Posted by: Chris Maloney | September 7, 2011

Thrush: Is Gentian Violet Better Than Lemon Juice?

Gentian Violet (en) Kristallviolett (de)

Image via Wikipedia

I had a question from a parent about Gentian Violet.  For those of you without children, or who’s children miraculously avoided thrush as infants, Gentian Violet is an old school treatment.

Despite its age, Gentian Violet hasn’t been well researched.  It is supposed to be for topical use only, but the most common use is swabbing out the mouths of infants to give them a purple stain.  Lest we think that the stain is a side effect, Gentian Violet is the name given to cosmetic dyes 1 and 3.  The color is the focus, and the side effect is that it inhibits thrush.

Does it really?  Yes, in one study it inhibits thrush as well as iodine, which is the standard for sterile fields.  It does this inhibition with quaternary ammonium compounds, that basically kill back the thrush.

So any danger from these active compounds?  It used to be a mostly no, but we’re seeing some new data on the possible effects of ammonium compounds on creatures who are bathed in the stuff all the time (fish,etc.)  It isn’t conclusive for them, so short-term application is definitely not conclusive.

But do we need Gentian Violet?  In a small study in South African, they found HIV patients with thrush did as well on lemon juice or lemon balm as they did on Gentian Violet.  The dye was refused often because having a purple mouth in that community was the same as saying “I have HIV.”  If lemon juice and lemon balm work as well, then perhaps Gentian Violet will go back to being a dye.

Of the two, lemon balm is preferable.  It doesn’t sting as much.

Studies are below:

Phytomedicine. 2009 Mar;16(2-3):118-24. Epub 2008 Dec 23.

Treatment of oral thrush in HIV/AIDS patients with lemon
juice and lemon grass (Cymbopogon citratus) and gentian violet.

Wright SC, Maree JE, Sibanyoni M.


Adelaide Tambo School of Nursing Science, Tshwane University
of Technology, Staatsartillerie Road, Pretoria-West, Pretoria 0001, Gauteng,
South Africa.



The purpose of the study was to investigate the safety and
efficacy of lemon juice and lemon grass (Cymbopogon citratus) in the treatment
of oral thrush in HIV/AIDS patients when compared with the control group using
gentian violet aqueous solution 0.5%. Oral thrush is a frequent complication of
HIV infection. In the Moretele Hospice, due to financial constraints, the
treatment routinely given to patients with oral thrush is either lemon juice
directly into the mouth or a lemon grass infusion made from lemon grass
(Cymbopogon citratus) grown and dried at the hospice. These two remedies have
been found to be very efficacious therefore are used extensively. Gentian
violet, the first line medication for oral thrush in South Africa, is not
preferred by the primary health clinic patients due to the visible purple stain
which leads them to being stigmatized as HIV-positive. Cymbopogon citratus and
Citrus limon have known antifungal properties.


The study design was a randomised controlled trial. Ninety
patients were randomly assigned to one of three groups: gentian violet, lemon
juice or lemon grass. Inclusion criteria included being HIV-positive with a
diagnosis of oral thrush. The study period was 11 days and patients were
followed up every second day. International ethical principles were adhered to
during the study.


Of the 90 patients, 83 completed the study. In the
intention-to-treat analysis, none of the p-values were significant therefore
the null hypothesis could not be rejected. In the analysis of the participants
who actually completed the trial, the lemon juice showed better results than
the gentian violet aqueous solution 0.5% in the treatment of oral thrush in an
HIV-positive population (p<0.02). The null hypothesis in terms of the lemon
grass and gentian violet could also be rejected on the basis of the Chi-square
test and the likelihood ratio test (p<0.05).


Though the patient population was small, the use of lemon
juice and lemon grass for the treatment of oral candidiasis in an HIV
population was validated by the randomised controlled trial.

PMID: 19109001

Mycopathologia. 2011 Aug 12. [Epub ahead of print]

Comparison of Antifungal Activities of Gentian Violet and
Povidone-Iodine Against Clinical Isolates of Candida Species and Other Yeasts:
A Framework to Establish Topical Disinfectant Activities.

Kondo S, Tabe Y, Yamada T, Misawa S, Oguri T, Ohsaka A,
Miida T.


Department of Clinical Laboratory Medicine, School of
Medicine, Juntendo University, Tokyo, Japan,


We evaluated antifungal activity as assessed by the contact
time in topical use of gentian violet (GV) and povidone-iodine (PI) against
Candida strains. A total of 102 yeast isolates were used in this study. A
markedly lower minimal inhibitory concentration (MIC)(90) of GV than of PI was
detected for all yeast isolates. No remarkable difference in the MICs was
observed among the identical strains isolated from different clinical sites for
both GV and PI. Although the minimal fungicidal activities (MFCs) of PI were
identical for all tested time points, the fungicidal activity of GV decreased
during the time course of incubation. These results indicate that, whereas GV
is more effective than PI, the topical disinfectant efficacy of GV should be
estimated using the MFC(5 min) and not the MIC or the MFC(24 h) for overall
prevention of catheter-related bloodstream infections and oral infections.

PMID: 21837508

Antimicrob Agents Chemother. 2011 Jun;55(6):3043-5. Epub
2011 Mar 28.

Gentian violet exhibits activity against biofilms formed by
oral Candida isolates obtained from HIV-infected patients.

Traboulsi RS, Mukherjee PK, Chandra J, Salata RA, Jurevic R,
Ghannoum MA.


Center for Medical Mycology, Department of Dermatology,
Division of Infectious Diseases and HIV Medicine, University Hospitals Case
Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.


The effect of gentian violet against Candida albicans and
non-Candida albicans biofilms formed on polymethylmethacrylate strips was
evaluated using a dry weight assay and confocal laser scanning microscopy. The
ability of gentian violet to inhibit Candida albicans germination was also
assessed. Gentian violet activity against Candida biofilms was demonstrated by
a reduction in dry weight, disruption of biofilm architecture, and reduced
biofilm thickness. Additionally, gentian violet inhibited Candida germination
in a concentration-dependent manner

PMID: 21444708

Int J Toxicol. 2009 Nov-Dec;28(6 Suppl 2):193S-204S.


Final report on the safety assessment of Basic Violet 1,
Basic Violet 3, and Basic Violet 4.


Diamante C, Bergfeld WF, Belsito DV, Klaassen CD, Marks JG
Jr, Shank RC, Slaga TJ, Snyder PW, Alan Andersen F.


Cosmetic Ingredient Review, 1101 17th Street, NW, Suite 412,
Washington, DC 20036, USA.


Basic Violet 3, Basic Violet 1, and Basic Violet 4 are
triphenylmethane dyes that function as direct (nonoxidative) hair colorants. No
current uses or use concentrations in cosmetics are reported. The term Gentian
Violet is used synonymously with Basic Violet 1 and Basic Violet 3, although
the chemical structures of these 2 dyes are not the same. The Cosmetic
Ingredient Review Expert Panel noted that Basic Violet 1, 3, and 4 contain
quaternary ammonium ions, and therefore the rate of penetration across the
epidermis is expected to be slow. The panel concluded that because of the
carcinogenic potential of these dyes, insufficient data exist to support the
safety of Basic Violet 1, 3, and 4 in cosmetic formulation. Dermal absorption
data and a risk assessment are needed to complete this safety assessment.

PMID: 20086192

J Hazard Mater. 2011 Aug 5. [Epub ahead of print]

Mutagenicity of quaternary ammonium salts containing
carbohydrate moieties.

Dmochowska B, Piosik J, Woziwodzka A, Sikora K, Wiśniewski
A, Węgrzyn G.


Department of Carbohydrate Chemistry, University of Gdańsk,
Sobieskiego 18, 80-952 Gdańsk, Poland.


Quaternary ammonium salts are widely used in industrial,
agricultural, healthcare and domestic applications. They are believed to be
safe compounds, with little or no health hazard to humans. However, in this
report, we demonstrate that a series of newly synthesized quaternary ammonium
salts containing carbohydrate moieties reveal potent mutagenic activities, as
assessed by using the Vibrio harveyi bioluminescence mutagenicity test.
d-Gluco- and d-galacto-derivatives were found to have a higher mutagenic
potential than d-manno-derivatives. Among the former groups of compounds, the
N-[2-(d-glycopyranosyloxy)ethyl]-N,N,N-trimethylaminium salts were of the
highest activity in the mutagenicity assay. These results suggest that the
safety of quaternary ammonium salts may be lower than previously supposed,
indicating a need for testing such compounds for their mutagenicity.

Copyright © 2011 Elsevier B.V. All rights reserved.

PMID: 21868154


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