Gentian Violet and Breastfeeding

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]

Drug levels in milk and infant serum

### 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

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.

Alternative 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;51:652-4.13481803 PubMed
2. John RW. Necrosis of oral mucosa after local application of crystal violet. Br Med J 1968;1:157-8.20791427 PubMed
3. Björnberg A, Mobacken H. Necrotic skin reactions caused by 1 per cent gentian violet and brilliant green. Acta Derm Venereol 1972;52:55-60.4111108 PubMed
4. Utter AR. Gentian violet and thrush. J Hum Lact 1992;8:6.1558661 PubMed
5. Utter AR. Gentian violet treatment for thrush: Can its use cause breastfeeding problems. J Hum Lact 1990;6:178-80.2271112 PubMed
6. Baca D, Drexler C, Cullen E. Obstructive laryngotracheitis secondary to gentian violet exposure. Clin Pediatr (Phila) 2001;40:233-5.11336425 PubMed
7. Rosenkranz HS, Carr HS. Possible hazard in use of gentian violet. Br Med J 1971;3:702-3.5569557 PubMed
8. Bielicky T, Novak M. Contact-group sensitization to triphenylmethane dyes. Gentian violet, brilliant green, and malachite green. Arch Dermatol 1969;100:540-3.5350405 PubMed
9. Berens P, Eglash A, Malloy M, et al. ABM Clinical Protocol #26: Persistent pain with breastfeeding. Breastfeed Med 2016;11:46-53.26881962 PubMed
10. Brent NB. Thrush in the breastfeeding dyad: Results of a survey on diagnosis and treatment. Clin Pediatr (Phila) 2001;40:503-6.11583049 PubMed
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;9:185-7.8260040 PubMed