Ammonium bituminosulfonate: Effect in Dermatology
Ammonium bituminosulfonate, often also referred to as ichthyol or shale oil, is an active ingredient derived from shale oil that has been used in dermatology since the late 19th century. It is obtained by the destructive distillation of bituminous shale rocks containing remains of fossil microorganisms. This produces a dark oil with a characteristic odor that, after sulfonation and neutralization with ammonia, becomes pharmaceutically usable. In Germany, ammonium bituminosulfonate is traditionally available as ointment, cream, or solution in various concentrations.
Despite its historical background, ammonium bituminosulfonate remains a well-established therapeutic option in modern dermatology for localized inflammatory skin conditions. It is available without prescription and is a proven household standard for many minor skin conditions such as boils, calluses, or incipient abscesses. The effect develops slowly, which requires patience with acute complaints, but the advantage lies in good tolerability.
Mechanism of Action
Ammonium bituminosulfonate has several pharmacological effects that, in combination, lead to its dermatological profile. The active ingredient has anti-inflammatory properties, thus inhibiting inflammatory processes in the skin. Experimental studies have shown that ammonium bituminosulfonate reduces the activity of 5-lipoxygenase and cyclooxygenase, thereby lowering the formation of pro-inflammatory mediators such as leukotrienes and prostaglandins.
Additionally, the active ingredient has antibacterial and antifungal properties against various skin pathogens, including gram-positive bacteria such as staphylococci and yeasts such as Malassezia. This antimicrobial component supports therapy in boils and acne-like skin conditions where bacterial colonization plays a role. The exact mechanism of antimicrobial action is not fully understood but appears to be multifactorial.
Another important effect is the promotion of maturation of boils and small abscesses. Ammonium bituminosulfonate in higher concentrations (for example 50 percent) draws the pus formation to a center, allowing the boil to mature and drain spontaneously or through surgical incision. This drawing effect is a classic characteristic of the substance.
Areas of Application
- Boils and carbuncles in the maturation phase to center the suppuration and promote spontaneous rupture
- Hidradenitis suppurativa (acne inversa) in mild to moderate manifestation as adjunctive topical therapy
- Acne vulgaris, especially with pustular or nodular lesions, often in combination with other acne therapeutics
- Rosacea in inflammatory stages, in specific constellations
- Perioral dermatitis as part of a treatment plan
- Eczemas such as chronic hand and foot eczema with inflammatory component
- Pilonidal sinus, Bartholin abscess and similar abscess-forming processes as adjunctive local therapy before or after surgical treatment
Ammonium bituminosulfonate is not suitable for application on large skin areas with open wounds because relevant systemic absorption cannot be excluded.
Dosage and Administration
Boils and carbuncles: Ointment or drawing salve with 20 to 50 percent ammonium bituminosulfonate 1 to 2 times daily to the affected area, fixed with a dressing. Treatment until maturation and spontaneous rupture, then wound treatment.
Acne vulgaris and hidradenitis suppurativa: Cream or solution with 5 to 20 percent 1 to 2 times daily to the affected skin areas.
Acne inversa: Ointment with 20 to 50 percent in the acute phase, lower concentrations in maintenance therapy.
Eczemas: Cream or ointment with 2 to 10 percent 1 to 2 times daily.
Duration of use: usually 5 to 10 days acutely, re-evaluation if no progress. Long-term use possible in chronic diseases such as acne inversa.
Administration: Apply to cleansed, dry skin, layer thickness as needed, bandage if necessary. Wash hands thoroughly after application, as the odor and discoloration are stubborn.
Renal insufficiency/liver insufficiency: With local application in usual concentration, adjustment is generally not required.
Note: Clothing may become discolored, use old laundry or dressing. With prolonged use, observe clothing and skin area carefully.
Side Effects
Frequent: Local skin irritation, burning, redness, itching, occasionally eczema-like reactions.
Occasional: Contact allergies, especially with prolonged use. If suspected, perform patch test in allergy testing.
Rare: Phototoxic and photoallergic reactions with UV exposure. Protect treated skin areas with sunscreen or clothing during intense sun exposure.
Local: Skin discoloration (temporarily brownish), strong odor, discoloration of clothing and dressings.
With large-scale application: Theoretically systemic side effects possible, rarely described in practical application.
Drug Interactions
- Other topical therapeutics: pharmacodynamic interactions possible when applied to the same skin area. Minimum interval recommended between applications.
- Topical glucocorticoids: can be combined meaningfully, however do not apply directly on top of each other, but at different times.
- UV radiation: increased risk of phototoxic reactions, protect treated areas during sun exposure.
- Topical antibiotics and antifungals: combined use meaningful for specific indications, medical guidance recommended.
- Systemic interactions: not relevant with local application.
Special Information
Pregnancy: Ammonium bituminosulfonate is considered well-tolerated with local small-scale application. Nevertheless, strict indication and medical consultation. Lactation: Do not apply directly to the breast area, otherwise well-tolerated.
Children: Ammonium bituminosulfonate in age-appropriate concentration is also applicable in children, well-tolerated in pediatric dosing.
Contraindications: Known hypersensitivity, large open wounds, mucous membranes (except for specific indications).
Before use: Cleanse and dry the skin area, if necessary remove or trim hair in the area.
During therapy: If the skin area worsens or side effects occur, discontinue therapy and seek medical advice.
Lifestyle: When using in summer, protect skin area from UV radiation. Laundry and dressings that come into contact with the active ingredient may become permanently discolored.
Ability to drive: Not impaired by local application.
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Frequently Asked Questions
What is a drawing salve and how does it work on a boil?
Drawing salve contains ammonium bituminosulfonate or related substances in higher concentration. It is applied to a boil or abscess and covered with a dressing. The salve intensifies pus formation in the center, promotes maturation of the boil, and can lead to spontaneous rupture of the skin area. For large or fluctuant boils, medical evaluation is important because incision by a physician may be necessary.
Why does ichthyol smell so strong?
The characteristic odor is created by the sulfur compounds in shale oil. These compounds are part of the pharmacological effect, so their odor is unavoidable. In modern formulations with lower concentration, the odor is less pronounced but can always be noticeable. The odor largely disappears after thorough washing.
Can I use ammonium bituminosulfonate during pregnancy?
Ammonium bituminosulfonate is considered well-tolerated in pregnancy with local small-scale application. Large-scale application should be avoided because systemic resorption has not been conclusively studied. Medical consultation should be obtained before use, especially in the first trimester. During lactation: do not apply to the breast area.
How long does it take for a boil to heal under drawing salve?
Maturation of a boil under drawing salve typically takes 3 to 7 days. During this time, the pus concentrates, the skin area becomes increasingly tender to pressure, and eventually the boil opens spontaneously or under surgical incision. After drainage, wound healing begins, which may take another 1 to 2 weeks depending on size. For large or recurrent boils, medical evaluation is worthwhile.
Sources
- Gelbe Liste, Ammonium bituminosulfonate Active Ingredient Profile
- BfArM, Federal Institute for Drugs and Medical Devices
- German Dermatological Society (DDG)
- AWMF Guidelines for Acne and Hidradenitis Suppurativa
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The information provided on this page is for general informational purposes only and does not constitute medical advice, diagnosis, or treatment recommendation. It does not replace the advice of a licensed physician or pharmacist. All information is based on technical information published at the time of creation and recognized scientific sources; the current package insert of the manufacturer is always authoritative. Sanoliste assumes no liability for completeness, timeliness, or accuracy of the information presented. In case of medical emergency, call the emergency number 112.