Ichthammol has not been formally banned or recalled by the U.S. Food and Drug Administration. The dark, tar-like ointment that your grandmother might have called “drawing salve” is still legally sold in the United States, but it has quietly vanished from most pharmacy shelves over the past decade. The real story involves a combination of regulatory limbo, declining manufacturer interest, and a lack of modern clinical evidence rather than a single dramatic ruling. Understanding the distinction matters, because the path to finding ichthammol or replacing it depends on why it disappeared in the first place.
What Ichthammol Is and Why People Used It
Ichthammol, also known as ammonium bituminosulfonate, is derived from oil shale. The raw material is mined, heated to extract sulfur-rich organic compounds, and then processed into a thick, dark paste with a distinctive odor. It has been used as a topical treatment for well over a century, applied to conditions ranging from boils and splinter wounds to eczema, psoriasis, and leg ulcers.1PubMed Central. Ichthammol revisited The ingredient was already well established in European pharmacopeias by the late 1800s, and it was recognized as a substance of natural origin in European regulatory frameworks.2PubMed. Anti-inflammatory, antibacterial and antimycotic effects of dark sulfonated shale oil (ichthammol)
In the U.S., ichthammol was most commonly sold as a 10% or 20% ointment and marketed as a “drawing salve,” meaning it was supposed to help pull splinters, boils, and infections toward the skin’s surface. Veterinary use was also widespread, particularly in equine care for hoof conditions. For decades, you could find a small tin or tube of ichthammol ointment in nearly any pharmacy’s first-aid aisle. That is no longer the case for most people, and the reason is more bureaucratic than dramatic.
Why Ichthammol Products Have Disappeared from Shelves
The disappearance of ichthammol from mainstream retail is best understood as a slow economic death rather than a sudden ban. Several forces converged over the past two decades to make it commercially unviable for most manufacturers and retailers.
The first factor is the FDA’s long-running Over-the-Counter Drug Monograph process. This system, which dates back to the 1970s, categorizes OTC drug ingredients as either generally recognized as safe and effective (GRASE), not GRASE, or still awaiting a final determination. Ichthammol was reviewed for several potential OTC categories, including skin protectant and external analgesic, but it never received a definitive positive GRASE classification for most of the uses it was traditionally sold for. Ingredients stuck in this regulatory gray zone are not illegal to sell, but they exist without the FDA’s explicit stamp of approval. That uncertainty discourages large pharmacy chains and manufacturers from keeping the product on shelves.
The second factor is pure economics. Ichthammol requires a specific type of bituminous shale, and the number of suppliers capable of producing pharmaceutical-grade material has shrunk over time. Production volumes were already low because demand was modest, and as larger manufacturers consolidated their OTC product lines around higher-margin items, ichthammol ointments were among the first to be dropped. When a product sells a few thousand units a year in a given retail chain, it does not survive the next shelf-space review.
The third factor is the rise of modern alternatives. Dermatologists today have access to a wide range of topical treatments with robust clinical trial data behind them. When a clinician can prescribe or recommend a well-studied topical antibiotic, corticosteroid, or keratolytic agent, there is little professional incentive to reach for an ingredient whose evidence base is thin by contemporary standards. This professional disinterest trickles down to consumers, who hear fewer recommendations for ichthammol and therefore buy less of it, completing the cycle that pushes it off the shelf.
The FDA’s Current Position
To be clear about what the FDA has and has not done: the agency has not issued a ban, a recall, or a safety warning specifically targeting ichthammol ointments. No FDA enforcement action has been taken against ichthammol products the way it has been taken against, say, certain antiseptic ingredients that were formally ruled not GRASE.
What has happened is that ichthammol sits in a regulatory category sometimes described as “enforcement discretion.” The FDA’s OTC monograph system was modernized by legislation in 2020, giving the agency new authority to finalize outstanding monograph decisions through administrative orders rather than the old, glacially slow rulemaking process. In theory, this could result in a definitive ruling on ichthammol’s status in the future. In practice, the FDA has a long backlog of OTC ingredients to evaluate, and ichthammol is unlikely to be prioritized given its small market and low public-health urgency.
The practical upshot is that ichthammol occupies a gray zone. It is not approved, but it is not prohibited. Manufacturers who want to sell it can do so, but they do so without the clear regulatory pathway that a GRASE-classified ingredient enjoys. This is why you can still find ichthammol products from smaller, specialty manufacturers and in veterinary supply channels, but not on the shelf at a typical chain pharmacy.
What the Clinical Evidence Actually Shows
Part of ichthammol’s regulatory difficulty stems from the fact that its evidence base, while old and voluminous in anecdotal terms, is thin by the standards modern regulators require. Older European studies documented anti-inflammatory, antibacterial, and antifungal properties in laboratory settings, and those properties are real.2PubMed. Anti-inflammatory, antibacterial and antimycotic effects of dark sulfonated shale oil (ichthammol) The problem is that lab activity does not automatically translate into clinical effectiveness when you spread the stuff on skin.
For psoriasis, one of the conditions ichthammol was traditionally used for, a comparative study found discouraging results. When ichthammol was tested against plain petroleum jelly in patients with mild plaque psoriasis, the ointment did not outperform the control in a meaningful way. The petroleum jelly group actually showed comparable or better clearance rates, and ichthammol caused burning sensation and irritation in a notable number of patients.3South Asian Research Journal of Pharmaceutical Sciences. Efficacy of Topical Ichthammol in Treatment of Mild Plaque Psoriasis That study concluded ichthammol was not cost-effective for psoriasis treatment.
For boils and skin abscesses, the evidence is mostly experiential rather than trial-based. Generations of users swear by ichthammol’s ability to “draw out” infections, and some dermatologists acknowledge that occlusive ointments (including ichthammol) can soften the skin over an abscess and allow it to drain more easily. But the drawing-out mechanism has not been demonstrated in controlled trials in a way that distinguishes ichthammol from other occlusive agents. The historical consensus that ichthammol works for boils is strong enough that the product retains a loyal following, but it is not the kind of evidence that earns a GRASE classification.
The honest assessment is that ichthammol probably does have mild anti-inflammatory and antimicrobial activity when applied to skin, but its clinical superiority over simpler alternatives has never been convincingly proven in modern trials. This does not mean it is useless. It means the evidence does not meet the bar that regulators and clinicians now expect.
Safety and Side Effects
One thing ichthammol has going for it is a relatively clean safety record, at least by the standards of a product that has been in use since the 1880s. As of March 2025, only 219 adverse drug reactions associated with ichthammol had been reported in the global pharmacovigilance database VigiFlow. Of those, about 41% involved skin and tissue reactions, making contact dermatitis and local irritation the most commonly documented problems.4National Journal of Pharmacology and Therapeutics. Ichthammol-induced contact dermatitis in a pediatric patient That low number almost certainly reflects both genuine rarity of serious reactions and substantial underreporting, since many people use ichthammol at home without medical supervision.
Mild irritation at the application site, including burning or stinging, appears to be the most common complaint. True allergic contact dermatitis is possible but uncommon. A case report documented a pediatric patient who developed acute contact dermatitis from ichthammol, a reminder that children’s skin can be more reactive and that even historically “gentle” remedies deserve a patch test if you have never used them before.4National Journal of Pharmacology and Therapeutics. Ichthammol-induced contact dermatitis in a pediatric patient
Ichthammol stains clothing and skin, which is more of a practical issue than a medical one, but it is worth noting because it affects compliance. The dark ointment is messy, and many people stop using it simply because they do not want to ruin bedsheets. This mundane annoyance may have contributed as much to its market decline as any regulatory factor.
Where You Can Still Find Ichthammol
If you specifically want ichthammol, it is still obtainable. It has not vanished from the market entirely; it has just moved from mainstream pharmacy shelves to less visible channels.
- Online retailers: Several smaller manufacturers continue to produce 10% and 20% ichthammol ointments sold through major online marketplaces. Brands that specialize in traditional or “old-fashioned” remedies tend to carry it.
- Veterinary supply stores: Ichthammol remains popular in equine and livestock care, and veterinary supply retailers often stock it in larger quantities than human pharmacies ever did.
- Compounding pharmacies: A compounding pharmacy can prepare ichthammol ointment in custom concentrations if you have a clinical reason for wanting it, though this typically requires a prescription or at minimum a consultation with the pharmacist.
- International pharmacies: In parts of Europe, ichthammol products remain more widely available in standard pharmacies, reflecting a different regulatory and cultural relationship with the ingredient.
The concentration matters. Products labeled as “drawing salve” that contain ichthammol typically come in 10% or 20% formulations. Higher concentrations are more likely to cause the irritation and burning that clinical studies have noted, so starting with the lower strength is reasonable if you have not used it before.
Alternatives for the Conditions Ichthammol Treated
What you should use instead of ichthammol depends entirely on what you were using it for. The product was a generalist, applied to a wide range of conditions, and the modern replacements are more specialized.
For boils and skin abscesses, the evidence-based first-line treatment is warm compresses applied several times a day to encourage the abscess to come to a head and drain on its own. If the boil is large, painful, or does not resolve within a week or so, a healthcare provider can perform incision and drainage, which is the most effective intervention. Topical antibiotics like mupirocin can help with surrounding skin infection but do not replace drainage for a mature abscess. Some people use other occlusive ointments or hydrocolloid bandages to achieve a similar softening effect to what ichthammol was credited with.
For eczema and dermatitis, over-the-counter hydrocortisone cream at 1% is the standard starting point for mild flare-ups, and colloidal oatmeal preparations can soothe itching without steroids. More severe eczema warrants prescription-strength topical corticosteroids or newer non-steroidal options like crisaborole or ruxolitinib cream.
For psoriasis, coal tar remains an OTC option that has a more established evidence base than ichthammol. Salicylic acid helps with scale removal. Prescription topicals including vitamin D analogs and corticosteroids are the workhorses of modern psoriasis management, and biologics have transformed care for moderate-to-severe disease.
For splinters and minor foreign bodies, the folklore around “drawing salve” often overstates what any ointment can do. An occlusive layer of any thick ointment or petroleum jelly, combined with a bandage, can soften the surrounding skin and make it easier to extract a shallow splinter with tweezers. There is no pharmacological magic happening. If a splinter is deep enough that you cannot reach it with clean tweezers, a doctor visit is more useful than any salve.
Ichthammol and “Black Salve” Are Not the Same Thing
This distinction is important enough to state plainly, because people searching for ichthammol alternatives sometimes stumble into a much more dangerous product category. Traditional ichthammol ointment is dark in color and is sometimes informally called “black drawing salve” or just “black salve.” However, the products marketed online as “black salve” for cancer treatment or mole removal are typically something entirely different: escharotic pastes containing bloodroot (sanguinarine) and zinc chloride, which chemically burn and destroy tissue.5PubMed Central. Black salve: risky escharotic
These corrosive black salves are sold with claims that they can “draw out” cancer from the skin. In reality, they produce deep chemical burns, can cause severe scarring, and have led to cases where people delayed proven cancer treatment in favor of a paste that destroyed healthy tissue while leaving underlying malignancy untreated. The FDA has specifically warned consumers against these products and has taken enforcement action against some sellers.
Ichthammol is not an escharotic. It does not burn or destroy tissue. Conflating the two because they share the word “black” and the word “salve” is a genuine safety hazard. If you encounter an online product marketed as “black salve” that claims to treat cancer, remove moles, or “draw out” tumors, that is not ichthammol and it is not safe.
The Veterinary Side of Ichthammol
While human-use ichthammol has faded into the background, the veterinary market tells a different story. Ichthammol remains a common item in equine first-aid kits, used to pack horse hooves after abscesses, draw out infections, and reduce swelling in soft tissue injuries. Its inclusion in European veterinary regulatory frameworks reflects this ongoing use.2PubMed. Anti-inflammatory, antibacterial and antimycotic effects of dark sulfonated shale oil (ichthammol)
Veterinary ichthammol is sometimes the same formulation sold for human use, just in larger containers. Some people who cannot find human-labeled ichthammol buy the veterinary version and use it on themselves. While the active ingredient is identical, veterinary products are manufactured under different quality standards and are not intended for human use. The practical risk is probably low for a topical ointment applied to intact skin, but it is worth knowing that the quality-control oversight differs.
The persistence of ichthammol in veterinary medicine is itself an interesting commentary on how human and animal healthcare diverge in their tolerance for traditional remedies. In equine care, where the treatment options are more limited and the patients are less bothered by a messy black paste, a product with 140 years of practical use and a low side-effect profile fills a genuine niche that modern alternatives have not fully replaced.