Author: Anoma Ranaweera B.V. Sc; PhD (Clinical Biochemistry, University of Liverpool, UK), 2013.

Sulfasalazine is an anti-inflammatory medication consisting of a combination of 5-aminosalicylic acid and the sulphonamide sulfapyridine. Currently this drug is approved by the US FDA for the treatment of ulcerative colitis and rheumatoid arthritis. Sulfasalazine has also been used for some skin conditions.

Off-label indications of sulfasalazine in dermatology

Non-approved reported uses of sulfasalazine in dermatology include:

With the exception of psoriasis, alopecia areata and lichen planus, all off-label dermatology indications are based on isolated case reports and/or small, uncontrolled series.

Pemphigus vulgaris

Chronic idiopathic urticaria

Lichen planus

Cutaneous lupus erythematosus

Plaque psoriasis

Atrophie blanche

Alopecia areata

Pyoderma gangrenosum

Dermatitis herpetiformis

Mechanism of action of sulfasalazine

Drug interactions with sulfasalazine

Adverse effects with sulfasalazine

Common but harmless and transient adverse effects include:

Other rare but potentially serious adverse effects include:

Practical tips for using sulfasalazine in dermatology

As the dermatological indications are all off-label, treatment should only be started after receiving patient consent. Contraindications to its use are:

A pretreatment work-up should include:


The US FDA has classified sulfasalazine as Category B. The effect that sulfasalazine has on an unborn child has not been studied extensively. Sulfasalazine should only be used during pregnancy if clearly needed. Sulfasalazine does pass into breast milk, and could affect a nursing infant.

The Australian TGA has classified sulfasalazine as Category A. Category A medicines have been taken by a large number of pregnant women and women of childbearing age, without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the fetus having been observed.

Treatment monitoring

New Zealand approved datasheets are the official source of information for these prescription medicines, including approved uses and risk information. Check the individual New Zealand datasheet on the Medsafe website.

Related information

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