"Black ointment" redirects here; not to be confused withblack salve.
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Ichthammol orammonium bituminosulfonate (brand nameIchthyol), also known asblack ointment, is a medication derived fromsulfur-richoil shale (bituminousschists). It is used (sometimes in combination withzinc oxide) as a treatment for differentskin diseases, includingeczema andpsoriasis (see below). It is applied on the skin as anointments, most commonly containing 10% or 20% ichthammol.
Bituminosulfonates are consideredtopical therapeutic agents with very good tolerability.[1]
Ichthammol ointments, commonly known asblack ointment ordrawing salve, should not be confused withblack salve, anescharotic (corrosive) paste intended to destroy skin tissue.[5] In contrast, ichthammol does not have any corrosive properties on the skin.
Ichthammol is obtained through three steps from bituminous schists: dry distillation, sulfonation of the resulting oil (or purified fractions thereof), and finally neutralization with ammonia.[6]
Ichthammol is a viscous, water-soluble substance with a characteristic bitumen-like odor.[6] It is incompatible with acids, alkali carbonates or hydrates and alkaloidal salts. It is a thick reddish brown liquid, possessing a bituminous odor and taste. It is soluble in water and miscible withglycerin, but is nearly insoluble in strong alcohol or concentrated ether. It contains a large percentage of organically combinedsulfur.
Chemically speaking ichthammol is asulfonatedshale oil. From elemental analysis, the composition of ichthammol was calculated to be C28H36S5O6(NH4)2.[7] However, as a product of natural origin, it is a mixture of many different compounds.[8]
Similar substances can be made by altering the starting material. An "ammonium sufobitol" (Tumenol-Ammonium), made from light shale oil of theMessel pit, was sold until 2000 in Germany.[9] The Chinese material labelled as "ichthammol" are actually anersatz product made from vegetable oil.
Ichtasol (USAN: Ictasol) is produced from the light (as opposed to heavy) fraction of distilled shale oil. It has a pale appearance.[10] There appears to be an oral preparation made from this mixture.[11]
"Ichthammol" (鱼石脂 Yushizhi) made in China does not meet standards for ichthammol as specified in United States Pharmacopoeia (USP), European Pharmacopoeia (Ph.Eur), or for the CAS number. Instead of requiring bituminous schists like these definitions, theChinese Pharmacopoeia definition for "ichthammol" uses ordinaryvegetable oil:
Ichthammol is a mixture obtained bysulfurization of vegetable oils (soybean oil, tung oil, corn oil, etc.), sulfonation, and neutralization with ammonia. Organic sulfur content ≥ 5.5%, ammonium content ≥ 2.5%. — Chinese definition according to ChP 10[12]
As a result, Chinese "ichthammol" is very different from standard ichthammol. The characteristic bitumen-like odor (originating from the bituminous source material) is missing with Chinese material.[13]
According to the "list of preferred Specials" by the British Association of Dermatologists (BAD) ichthammol can be used in dermatology prescribing to treat acutely inflamed atopic eczema, among others.[16] A corresponding recommendation exists for bituminosulfonates in Germany. According to "guideline atopic eczema" bituminosulfonates can be considered for treatment of atopic eczema based on general clinic experience.[17] In the European Dermatology Forum (EDF) guidelines for treatment of atopic eczema ichthammol is recommended as a useful addition to the basic treatment regimen, especially in mild disease or if TCS treatment is not possible from a patient's perspective, e.g. corticophobia (steroid phobia).[18]
Inotology, a mixture of glycerol and ichthammol (G & I) is used for the topicaltreatment ofear infections.[19] It is effective againstGram-positive bacteria. The anti-inflammatory action is explained by its influence on the formation, secretion, and effect ofinflammation mediators.[20][21]
Ichthammol is available in pharmacies for compounding medications. Different sources of information exist for exemplary formulations (creams, shake lotions, suppositories, etc.).[22][23][24]
TheEuropean Medicines Agency published a summary report on ichthyol-substances (synonym: bituminosulfonates) during the course of the European Maximum Residue Limits (MRL) procedure[11] in veterinary medicine. TheCommittee for Medicinal Products for Veterinary Use (CVMP) decided that due to good tolerance and safety, there is no need to establish an MRL for ichthyol-substances. As a result, ichthyol-substances can be applied topically in allmammalian food-producing species without restriction.
^Schmid-Wendtner MH, Korting HC, Sterry W (2001). "Bituminosulfonate.".Therapeutische Verfahren in der Dermatologie–Dermatika und Kosmetika. Berlin, Wien: Blackwell Wissenschafts-Verlag. pp. 165–171.
^Paul Gerson Unna: About Ichthyol. In: Monatshefte für praktische Dermatologie, Band XXV, 1897 (in German).
^Bracher F, Heisig P, Langguth P, Mutschler E, Rücker G, Scriba G, Stahl-Biskup E, Troschütz R, eds. (2014). "Ammoniumbituminosulfonat".Kommentar zum Europäischen Arzneibuch, Wissenschaftliche Erläuterungen zum Arzneibuch [Commentary to the Pharmacopoeia Europaea, Scientific explanations of the Pharmacopoeia] (in German).4. Stuttgart: Wissenschaftliche Verlagsgesellschaft.
^Warnecke J, Wendt A (February 1998). "Anti-inflammatory action of pale sulfonated shale oil (ICHTHYOL pale) in UVB erythema test".Inflammation Research.47 (2):75–78.doi:10.1007/s000110050282.PMID9535545.S2CID9014012.
^Buckley DA, Root T and Bath S, Specials Recommended by the British Association of Dermatologists for Skin Disease, Clinical Standards Unit of the British Association of Dermatologists, London, UK, 2014, p. 9 (www.bad.org.uk/specials accessed October 2nd, 2015)
^Werfel T, Aberer W, Ahrens F, Augustin M, Biedermann T, Diepgen T, et al. (January 2016). "[Not Available]".Journal der Deutschen Dermatologischen Gesellschaft.14 (1): e1-75.doi:10.1111/ddg.12884.PMID26713660.S2CID203739944.
^Masood A, Moumoulidis I, Ray S, Chawla O, Panesar J (August 2008). "A randomised controlled trial comparing Triadcortyl with 10% glycerine-ichthammol in the initial treatment of severe acute otitis externa".European Archives of Oto-Rhino-Laryngology.265 (8):881–885.doi:10.1007/s00405-007-0463-1.PMID17922130.S2CID26976193.
^Schewe C, Schewe T, Rohde E, Diezel W, Czarnetzki BM (1994). "Inhibitory effects of sulfonated shale oils (ammonium bituminosulphonates, Ichthyols) on enzymes of polyenoic fatty acid metabolism".Archives of Dermatological Research.286 (3–4):137–141.doi:10.1007/bf00374208.PMID7911653.S2CID12647893.
^Altmeyer P (2005).Therapielexikon Dermatologie und Allerlogie (2nd ed.). Berlin: Springer. pp. 1024, 1040, 1051.
^Langley CA, Belcher D (2012). "Suppositories and pessaries".Pharmaceutical Compounding and Dispensing (2nd ed.). London, UK: Pharmaceutical Press. p. 143.ISBN978-0-85711-055-8.
^Gayko G, Cholcha W, Kietzmann M (October 2000). "[Anti-inflammatory, antibacterial and antimycotic effects of dark sulfonated shale oil (ichthammol)]".Berliner und Munchener Tierarztliche Wochenschrift.113 (10):368–373.PMID11084753.
Cholcha W, Leuschner J, Leuschner F (July 1994). "[The adverse effects of dark sulfonated shale oil following local and systemic administration]".Arzneimittel-Forschung (in German).44 (7):844–849.PMID7945520.
Diezel W, Schewe T, Rohde E, Rosenbach T, Czarnetzki BM (December 1992). "[Ammonium bituminosulfonate (Ichthyol). Anti-inflammatory effect and inhibition of the 5-lipoxygenase enzyme]".Der Hautarzt (in German).43 (12):772–774.PMID1361926.
Nilssen E, Wormald PJ, Oliver S (April 1996). "Glycerol and ichthammol: medicinal solution or mythical potion?".The Journal of Laryngology and Otology.110 (4):319–321.doi:10.1017/s0022215100133547.PMID8733451.S2CID37026367.
