Gentian violet (1% solution in water) is an excellent treatment
for Candida albicans. Candida albicans is a yeast which may cause
an infection of skin and/or mucous membranes in both children and
adults. In small children, this yeast may cause white patches in
the mouth (thrush), or diaper rash. When the nursing mother has
a yeast infection of the nipple, she may experience severe nipple
pain, as well as deep breast pain.
Nipple pain caused by Candida albicans
The pain caused by a yeast infection is generally different from
the pain caused by poor positioning and/or ineffective suckling.
The pain caused by a yeast infection:
- is often burning in nature, rather than the sharp, stabbing
or pinching pain associated with other causes. Burning pain may
be due to other causes, however, and pain due to a yeast infection
does not necessarily burn.
- frequently lasts throughout the feeding, and occasionally continues
after the feeding has ended. This is in contrast to the pain due
to other causes which usually hurts most as feeding begins, and
gradually improves as the baby nurses.
- may radiate into the mother's armpit or into her back.
- may cause no change in appearance of the mother's nipples or
areolas, though there may be redness, or some scaling, or the
skin of the areola may be smooth and shiny.
- not uncommonly will begin after a period of pain free nursing.
This characteristic alone is reason enough to try treatment for
yeast. However, milk blisters on the nipple also may cause nipple
pain after a period of pain free nursing.
- may be associated with recent use of antibiotics by the baby
or mother, but not necessarily.
- may be quite severe, may or may not be itchy.
- may occur only in the breast. This pain is often described
as "shooting", or "burning" in nature, and is often worse after
the feeding is over. It is often said to be worse at night. At
the same time, the breast appears or feels normal. This is not
mastitis and there is no reason to treat with antibiotics. On
the contrary, antibiotics may make the problem worse.
- The baby does not have to have thrush in his mouth.
- A yeast infection of the nipple may be combined with other
causes of soreness.
Using Gentian Violet
We believe that gentian violet is the best treatment of nipple
soreness due to Candida albicans for the breastfeeding mother. This
is because it works almost always, and relief is rapid. It is messy,
and will stain clothing, but not skin. The baby's lips will turn
purple, but the purple will disappear after a few days. Gentian
violet is available without prescription but is not available at
all pharmacies. Call around before going out to get it.
- About 10 ml (two teaspoons) of gentian violet is more than
enough for an entire treatment.
- Many mothers prefer doing the treatment just before bed so
that they can keep their nipples exposed and not worry about staining
their clothing. The baby should be undressed to his diaper, and
the mother should be uncovered from the waist up. Gentian violet
- Dip an ear swab (Q-tip) into the gentian violet.
- Put the purple end of the ear swab into the baby's mouth and
let him suck on the swab for a few seconds. The gentian violet
usually spreads around the mouth quickly. If it does not, paint
the inside of the mouth to cover as much of the inside of the
cheeks and tongue as possible.
- Put the baby to the breast. In this way, both the baby's mouth
and your nipple are treated.
- If, at the end of the feeding, you have a baby with a purple
mouth, and two purple nipples, there is nothing more to do. If
only one nipple is purple, paint the other one with the ear swab
and the gentian violet. In this way, the treatment is finished
in one go.
- Repeat the treatment each day for three or four days.
- There is often some relief within hours of the first treatment,
and the pain is usually gone or virtually gone by the third day.
If it is not, it is unlikely that Candida was the problem, though
it seems Candida albicans is starting to show some resistance
to gentian violet, as it is to other antifungal agents. Of course
there may be more than one cause of nipple pain, but after three
days the contribution to your pain caused by Candida albicans
should be gone. Do not continue the gentian violet if no relief
occurs after 3-4 days of treatment. Instead, get more information.
- All artificial nipples that the baby uses should be boiled
daily during the treatment, or well covered with gentian violet.
Consider stopping artificial nipples.
- There is no need to treat just because the baby has thrush
in his mouth. The reason to treat is the mother's and/or the baby's
discomfort. Babies, however, do not commonly seem to be bothered
- Uncommonly, babies who are treated with gentian violet develop
sores inthe mouth which may cause them to reject the breast. If
this occurs, or if the baby is irritable while nursing, stop the
gentian violet immediately, and contact the clinic. The sores
clear up within 24 hours and the baby returns to feeding.
If the infection recurs, treatment can be repeated as above. But
if the infection recurs a third time, a source of reinfection should
be sought out. The source may be the mother who may be a carrier
for the yeast (but may have no sign of infection elsewhere), or
from artificial nipples the baby puts in his mouth. Treatment of
the mother (usually with a medication other than gentian violet)
at the same time as treatment is repeated for the nipples will usually
eliminate reinfection. Contact your doctor.
Handout #6. Using Gentian Violet. Revised January
Using Gentian Violet
Written by Jack Newman, MD, FRCPC
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