The Hunt for Gentian Violet

What's that white stuff on his tongue? Looks like cottage cheese. I can't brush it off. Wait, he's bleeding somewhere. Did he bite his tongue? His lip? Ah, the telltale signs of oral thrush (yeast infection in the mouth). He has no other symptoms and his eating habits have not changed. Breastfed babies commonly acquire oral thrush. Other risk factors include breastfeeding, use of antibiotics or inhaled corticosteroids, a weakened immune system, and diabetes. No, he is not taking inhaled corticosteroids, but I was on a course of antibiotics a month ago for 10 days. I'm not rushing to the pediatrician just yet because his daily activities do not indicate that he is in pain or that the thrush is bothering him. I am, however, increasing his yogurt intake to restore the balance of normal gut bacterial flora to minimize the overgrowth of the fungus. A trip to the pediatrician will buy him a prescription for nystatin suspension, which will have to be swished and swallowed for a couple of weeks. Gentian violet 1% is an over-the-counter remedy that I am considering a brief trial of 3 days before taking him in.

Growing up, my mother used gentian violet on my cuts, scrapes, and mouth sores. I remember taking a class picture with a purple scab on my upper lip. As a pharmacy intern, I ordered and stocked the shelf with this product. This past weekend, I could not find it in any pharmacy, chain or independent. Some pharmacists thought it was an herbal supplement and sent me to GNC. Another pharmacist tried to order it for me for $17 when it used to be $1.69 (or something like that 10+ years ago). Walgreen's ordered it for $2.09. Interestingly, gentian violet is not made of gentian or violet, but is named after the deep purple color. It is used in laboratories as a stain to identify bacteria via the Gram stain test. If you read the label, it is an antiseptic for minor cuts and burns. When used sparingly, it can treat oral thrush [1]. It is generally safe, as long as it is not doused on the lesions repeatedly (just 2-3 times a day) and it is not drunk like medicine. The most common side effect is staining of the skin and clothes. Other concerns that have not been soundly supported are the risk of ulceration and oral cancer (probably due to the 10% alcohol the product contains). In the breastfeeding community, gentian violet has been used frequently with good results. Here is a guide on how to administer the gentian violet, that is, after you locate it in your local pharmacy. Actually, just call and ask them to order gentian violet 1% in a 1 ounce bottle. Make sure it's kept out of reach when you get it.

[1] Weisse ME and Aronoff SC. Chapter 231. Kliegman: Nelson's Textbook of Pediatrics. 2007. Accessed via MDConsult.