Ichthammol ointment has not been formally banned or pulled from the market by a single regulatory action. Instead, it has gradually disappeared from pharmacy shelves due to a combination of factors: it was never approved by the FDA as safe and effective, its raw material is difficult to source, and modern wound care has largely moved past it. Some products are still manufactured, but many familiar brands have quietly stopped production, leaving people who relied on “black drawing salve” unable to find it.
Ichthammol’s Unusual FDA Status
The most important thing to understand is that ichthammol sits in a regulatory gray area. The FDA’s DailyMed database lists ichthammol ointment under the marketing category “unapproved drug other,” and its labeling carries a blunt disclaimer: “This drug has not been found by FDA to be safe and effective, and this labeling has not been approved by FDA.” That does not mean the FDA declared it dangerous. It means ichthammol never went through the formal approval process that modern over-the-counter drugs require.
For decades, many older topical products like ichthammol were sold under the FDA’s OTC monograph system, which allowed ingredients with long histories of use to remain on shelves while the agency slowly reviewed them. As the FDA has tightened its monograph process over the years, products that lack strong clinical evidence of both safety and efficacy have faced increasing pressure. Manufacturers who would need to invest in new studies to keep an already low-profit product on the market often decide it is not worth the cost. That quiet business decision, repeated across multiple companies, is a major reason ichthammol has become harder to find.
Safety Questions Around Shale Oil
Ichthammol is derived from oil shale, a type of sedimentary rock rich in organic material. The rock is mined, heated to extract oil, and then chemically processed to produce ammonium bituminosulfonate, the active compound in ichthammol ointment. Because it originates from fossil material, the finished product contains trace amounts of polycyclic aromatic hydrocarbons (PAHs), a broad class of compounds found in coal tar, crude oil, and combustion byproducts.
PAHs are a known concern in toxicology. The Agency for Toxic Substances and Disease Registry notes that skin cancer has been reported among workers with prolonged dermal exposure to shale oils. While ichthammol ointment is a refined product used in small amounts rather than a raw industrial shale oil, the presence of PAHs has made regulators and manufacturers increasingly cautious. In an era where safer, well-studied alternatives exist, the theoretical cancer risk from PAH exposure gives companies little incentive to defend the product through an expensive approval process.
Supply Chain and Manufacturing Challenges
Producing ichthammol is not like synthesizing a standard pharmaceutical ingredient in a chemical plant. It requires mining specific bituminous shale deposits, a process concentrated in a small number of locations worldwide (historically, parts of the Austrian and German Alps). The distillation and sulfonation steps that follow are specialized and not easily scaled. As global demand has dropped, the economics of maintaining this niche supply chain have worsened. Fewer suppliers mean higher costs per unit, which further discourages manufacturers from keeping ichthammol products in their catalogs.
How Ichthammol Actually Works
People who swear by ichthammol typically describe it as “drawing out” infections, particularly boils, splinters, and deep cysts. A 2022 study using a 3D skin model helped clarify what is actually happening at a cellular level. The ointment increases skin permeability in a concentration-dependent way, essentially loosening the outer layers of skin. It does this by interacting with structural proteins in the epidermis: higher concentrations reduced levels of filaggrin and laminin, two proteins that help hold skin layers together and maintain the skin barrier. The result is that trapped pus and fluid can drain more easily to the surface.
This mechanism is real, but it is not unique. Warm compresses accomplish something similar by increasing blood flow and softening tissue. And the “drawing” effect does not treat the underlying bacterial infection, which is why modern guidelines focus on drainage procedures and, when necessary, antibiotics.
What Replaced Ichthammol in Practice
For boils and abscesses, the standard treatment today is incision and drainage. A doctor numbs the area with a local anesthetic, opens the boil, and allows the pus to escape. Gauze or silicone strips are sometimes packed into the wound to wick out remaining fluid and keep the cavity clean while it heals from the inside out. The wound is typically cleansed with sterile saline, and antiseptic ointments or dressings may be applied afterward.
Antibiotics are reserved for specific situations: boils on the face (especially around the nose and upper lip), multiple boils occurring at once, signs of spreading infection through the lymph system, or systemic symptoms like fever and rapid heart rate. For a single, uncomplicated boil, warm compresses applied several times a day often bring it to a head on their own, no ointment needed.
This shift in clinical practice matters because it reduced demand for ichthammol long before supply issues or regulatory pressure became factors. Doctors stopped recommending it, pharmacies stopped stocking it, and manufacturers stopped making it. The “discontinuation” was less a dramatic event than a slow fade.
Can You Still Buy Ichthammol?
Yes, in some cases. A few brands still produce ichthammol ointment, typically in 10% or 20% concentrations, and sell it online or through specialty pharmacies. Veterinary supply stores also carry it, since ichthammol remains common in horse and livestock care for treating hoof abscesses and skin irritation. The product has not been made illegal to sell. It simply occupies the same space as other “unapproved” legacy products that persist at the margins of the market without full FDA backing.
If you do find ichthammol, keep in mind that the lack of FDA approval means there is no standardized quality control across brands. Concentration, purity, and PAH content can vary. For a straightforward boil or abscess, warm compresses and professional drainage remain the most effective and well-supported approach.