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Rapid response to:

Clinical Review Clinical evidence

Atopic eczema

BMJ 1999; 318 doi: (Published 12 June 1999) Cite this as: BMJ 1999;318:1600

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Ichthammol (ichtyol, ammonium bituminosulfonate) is a product of dry distillation of oil shale. Vishnevsky liniment (VL) contains birch-tar, xeroformium (bismuth tribromophenolate) and castor oil. Both have been broadly used for topical medication in the former Soviet Union (SU). VL has been used for the management of wounds, burns, skin ulcers and suppurations. Ichthammol has been used for the treatment of skin diseases and burns; it was on the lists of medications for first-aid outfits and medical chests for construction brigades etc. Besides, in the former SU, ichthammol was used as an anti-inflammatory and antiseptic agent in urology, gynecology and other fields of medicine, e.g., for inflammatory conditions of the female genital tract including endometritis, for prostatitis [1-3], gonorrhea [4-6], and trichomoniasis [7], being inserted into the urethra, vagina, cervical canal, and rectum in the form of suppositories, tampons and instillations. Ichthammol and VL are discussed together because they contain polycyclic hydrocarbons [3,8,9], which is a group of substances that includes known carcinogens [10,11]. Besides, birch tar contains phenolic compounds [9] and methanol [12].

Xerophormium, a heterocyclic compound, has been used not only as an ingredient of VL but also in the rectal suppositories Anusol widely used in the former SU. Carcinogenicity of VL was not confirmed in an experiment on 116 mice [13]. However, considerable variation of the contents of known carcinogens (e.g. benzopyrene) in VL from different manufacturers was noticed [14]. Besides, tars of coal and wood (other than birch) origin were used for preparation of salves [14]. It appears probable that in conditions of insufficient quality control and mass production some manufacturers would replace birch-tar by other substances that can be more carcinogenic.

VL was broadly used in the Soviet army during the World War II [15]; the topic can gain significance today considering conflicts in Ukraine end elsewhere. Apart from antiseptic properties, among advantages of VL was pointed out an ability to accelerate tissue regeneration [2]. This latter quality is hardly understandable from the physiological viewpoint. In the author’s opinion, it could have originated from misconceived information about protruding skin lesions observed in tar workers [16]. Considering that the wounded are treated with VL on average for a relatively short time, the supposed carcinogenicity of VL can be more important for the medical personnel working with it. However, a prolonged application of VL e.g. for chronic skin ulcers, wounds or burns can be associated with enhanced risk of skin cancer, hematologic [17], and other malignancy. The same is apparently true in regard to the gynecological applications of ichthammol [1-6] in conditions of inefficient cervical cancer prevention in the former SU [18]. Considering the above, other antimicrobial agents should be used today. Antiseptics are preferable to topical antibiotics to prevent development of bacterial resistance in consequence of the mass application of antibiotics for topical medication [19]. The spectrum of antiseptics is broad; their comparison and selection for military and other applications [20] should be further investigated. The use of tar and ichthammol in dermathology e.g. for the treatment of atopic eczema [21] is a separate topic not discussed here.

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18. Jargin SV. Perspectives of cervical cytology in Russia. Am J Obstet Gynecol. 2008; 199:e10.
19. O'Meara S, Al-Kurdi D, Ologun Y, et al. Antibiotics and antiseptics for venous leg ulcers. Cochrane Database Syst Rev 2014; 1:CD003557.
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21. Charman C. Clinical evidence: atopic eczema. BMJ. 1999;318(7198):1600-4.

Competing interests: No competing interests

27 August 2014
Sergei V. Jargin
Peoples' Friendship University of Russia
Clementovski per 6-82, Moscow, Russia