Summary of Use during Lactation

Gentian violet (crystal violet) was used in the past to treat oral and nipple thrush during breastfeeding. Gentian violet is potentially toxic to the mucous membranes, causing oral ulceration with partial airway obstruction in one case,[1-6] and potentially tattooing the skin. It can also interact with DNA,[7] is carcinogenic and mutagenic in animals, and occasionally causes allergic sensitization, with cross-reactions to other triphenylmethane dyes.[8] Its use has been severely curtailed by authorities in Australia, Canada, England and France.[9-11] It is also very messy, staining skin and clothing. A 2001 survey of the members of the Academy of Breastfeeding Medicine (ABM) found that gentian violet is rarely (1 to 2% of respondents) used by breastfeeding experts for initial treatment of oral thrush and is very infrequently (3 to 4% of respondents) used for recurrent or persistent thrush.[10] ABM guidelines for treating Candida infection of the nipples state that an aqueous solution of gentian violet of less than 0.5% can be used for no more than 7 days on the nipple.[9] However, safer alternatives for treating thrush are available.[12]

Effects in Breastfed Infants

Gentian violet has caused oral ulceration in breastfed infants treated with 1% or 2% solution applied to the mouth and tongue for thrush.[3-5]

A 2-week-old exclusively breastfed infant was treated for oral thrush with aqueous 1% gentian violet solution twice daily for 1 day. The parents discontinued it because they thought it was causing airway discomfort. After 2 days, it was restarted at 4 times a day. Cough and difficulty feeding developed after 1 day and the infant was then admitted to the hospital, ultimately requiring intubation.[6]

Effects on Lactation and Breastmilk

Relevant published information was not found as of the revision date.

Alternate Drugs to Consider

Clotrimazole, Fluconazole, Miconazole, Nystatin

References

1.

Slotkowski EL. Formation of mucous membrane lesions secondary to prolonged use of one per cent aqueous gentian violet. J Pediatr. 1957;51:652–4. [PubMed: 13481803]

2.

John RW. Necrosis of oral mucosa after local application of crystal violet. Br Med J. 1968;1:157–8. [PMC free article: PMC1984530] [PubMed: 20791427]

3.

Björnberg A, Mobacken H. Necrotic skin reactions caused by 1 per cent gentian violet and brilliant green. Acta Derm Venereol. 1972;52:55–60. [PubMed: 4111108]

4.

Utter AR. Gentian violet and thrush. J Hum Lact 1992;8:6. Letter. PMID: 1558661. [PubMed: 1558661]

5.

Utter AR. Gentian violet treatment for thrush: Can its use cause breastfeeding problems. J Hum Lact 1990;6:178-80. Letter. PMID: 2271112. [PubMed: 2271112]

6.

Baca D, Drexler C, Cullen E. Obstructive laryngotracheitis secondary to gentian violet exposure. Clin Pediatr (Phila). 2001;40:233–5. [PubMed: 11336425]

7.

Rosenkranz HS, Carr HS. Possible hazard in use of gentian violet. Br Med J 1971;3:702-3. Letter. PMID: 5569557. [PMC free article: PMC1799004] [PubMed: 5569557]

8.

Bielicky T, Novak M. Contact-group sensitization to triphenylmethane dyes. Gentian violet, brilliant green, and malachite green. Arch Dermatol. 1969;100:540–3. [PubMed: 5350405]

9.

Berens P, Eglash A, Malloy M, et al. ABM Clinical Protocol #26: Persistent pain with breastfeeding. Breastfeed Med. 2016;11:46–53. [PubMed: 26881962]

10.

Brent NB. Thrush in the breastfeeding dyad: Results of a survey on diagnosis and treatment. Clin Pediatr (Phila). 2001;40:503–6. [PubMed: 11583049]

11.

Anon. Gentian violet when breastfeeding: Irritant and carcinogenic. Prescrire Int. 2020;29:243.

12.

Stoukides C. Topical medications and breastfeeding. J Hum Lact. 1993;9:185–7. [PubMed: 8260040]

Substance Name

Gentian Violet

CAS Registry Number

548-62-9

Drug Class

Breast Feeding

Lactation

Anti-Infective Agents, Local