Using
Gentian Violet
by
Jack Newman, MD, FRCPC
Gentian
violet (1% solution in water) is an excellent treatment for
Candida albicans. Candida albicans is a fungus which may cause
an infection of skin and/or mucous membranes (inside of mouth,
for example) 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 Candidal 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 Candidal infection is generally different
from the pain caused by poor positioning and/or ineffective
suckling. The pain caused by a Candidal 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 Candidal 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 Candida. However, milk blisters on the nipple also
may cause nipple pain after a period of pain free nursing
as may eczema or other skin condition.
- 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.
Please
Note:
a) The baby does not have to have thrush in his mouth.
b) A Candidal infection of the nipple may be combined with
other causes of soreness.
Using
Gentian Violet
We believe that gentian violet (combined with "all purpose
nipple ointment", see Treatments for Problems handout
#24) 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 (actually, it usually will wash out),
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 is messy.
- Dip
an clean 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 (see handout
Candida Protocol for how long to use gentian violet).
- 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 already
has 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. However, if your pain is virtually gone
after 3 or 4 days, but not completely, you can use gentian
violet a few more days if necessary.
- 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 by thrush.
- Uncommonly,
babies who are treated with gentian violet develop sores
in the 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 the clinic.
Questions?
(416) 813-5757 (option 3) or newman@globalserve.net
Handout #6. Using Gentian Violet Revised January 2000
Written by Jack Newman, MD, FRCPC
Jack
Newman, MD, FRCPC is a pediatrician, a graduate of the University
of Toronto medical school. He started the first hospital-based
breastfeeding clinic in Canada in 1984. He has been a consultant
with UNICEF for the Baby Friendly Hospital Initiative in Africa.
Dr. Newman has practiced as a physician in Canada, New Zealand,
and South Africa.
This
article may be copied and distributed without further permission.
|
