Generally, pH related positively with both the Patrick (R = 0.79, n = 22, p < 0.001) and Shannon indices (R = 0.67, n = 22, p < 0.001); the soil S related negatively with both the Patrick (R = 0.85, n = 22, p < 0.001) and Shannon indices (R = - 0.79, n = 22, p < 0.001). S content was highest (S = 1.0%) in GP plots, was lower in CK-near plots (S = 0.3%) and was the lowest of all in the plots distant from the coal mine (S = 0.1%, CK-far). S content was negatively correlated with pH. Soil pH decreased significantly, from 7.0 in CK-far, to 5.9 in CK-near, to 4.2 in GP. Soil Fe was 3.4 times higher in GP and CK-near than in CK-far. The excess sulfur and Fe elements and the acidified soil drove changes in soil and vegetation in the coal gangue areas. After 8 years of natural recovery, only a few plants, like Miscanthus floridulus, were able to live near the coal gangue in the area where the soil was still acidic and high in S and Fe.

A comparison of the efficacy and tolerability of topical agents used in facial Demodex treatment.

BACKGROUND: Demodex spp. is the most common ectoparasite in humans. This parasite is believed to play a role in the etiology of many dermatological and ocular disorders. AIM: The aim of this study was to compare the efficacy and tolerability of the sulfur-sodium sulfacetamide combination, crotamiton, and permethrin, which are three topical agents commonly used in Demodex treatment. METHODS: A total of 28 patients with primary demodicosis and 44 patients with Rosacea + Demodex were included in the study. The pretreatment and post-treatment Demodex spp. counts, patient satisfaction, and erythema decrease rates were compared. RESULTS: Analysis of the efficacy of these topical agents on Demodex revealed that all three significantly decreased the number of parasites. The patient satisfaction was higher in the sodium acetamide group than the 10% crotamiton and 5% permethrin groups, and clinical evaluation (erythema/ papulopustules and white plugs) was better in the sodium acetamide group than the other groups but no statistically significant difference was found in terms of patient satisfaction and clinical evaluation. CONCLUSION: The sulfur-sodium combination, crotamiton, and permethrin are the three agents commonly used in the treatment of Demodex spp. and all significantly decreased the Demodex count. The three agents were similar in terms of tolerability. Our study needs to be supported with others on larger patient series.

Comparison of trace mineral repletion strategies in feedlot steers to overcome diets containing high concentrations of sulfur and molybdenum.

To compare trace mineral (TM) repletion in feedlot steers after depletion by S and Mo, 72 Red Angus steers blocked by BW (253 ± 14 kg) were assigned (6 steers per pen, fed via GrowSafe bunks) to corn silage depletion diets (depletion, DEP) supplemented with NRC (1996) recommended concentrations of Cu, Mn, Se, and Zn (CON) or supplemented with 0.3% S (CaSO4), 2 mg of Mo/kg dry matter (DM), and no added Cu, Mn, Zn, or Se (antagonist, ANT). Three 62 d TM repletion strategies (repletion, REP) were applied within DEP diets on day 89: 1) Multimin90 injection (contains Cu, Mn, Se, Zn) and 100% of recommended Cu, Mn, Zn, and Se from inorganic sources (ITM), 2) saline injection and 150% of recommended TM from inorganic sources (ING), or 3) saline injection and 150% of recommended TM provided as 25% organic and 75% inorganic sources (BLEND). Subcutaneous injections were given at 1 mL/68 kg BW. Inorganic sources were Cu, Mn, and Zn SO4, and sodium selenite, and organic sources were Availa Cu, Mn and Zn, and SelPlex Se. Repletion period liver and blood were collected on day -10, 14, 28, and 42 and data were analyzed as a 2 × 3 factorial (n = 12 steers per treatment) using Proc Glimmix of SAS with plasma and liver analytes analyzed as repeated measures. Liver Cu, Se, and Mn were decreased (P < 0.01) by ANT during DEP. There were no DEP × REP × day interactions in liver TM (P ≥ 0.18). A DEP × day effect was noted for liver Cu (P < 0.01) and Mn (P = 0.07), where ANT Cu increased linearly from day 0 to day 42, CON Cu was slightly increased on day 14 and day 28, and ANT Mn was lesser than CON Mn on all days except day 42. There were REP × day effects on liver Cu (P < 0.01) and Se (P < 0.01) where status was improved by ITM by day 14, increased in BLEND by day 28, and not different by day 42. Liver Se concentrations were lesser (P < 0.01) in ANT vs. CON throughout repletion. Liver Zn was greater (P < 0.01) on day 0 than day 14, 28, and 42, and concentrations were greater on day 42 than day 28. Glutathione peroxidase activity tended to be lesser (P = 0.07) on day 14 relative to other days. Manganese superoxide dismutase activity was lesser (P < 0.01) on day 14 and 28 compared to day 0 and 42, and tended to be lesser (P = 0.06) in ANT than CON during repletion. Final body weight (BW) and average daily gain (ADG) were not affected by treatment (P ≥ 0.60), and ANT decreased dry matter intake (DMI) (P = 0.04) and improved G:F (P < 0.01) during repletion. All repletion strategies were effective at increasing TM status of steers, and ITM had the most rapid recovery of Cu and Se status, followed by BLEND, and ING.

Associations of Spatial Disparities of Alzheimer's Disease Mortality Rates with Soil Selenium and Sulfur Concentrations and Four Common Risk Factors in the United States.

BACKGROUND: Associations between environmental factors and spatial disparity of mortality rates of Alzheimer's disease (AD) in the US are not well understood. OBJECTIVE: To find associations between 41 trace elements, four common risk factors, and AD mortality rates in the48 contiguous states. METHODS: Isopleth maps of AD mortality rates of the 48 states and associated factors were examined. Correlations between state average AD mortality rates and concentrations of 41 soil elements, wine consumption, percentage of current smokers, obesity, and diagnosed diabetes of the 48 states between 1999 and 2014 were analyzed. RESULTS: Among 41 elements, soil selenium concentrations have the most significant inverse correlations with AD mortality rates. Rate ratio (RR) of the 6 states with the lowest product of soil selenium and sulfur concentrations is 53% higher than the 6 states with the highest soil selenium sulfur product in the 48 states (RR = 1.53, CI95% 1.51-1.54). Soil tin concentrations have the most significant inverse correlation with AD mortality growth rates between 1999 and 2014, followed by soil sulfur concentrations. Percentages of obesity, diagnosed diabetes, smoking, and wine consumption per capita also correlate significantly with AD mortality growth rates. CONCLUSIONS: High soil selenium and sulfur concentrations and wine consumption are associated with low AD mortality rates. Given that average soil selenium and sulfur concentrations are indicators of their intakes from food, water, and air by people in a region, long-term exposure to high soil selenium and sulfur concentrations might be beneficial to AD mortality rate reduction in a region.

Sulfur and sulfur nanoparticles as potential antimicrobials: from traditional medicine to nanomedicine.

INTRODUCTION: The alarming rate of infections caused by various pathogens and development of their resistance towards a large number of antimicrobial agents has generated an essential need to search for novel and effective antimicrobial agents. Metal nanoparticles such as silver have been widely used and accepted as strong antimicrobial agents, but considering the cost effectiveness and significant bioactivities, researchers are looking to utilize sulfur nanoparticles as an effective alternative to silver nanoparticles. AREAS COVERED: This review has been focused on different approaches for the synthesis of sulfur nanoparticles, their broad spectrum bioactivities and possible mechanisms involved in their bioactivities. Expert commentary: Sulfur nanoparticles are reported to possess broad spectrum antimicrobial activity, and hence can be used to treat microbial infections and potentially tackle the problem of antibiotic resistance. Thus, in the future, sulfur nanoparticles can be used as an effective, non-toxic and economically viable alternative to other precious metal nanoparticles.

Elemental diet induces the proliferation of sialomucin goblet cells in the rat duodenum and jejunum.

We histologically examined the effects of elemental diet (ED) on the goblet cell profile in the rat small intestine. The sulfomucin goblet cells were predominant throughout the small intestine in the control group, while sialomucin goblet cells were manifest in the duodenum and jejunum in the ED group. Next, we investigated the possible relevance of luminal osmolality to the goblet cell profile. Gastric osmolality in the ED group was within the physiological range. Meanwhile, ingestion of high glucose diet elevated gastric osmolality and increased the number of sialomucin goblet cells in the duodenum and jejunum. Further, it turned out that the lower sulfur contents in ED was not related to the unique goblet cell profile by ED ingestion. It is inductively suggested that the influx of high concentrations of low molecular nutrients into the small intestine could be associated with the goblet cell alteration, but the alteration was not necessarily due to the changes in the gastric osmolality by ED ingestion.

Particulate matter composition and respiratory health: the PIAMA Birth Cohort study.

BACKGROUND: Ambient particulate matter (PM) exposure is associated with children's respiratory health. Little is known about the importance of different PM constituents. We investigated the effects of PM constituents on asthma, allergy, and lung function until the age of 11-12 years. METHODS: For 3,702 participants of a prospective birth cohort study, questionnaire-reported asthma and hay fever and measurements of allergic sensitization and lung function were linked with annual average concentrations of copper, iron, potassium, nickel, sulfur, silicon, vanadium, and zinc in particles with diameters of less than 2.5 and 10 µm (PM2.5 and PM10) at birth addresses and current addresses from land-use regression models. Exposure-health relations were analyzed by multiple (repeated measures) logistic and linear regressions. RESULTS: Asthma incidence and prevalence of asthma symptoms and rhinitis were positively associated with zinc in PM10 at the birth address (odds ratio [95% confidence interval] per interquartile range increase in exposure 1.13 [1.02, 1.25], 1.08 [1.00, 1.17], and 1.16 [1.04, 1.30], respectively). Moreover, asthma symptoms were positively associated with copper in PM10 at the current address (1.06 [1.00, 1.12]). Allergic sensitization was positively associated with copper and iron in PM10 at the birth address (relative risk [95% confidence interval] 1.07 [1.01, 1.14] and 1.10 [1.03, 1.18]) and current address. Forced expiratory volume in 1 second was negatively associated with copper and iron in PM2.5 (change [95% confidence interval] -2.1% [-1.1, -0.1%] and -1.0% [-2.0, -0.0%]) and FEF75-50 with copper in PM10 at the current address (-2.3% [-4.3, -0.3%]). CONCLUSION: PM constituents, in particular iron, copper, and zinc, reflecting poorly regulated non-tailpipe road traffic emissions, may increase the risk of asthma and allergy in schoolchildren.

Sulfur spring dermatitis.

Thermal sulfur baths are a form of balneotherapy promoted in many cultures for improvement of skin conditions; however, certain uncommon skin problems may occur after bathing in hot sulfur springs. We report the case of a 65-year-old man who presented with multiple confluent, punched-out, round ulcers with peripheral erythema on the thighs and shins after bathing in a hot sulfur spring. Histopathologic examination revealed homogeneous coagulation necrosis of the epidermis and papillary dermis. Tissue cultures showed no evidence of a microbial infection. The histopathologic findings and clinical course were consistent with a superficial second-degree burn. When patients present with these findings, sulfur spring dermatitis should be considered in the differential diagnosis. Moreover, the patient's clinical history is crucial for correct diagnosis.

A case study involving allergic reactions to sulfur-containing compounds including, sulfite, taurine, acesulfame potassium and sulfonamides.

A case study is reported whereby an individual with known sulfite and sulfonamide allergies develops hypersensitivity to taurine above a threshold level as well as to the non-nutritive sweetener acesulfame potassium, compounds that are not normally associated with allergic reactions. Sulfites, sulfonamides, taurine and acesulfame potassium all contain a SO3 moiety. Challenge tests provide evidence for the hypersensitivities to taurine and acesulfame potassium. The subject is also allergic to thiuram mix and thimerosal, sulfur containing compounds, as well as to various food products. This may be the first case where hypersensitivities to taurine and acesulfame potassium have been documented and reported. Several mechanistic explanations are provided for the untoward reactions to taurine and acesulfame potassium.

Effect of varying concentrations of vitamin C on performance, blood metabolites, and carcass characteristics of steers consuming a common high-sulfur (0.55% S) diet.

The objective of this study was to examine the effects of vitamin C (VC) supplementation for an average of 102 d before harvest on finishing performance and blood metabolites of steers receiving a 40% dry distillers grains plus solubles diet (0.55% S). Yearling, Angus-cross steers (n = 140) were blocked by initial BW (432 ± 25.5 kg), stratified within blocks by intramuscular fat (3.6% ± 0.30%) determined by ultrasonography, and assigned to treatments (5 steers/pen, 7 pens/treatment). Treatments included 1) no VC control (CON), 2) 5 g VC • steer(-1) • d(-1) (5VC), 3) 10 g VC • steer(-1) • d(-1) (10VC), and 4) 20 g VC • steer(-1) • d(-1) (20VC). Jugular blood was collected from 2 steers/pen before feeding at the beginning and end of the 102-d study, and steers were harvested by block on 3 separate dates (d 91, 105, and 112). Sulfur intake linearly decreased (P = 0.01) as VC inclusion increased (59.2, 57.7, 57.0, and 54.8 ± 0.79 g S • steer(-1) • d(-1) for CON, 5 VC, 10 VC, and 20 VC, respectively). The CON cattle had greater (P < 0.01) DMI than the VC-supplemented cattle. Inclusion of VC did not influence ADG or final BW, resulting in a tendency for a linear increase (P = 0.08) in G:F as VC inclusion increased (0.150, 0.152, 0.158, and 0.160 ± 0.004 for CON, 5 VC, 10 VC, and 20 VC, respectively). Ending (2 d before harvest) plasma ascorbate showed a quadratic effect (P < 0.05) because of lesser concentrations exhibited by 5 VC cattle (1,186 µg/L) compared with the CON (1,454 µg/L), 10 VC (1,304 µg/L), and 20 VC (1,436 µg/L; SEM ± 64.8) cattle. Ending plasma insulin concentrations of CON cattle tended (P = 0.07) to be less than the VC-supplemented cattle. Plasma glucose and NEFA concentrations were not affected (P ≥ 0.23) by VC inclusion. Hot carcass weight, 12th-rib back fat, marbling, and quality grade were not affected (P ≥ 0.27) by VC inclusion. Increasing VC inclusion linearly increased (P = 0.02) rib eye area (84.9, 86.5, 88.7, and 89.1 cm(2) ± 1.17 for CON, 5 VC, 10 VC, and 20 VC, respectively), corresponding to a linear decrease (P = 0.02) in yield grade with increasing inclusions of VC. A tendency (P = 0.06) for a quadratic effect on KPH was observed, in which values generally increased from CON (2.27%) to 5 VC (2.37%) to and 10 VC (2.39%), then decreased in 20 VC (2.20%). In conclusion, VC supplementation to a high-S diet for an average of 102 d before harvest has limited effects on blood metabolites but increased rib eye area and tended to increase feed efficiency of yearling steers.

Understanding the role of sulfur-thiamine interaction in the pathogenesis of sulfur-induced polioencephalomalacia in beef cattle.

This study examined the role of sulfur (S) in the pathogenesis of S-induced polioencephalomalacia (PEM) in beef cattle in the context of thiamine status and metabolism. Thiamine, thiamine monophosphate (TMP) and thiamine pyrophosphate (TPP) status in rumen fluid, blood and brain tissue were determined in beef heifers fed 2 levels of S [low S (LS) vs. high S (HS)] at 2 forage-to-concentrate ratios (F:C). High S diet did not affect ruminal and blood thiamine status. Interestingly, however, HS diet showed increased brain thiamine levels. No gross or histopathological changes indicative of PEM were detected in the brains of the heifers. Of note, during the course of the present study, we documented an outbreak of S-induced PEM in commercial feedlot steers. Brain thiamine variables in experimental animals fed HS diet were then contrasted with brain thiamine status in PEM affected feedlot steers. Interestingly, in clinically normal animals, exposure to HS diet resulted in increased levels of both TMP and TPP in the brain tissue, in comparison to animals fed LS diet. In contrast, the PEM affected brains showed overall lower levels of thiamine phosphates. It is noteworthy that TPP levels were 36.5% lower, despite 4.9-fold higher free thiamine in PEM brains compared to normal brains. Our results indicate that high dietary S may increase the metabolic demand for TPP, and that animals incapable of maintaining requisite levels of brain TPP are at high risk to develop fulminant cerebrocortical necrosis.

Novel insights into the function of Arabidopsis R2R3-MYB transcription factors regulating aliphatic glucosinolate biosynthesis.

Arabidopsis transcription factors, MYB28, MYB29 and MYB76, positively regulate aliphatic glucosinolate (AGSL) biosynthesis. Mutual transcriptional regulation among these MYB genes makes it difficult to elucidate their individual function simply by analyzing knock-out mutants or ectopically overexpressing lines of these genes. In this study, we constructed transgenic lines expressing each MYB gene driven by its own promoter in the myb28myb29 background, where the expression of the endogenous MYB28, MYB29 and MYB76 was repressed with no AGSL accumulation. In leaves, transgenic MYB28 expression activated AGSL biosynthetic genes and restored accumulation of AGSLs with short side chains. Transgenic MYB29 expression activated the same biosynthetic pathway, but induction of the genes involved in side chain elongation was weaker than that by MYB28, resulting in a weaker recovery of AGSLs. Neither MYB28 nor MYB29 recovered long-chain AGSL accumulation. MYB76 was considered to require both MYB28 and MYB29 for its normal level of expression in leaves, and could not activate AGSL biosynthesis on its own. Interestingly, the accumulation in seeds of long- and short-chain AGSLs was restored by transgenic expression of MYB28 and MYB76, respectively. A sulfur stress experiment indicated that MYB28 expression was induced by sulfur deficiency, while the expression levels of MYB29 and MYB76 were positively correlated with sulfur concentration. This study illustrated how the individual MYBs work in regulating AGSL biosynthesis when expressed alone under normal transcriptional regulation.

Supramolecular reactive sulphur nanoparticles: a novel and efficient antimicrobial agent.

Antimicrobial resistance continues to be an inexorable threat for the biomedical and biochemical researchers. Despite the novel discoveries in drug designing and delivery, high-throughput screening and surveillance data render the prospects for new antimicrobial agents as bleak as ever. The advent of nanotechnology, however, strengthens pharmacology by offering effective therapeutics to treat this aforementioned problem. Several nanoparticles of the known elements have already been reported for their antimicrobial efficacy. Nanosized fabrication of elemental sulphur with suitable surface modifications offers to retrieve the use of sulphur (man's oldest known ecofriendly microbicide) as a potential antimicrobial agent. Sulphur nanoparticles (SNPs) are effective against both conventionally sulphur-resistant and sulphur-susceptible microbes (fungi and bacteria). Moreover, biocompatible polymers present on the surface of SNPs minimize toxicity during application. Here, we focus on various aspects of physicochemical features of SNPs and their biochemical interactions with microbes. The present review also illustrates the effects of SNPs on plants and animals in terms of cytotoxicity and biocompatibility.

Respiratory health status of US Army personnel potentially exposed to smoke from 2003 Al-Mishraq Sulfur Plant fire.

OBJECTIVE: To assess the impact of exposure to a 2003 sulfur plant fire on the health of deployed US Army personnel. METHODS: The authors identified a small firefighter group known to be at the fire source and a larger, more dispersed population. Self-reported health status and respiratory health outcomes for these two groups were reviewed compared with two unexposed groups. RESULTS: Self-reported health concerns, difficulty breathing, and shortness of breath were common in the exposed. Rates for chronic respiratory conditions increased in all groups from before to after deployment. Postdeployment medical encounters for chronic respiratory conditions among the exposed did not differ significantly from the unexposed comparison groups. CONCLUSION: Potential exposure to the sulfur fire was positively associated with self-reported health concerns and symptoms but not with clinical encounters for chronic respiratory health conditions.

Treatment of scabies using 8% and 10% topical sulfur ointment in different regimens of application.

BACKGROUND: Many therapeutic modalities for scabies were available, topical sulfur ointment is a cost-effective and safe therapeutic agent. It is often applied for the whole body for three successive days. OBJECTIVE: To evaluate their therapeutic regimen of 8% and 10% topical precipitated sulfur in petrolatum ointment for single day, three successive nights or three successive days in management of scabies. PATIENTS AND METHODS: This single-blinded, comparative study was conducted in the Department of Dermatology-Baghdad Teaching Hospital from April 2008 through October 2009. A total of 97 patients with scabies were enrolled in this study. The diagnosis was established on clinical basis. The patients treated with 8% and 10% topical sulfur in petrolatum ointment were divided randomly into three groups: Group A: 33 patients treated for single day (24 hours); Group B: 32 patients treated for three successive nights (from 6 p.m. to 8 p.m. to 6 a.m. to 8 a.m. and bathing every day); and Group C: 32 patients treated for three successive days (bathing every 24 hours). The patients were seen regularly every two weeks for the duration of four weeks. RESULTS: Study included 58 (59.8%) males and 39 (40.2%) females, with a male to female ratio 1.4:1. The age range of males at presentation from 3 to 64 (26.74±15.98) years, while the females age ranged at presentation from 3 to 60 (24.05±14.53) years of age. At the end of the study, the response to treatment was: Group A, response in 14 (42.4%) patients and no response in 19 (57.6%); Group B, response in 29 (90.6%) patients and no response in 3 (9.4%); and Group C, response in 31 (96.9%) patients and no response in 1 (3.1%). There is significant statistical difference among the response of 3 groups with (P=0.00000011), but no statistically significant difference between the response of Group C and Group B, (P=0.6055). Mild burning sensation and irritating (sulfur) dermatitis were the only side effects of 8% and 10% sulfur. Pruritic rash occurred in Group C mainly, in 11 (34.4%) patients, 8 (25%) in Group B and 4 (12.1%) in Group A, with no significance (P=0.1058). Recurrence or relapse occurred in Group A mainly, with 4 (12.1%) patients, and in Group B, 1 patient, (3.1%), with no recurrence in group C, with significance (P=0.0060). CONCLUSION: Three successive days and three successive nights of 8% and 10% sulfur ointment were effective regimens with no statistical difference in favor of three successive days, while single-day application was much less effective but with fewer side effects.