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.
pain caused by Candida
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.
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.
radiate into the mother's armpit or into her back.
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 crack.
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.
be associated with recent use of antibiotics by the baby or
mother, but not necessarily.
be quite severe, may or may not be itchy.
occur in one breast or nipple only.
occur only in the
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 Candida infection of the nipple may be combined with other
causes of soreness.
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.
10 ml (two teaspoons) of gentian violet is more than enough for an entire treatment.
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
a clean ear swab (Q-tip) into the gentian violet.
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.
the baby to the breast.
In this way, both the baby's mouth and your nipple
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.
the treatment each day for three or four days, up to a week
(see handout Candida
Protocol for how long to use gentian violet).
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.
artificial nipples that the baby uses should be boiled daily
during the treatment, or well covered with gentian violet. Consider stopping artificial nipples.
is no need to treat just because the baby has thrush in his
The reason to treat is the mother's and/or the baby's
however, do not commonly seem to be bothered by thrush.
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
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 Protocol.
813-5757 (option 3) or firstname.lastname@example.org or
my book Dr. Jack Newman’s Guide to Breastfeeding (called The Ultimate
Breastfeeding Book of Answers in
#6. Using Gentian Violet
Revised January 2005
Written by Jack Newman MD, FRCPC. © 2005
handout may be copied and distributed without further
on the condition that it
is not used in any context in which the WHO code on the
marketing of breastmilk substitutes is violated