If you grew up in the South, there is a good chance someone in your family kept a small tube of dark brown or black ointment in the bathroom cabinet. Maybe they called it "black salve," "drawing ointment," or just "that black stuff." It probably smelled faintly of coal. And when you got a splinter, an ingrown toenail, or a swollen insect bite, it came out.
That product is almost certainly ichthammol ointment, one of the oldest pharmacy preparations still in widespread use. Here is what it actually is, and what the science says about whether it works.
What Is Ichthammol?
Ichthammol (also written ammonium bituminosulfonate) is a derivative of sulfur rich oil shale, specifically, bituminous schist. It is produced by distilling shale oil, then sulfonating it and neutralizing with ammonia. The result is a dark brown to black, viscous, pungent substance with real pharmacological properties.
According to Wikipedia's entry on ammonium bituminosulfonate, ichthammol is used to treat various skin conditions including eczema, psoriasis, acne rosacea, and acne. The Cleveland Clinic includes it among topical medications that "may relieve discomfort caused by skin irritations, such as insect bites, poison ivy, or ingrown toenails."
The typical OTC formulation is 10 percent or 20 percent ichthammol in a petrolatum base, which is what you find in the familiar tubes at pharmacies like CVS (which lists ichthammol 100 mg/g, i.e., 10%, in their store brand formulation).
What "Drawing" Actually Means
The traditional claim about ichthammol is that it "draws out" infection, splinters, and foreign bodies from under the skin. This is where the science gets more nuanced.
For splinters and foreign bodies: A physician's review published by Lost Art Press notes that there is "no direct evidence that it would help get a splinter out of your body more quickly" but acknowledges that it "might help the body rid you of the splinter (and probably will make the process less painful)." The practical mechanism is thought to involve skin softening and hydration, which reduces the resistance around the embedded object and may make it easier for the body to expel.
For abscesses and infections: Human dermatologists have stated that there is "no evidence that ichthammol draws out abscess or infections." The mechanism that moves fluid in an abscess is osmotic pressure, which is better attributed to substances like magnesium sulfate (Epsom salt) than to ichthammol. Ichthammol does not have corrosive properties.
For skin conditions, this is where the evidence is stronger. Ichthammol has documented:
- Anti inflammatory properties
- Mild antiseptic activity (bacteriostatic)
- Keratolytic action (softens and loosens hardened skin)
- Emollient properties (moisturizing)
For eczema, psoriasis, and acne rosacea, the documented mechanisms give ichthammol genuine pharmacological relevance. Studies and clinical use support its role in these dermatological conditions.
How to Use It
- Clean and dry the affected area before application
- Apply a thin layer of ichthammol ointment to the affected skin
- Cover with a bandage or gauze if desired (this also prevents the dark color from staining clothing)
- Reapply once or twice daily
For ingrown toenails or splinters where the goal is softening, apply at night and cover with a bandage to allow extended contact.
Important warnings:
- External use only, do not apply to large areas of burned or damaged skin
- Do not use near eyes
- Report any allergic reaction (rash, hives, significant worsening of irritation)
- Ichthammol will stain fabric and surfaces. The dark brown color is due to the chemical itself, not contamination.
What It Won't Do
Ichthammol ointment is not:
- A substitute for professional treatment of a serious abscess or infected wound
- A treatment for deep infections (it is topical only)
- Evidence based for "drawing out" systemic infections
If a wound shows signs of spreading redness, warmth, swelling, red streaks extending away from the wound, fever, or increasing pain, that requires a physician evaluation, not more ointment.
OTC Availability
Ichthammol ointment is widely available OTC. CVS, Walgreens, Walmart, and most independent pharmacies carry it, typically in the topical skin care section. Concentrations of 10 and 20 percent are the standard OTC options.
You can shop ichthammol salve and topical remedies at Fairview Pharmacy.
This article is for general information only and is not a substitute for personalized medical advice. Before starting or changing any medication, including over the counter products and supplements, talk with your pharmacist or physician about your specific situation.