Drawing salve is a thick, dark ointment applied to the skin with the goal of pulling infections, splinters, or embedded debris toward the surface. The most common active ingredient is ichthammol, a sulfur-rich compound derived from oil shale that has been used in dermatology for well over a century. While the name suggests something almost magical, the mechanism behind drawing salve is more straightforward than it sounds, and the story gets more complicated once you learn that “drawing salve” and “black salve” are very different products that people routinely confuse.
What Goes Into a Drawing Salve
Most commercial drawing salves are built around ichthammol, also known as ammonium bituminosulfonate. Ichthammol is produced by distilling certain types of oil-bearing shale rock and then treating the resulting oil with sulfuric acid and ammonia. The end product is a dark, tar-like paste with a distinctive smell that most people either tolerate or strongly dislike. Concentrations in over-the-counter products typically range from about 10% to 50%, with higher-concentration versions sometimes marketed for more stubborn boils or abscesses.
The rest of the formulation is usually simple: a base of petrolatum, lanolin, or beeswax that keeps the ointment workable and helps it adhere to skin. Some brands add herbal extras like calendula or arnica, though the evidence behind those additions is thin compared to what we know about ichthammol itself. Ichthammol-based drawing salves have been used to treat conditions including psoriasis, eczematous dermatitis, leg ulcers, seborrheic dermatitis, and boils.1International Journal of Dermatology. Ichthammol revisited
How Drawing Salve Actually Works
The word “draw” makes it sound like the salve reaches into the skin and physically pulls things out. The reality involves several overlapping effects, none of them quite that dramatic, but together they do encourage material beneath the skin to move toward the surface.
Research on 3D skin models has shown that ichthammol ointments loosen the structure of the outer skin layers. In laboratory testing, treated skin showed reduced expression of filaggrin and laminin, two proteins that help hold skin cells together and anchor them to deeper layers. The effect was concentration-dependent, meaning stronger formulations caused more loosening.2European Journal of Pharmaceutical Sciences. In vitro investigation of the principle of action of ammonium bituminosulfonate ointments on a 3D skin model When those structural proteins are suppressed, the skin becomes more permeable. That increased permeability is essentially what “drawing” means in practical terms: the barrier between what is trapped under the skin and what is on the surface becomes thinner and more porous.
For a boil or abscess, this loosening effect can help the pocket of pus find its way to the surface rather than staying walled off deeper in the tissue. For a splinter, softening the surrounding skin makes it easier for the foreign body to work free or to be pulled out with tweezers. The salve does not create suction or generate any kind of pulling force. Instead, it changes the skin’s architecture so that the path of least resistance leads outward.
Antibacterial and Anti-Inflammatory Effects
Drawing salve is not just a mechanical skin-softener. Ichthammol has genuine antimicrobial properties, particularly against the gram-positive bacteria most often responsible for skin infections. Laboratory testing found that ichthammol produced inhibition zones of 18 mm against Staphylococcus aureus and 23 mm against Streptococcus pyogenes, both of which are common culprits in boils, abscesses, and wound infections.3The Journal of Laryngology & Otology. Glycerol and ichthammol: medicinal solution or mythical potion? Those are meaningful zones of bacterial killing. The same study found no significant activity against Proteus mirabilis or Pseudomonas aeruginosa, so ichthammol is not a broad-spectrum antibiotic and should not be treated as one.
Ichthammol also has anti-inflammatory properties that help reduce the redness, swelling, and pain around an infected area. When you combine reduced inflammation with antibacterial action and skin-softening, you get a product that can genuinely help a superficial infection resolve faster, especially if the infection just needs a pathway to drain. The therapeutic benefit of a glycerol and ichthammol combination has been attributed to both the antibacterial activity of ichthammol against gram-positive organisms and the dehydrating effect of the glycerol component.3The Journal of Laryngology & Otology. Glycerol and ichthammol: medicinal solution or mythical potion?
What People Typically Use It For
The most common use of drawing salve is on boils and furuncles, those painful, swollen lumps that form when a hair follicle becomes deeply infected. A thick layer of ichthammol ointment covered with a bandage, left on overnight, can help the boil come to a head and drain on its own. Many people swear by this approach, and given the documented skin-softening and antibacterial effects, there is a plausible mechanism behind the folk remedy.
Other common applications include:
- Splinters: Applying drawing salve over a shallow splinter and covering it with a bandage for several hours can soften the skin enough to ease removal.
- Insect bites and stings: The anti-inflammatory effect can reduce swelling and itching, though this is more about comfort than any “drawing out” of venom.
- Minor skin infections: Small areas of infected skin that have not progressed to the point of needing oral antibiotics sometimes respond to topical ichthammol.
- Ingrown hairs: Softening the overlying skin can help a trapped hair work its way to the surface.
What drawing salve cannot do is replace proper medical treatment for a deep or spreading infection. If you have a large abscess, an infection with expanding redness, fever, or red streaks running away from the site, you need a healthcare provider. Drawing salve works on the superficial end of the spectrum and should be seen as a first-aid measure, not as a substitute for antibiotics or surgical drainage.
The Dangerous Confusion With Black Salve
This is where things get serious. “Drawing salve” and “black salve” sound similar, look similar in photographs, and are sometimes marketed side by side. They are not the same thing. Black salve typically contains bloodroot (Sanguinaria canadensis) and zinc chloride, both of which are escharotics, meaning they chemically destroy living tissue. Applying black salve to skin creates a deep chemical burn that kills everything it contacts, healthy tissue and diseased tissue alike.
Black salve has been promoted in alternative medicine circles as a treatment for skin cancer, warts, and moles, with sellers claiming it selectively targets abnormal cells. It does not. It destroys whatever tissue it touches, often leaving disfiguring craters and scars. Secondary infection is a common consequence of applying black salve to skin lesions, sometimes requiring care from infectious disease specialists, surgeons, and dermatologists to manage.4PubMed Central. Black Salve: A Dangerous Corrosive Disguised as an Alternative Medicine
The FDA has taken action against companies selling black salve with medical claims. In 2017, the agency issued a warning letter to a company marketing black salve for malignancies and skin problems, stating that the products were “not generally recognized as safe and effective” and were misbranded because they targeted conditions not amenable to self-diagnosis and treatment by non-practitioners.5PubMed Central. Black salve: risky escharotic Despite these warnings, black salve remains available online and continues to cause harm.
The practical takeaway: if you are shopping for drawing salve and the ingredient list includes bloodroot, sanguinarine, or zinc chloride, you are looking at a black salve product, not a traditional ichthammol-based drawing salve. Put it back. An ichthammol drawing salve softens skin. A black salve burns through it.
Side Effects of Ichthammol Drawing Salve
Ichthammol-based drawing salves have a long safety track record, and serious adverse reactions are uncommon. As of early 2025, a global pharmacovigilance database had recorded only 219 adverse drug reactions associated with ichthammol, a remarkably small number given more than a century of widespread use. Among those reports, about 41% involved skin and subcutaneous tissue disorders, making dermatologic reactions the most commonly documented problem.6National Journal of Pharmacology and Therapeutics. Ichthammol-induced contact dermatitis in a pediatric patient
The most frequently noted side effect is mild skin irritation at the application site: some redness, slight stinging, or dryness. True allergic reactions can occur but are rare. Contact dermatitis, where the skin mounts an immune response to the ichthammol itself, has been documented in individual case reports, including in children. If you apply drawing salve and notice worsening redness, blistering, or spreading irritation rather than improvement, wash the area and stop using it. That small number of total reported reactions may partly reflect underreporting, since many people use drawing salve at home without medical supervision, but it also suggests that ichthammol is genuinely well tolerated for most people.
Drawing salve should not be applied to open wounds, mucous membranes, or the eyes. It is meant for intact skin overlying a bump, boil, or embedded object. Applying it to broken skin can cause pain and may delay healing rather than help.
How to Apply Drawing Salve Effectively
If you have a boil that is not yet ready to drain, or a splinter you cannot quite reach, the standard approach is simple. Clean the area with soap and water, then apply a thick layer of ichthammol ointment directly over the site. Cover it with a bandage or gauze pad. Many people do this at bedtime and leave the salve on overnight, checking the area in the morning. For boils, you may need to repeat the process for two or three nights before the lesion comes to a head.
A few practical notes that experienced users learn quickly: ichthammol stains everything. Clothing, sheets, towels, and countertops will all pick up dark marks that are difficult to remove. Use old bandaging materials and protect your bedding. The smell is strong and not pleasant for most people, though it fades once the bandage is in place. If you are using a higher-concentration product (above 20%), start with a small test area to make sure your skin tolerates it before slathering it on generously.
Warm compresses applied before the salve can speed things along. Heat increases blood flow to the area and helps soften tissue on its own, and the combination of heat followed by ichthammol is a time-tested pairing for stubborn boils. Some people alternate warm compresses and salve applications throughout the day when dealing with a particularly painful lesion.
When Drawing Salve Is Not Enough
Drawing salve works best on small, localized, superficial problems. A single boil that is close to the surface and not surrounded by spreading redness is a reasonable candidate. A splinter that is visible just under the skin and not too deep is another. But there are clear situations where reaching for the salve instead of a phone to call your doctor is the wrong move.
Any abscess larger than about two centimeters across often needs to be incised and drained by a healthcare provider. Drawing salve cannot replace a scalpel for a well-walled-off collection of pus that has no natural pathway to the surface. If you see red streaks extending away from the infected area, that suggests the infection is spreading along lymphatic channels and needs systemic antibiotics. Fever alongside a skin infection also signals that the problem has moved beyond something topical treatment can handle.
People with diabetes or compromised immune systems should be especially cautious. Skin infections in these groups can escalate quickly, and the window between “this looks like a simple boil” and “this is a dangerous deep tissue infection” can be narrower than expected. Drawing salve is not harmful for these individuals, but relying on it too long before seeking care is the risk.
The Evidence Gap
For a product that has been in continuous use since the late 1800s, ichthammol has remarkably little rigorous clinical trial data behind it. Most of what we know about its mechanism comes from laboratory and in-vitro research, like the 3D skin model studies showing how it loosens skin structure.2European Journal of Pharmaceutical Sciences. In vitro investigation of the principle of action of ammonium bituminosulfonate ointments on a 3D skin model The antimicrobial data comes from petri-dish testing, not from randomized controlled trials tracking whether patients with boils recover faster with ichthammol compared to, say, warm compresses alone or a topical antibiotic.
This is not unusual for old, inexpensive, unpatentable products. There is little financial incentive for a company to fund a large clinical trial on a generic compound that anyone can manufacture. The result is that drawing salve occupies a curious middle ground: it has enough laboratory evidence and historical use to be taken seriously, but not enough clinical trial evidence to be confidently recommended in modern treatment guidelines. Most dermatology textbooks mention ichthammol briefly and move on. A review in the dermatology literature described it as remaining “a useful topical medicament” while acknowledging the thin evidence base.1International Journal of Dermatology. Ichthammol revisited
For the person at home with a painful boil and a tin of ichthammol in the medicine cabinet, the evidence gap is mostly academic. The product is safe, the mechanism is plausible, and generations of practical experience suggest it does what people say it does. But if you are looking for a definitive clinical trial proving that drawing salve speeds healing of boils compared to no treatment, that study largely does not exist yet. The honest position is that drawing salve probably helps for superficial skin problems, is unlikely to cause harm when used as directed, and is absolutely not a substitute for medical evaluation when an infection looks serious or involves any of the warning signs described above.