Gentian violet (1% solution
in water) is still an excellent treatment
for Candida albicans. Candida albicans is
a fungus that 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 is
a frequent cause of 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.
Please note: Gentian violet 1% in water
also contains alcohol. Apparently some pharmacists
are now dissolving it in glycerin, thus
avoiding the use of alcohol.
Nipple pain caused by
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
1. 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.
2. Frequently lasts throughout
the feeding, and occasionally continues
after the feeding has ended. This is in
contrast to the pain due to other causes
that usually hurts most when the baby latches
on, and gradually improves as the baby sucks.
3. May radiate into the
mother's armpit or into her back.
4. 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 and the nipple may
5. 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.
6. May be associated with
recent use of antibiotics by the baby or
mother, but not necessarily.
7. May be quite severe,
may or may not be itchy.
8. May occur in one breast
or nipple only.
9. 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
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 Sore Nipples and Sore Breasts handout
#3b) is the best treatment of nipple soreness
due to Candida albicans for the breastfeeding
mother. This is because it usually works,
and relief is rapid. It is messy, and will
stain clothing (actually, it will usually
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.
1) About 10 ml (two teaspoons)
of gentian violet is more than enough for
an entire treatment.
2) 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.
3) Dip a clean ear swab
(Q-tip) into the gentian violet.
4) 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
5) Put the baby to the
breast. In this way, both the baby's mouth
and your nipple are treated.
6) 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.
7) Repeat the treatment
each day for three or four days, up to a
week (see handout Candida
Protocol for how long to use gentian
8) 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 three or four
days, but not completely, you can use gentian
violet a few more days if necessary.
9) All artificial nipples
that the baby uses should be boiled daily
during the treatment, or well covered with
gentian violet. Consider stopping artificial
10) 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.
11) Uncommonly, babies
who are treated with gentian violet develop
sores in the mouth that 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. See the Candida
Questions? (416) 813-5757
(option 3) or email@example.com
or my book Dr. Jack Newmans Guide
to Breastfeeding (called The Ultimate Breastfeeding
Book of Answers in the USA)
on how to latch a baby on, how to know the
baby is getting milk, how to use compression,
how to use a lactation aid, as well as other
#6. Using Gentian Violet Revised January
Written by Jack Newman MD, FRCPC. ©
handout may be copied and distributed without
on the condition that it is not used in
any context in which the WHO code on the
marketing of breastmilk substitutes is violated
Starting out right
importance of Skin-to-Skin contact
2. Colic in the Breastfed Baby
3. a) Sore Nipples
for Sore Nipple and Sore Breasts
4. Is my baby getting enough?
5. Using a Lactation Aid
6. Using Gentian Violet
7. Breastfeeding and Jaundice
8. Finger Feeding
9. a) You should continue breastfeeding
(Medications and breastfeeding)
should continue breastfeeding (Illness in the mother or baby)
10. Breastfeeding and other foods
11. Some breastfeeding myths
12. More breastfeeding myths
13. Still more breastfeeding
14. More and more breastfeeding
15. Breast compression
16. Starting solid foods
17. What to feed the baby when
the mother is working outside the home
18. How to know a health professional
is not supportive of breastfeeding
19. a) Domperidone 1
21. Breastfeed a toddler –
Why on earth?
22. Blocked ducts and
23. Breastfeeding your adopted baby
24. Miscellaneous treatments for problems
25. Slow weight gain after
the first few months
26. When the Baby refuses to
27. Expressing Milk
28. Toxins and Infant Feeding
How breastmilk protects Newborns
Risks of formula feeding
Breastfeeding and guilt
Protocol to increase the intake
of Breastmilk by the Baby ("Not enough milk")
Protocols for Induced Lactation