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Objective: To review the use of gentian violet in dermatology., Design: A comprehensive literature search on gentian violet in dermatology practice was performed through PubMed., Results: Gentian violet is effective in treating methicillin-resistant Staphylococcus aureus-colonized skin lesions; mean number of days for complete eradication was 9.1 days. Gentian violet is almost as effective as ketoconazole and more effective than nystatin in the treatment of oral thrush in AIDS patients. In an in vitro study on cutaneous T cell lymphoma cell lines, there was no difference between nitrogen mustard and gentian violet in stimulating apoptosis. When comparing gentian violet to silver sulfadiazine dressings in healing burn wounds, the gentian violet treatment group reported less pain, fewer febrile episodes, and decreased bacterial growth compared to control. In atopic dermatitis subjects, gentian violet decreased Staphylococcus aureus colonization and improved disease severity in lesional skin compared to non-lesional skin., Conclusion: Studies have investigated gentian violet's antibacterial, antifungal, antiviral, antiparasitic, anti-angiogenic, antitumor, and wound healing properties. Gentian violet is a low cost and well-tolerated topical agent with the potential for widespread applications in dermatology.

This case involved a 75-year-old female with left-eye epiretinal membrane (ERM) and cataract who developed serious eye disorders during vitreous surgery due to methylrosaniline chloride (MRC) being mistakenly injected and applied to the retina instead of Brilliant Blue G during internal limiting membrane staining. Once realized, MRC was washed out with intraocular infusion solution, and ERM surgery was successfully completed. Postoperatively, a Descemet's fold and corneal edema, marked reduction in corneal endothelial cell density, and inner retina damage and visual field defect extending from the macula toward the temporal side were observed. MRC was found highly toxic to eye tissues. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:1010-1015.]., (Copyright 2017, SLACK Incorporated.)

Objective: Compare the safety and efficacy of topical gentian violet with that of nystatin oral suspension (NYS) for the treatment of oropharyngeal candidiasis in HIV-1-infected adults in resource-limited settings., Design: Multicenter, open-label, evaluator-blinded, randomized clinical trial at eight international sites, within the AIDS Clinical Trials Group., Study Participants and Intervention: Adult HIV-infected participants with oropharyngeal candidiasis, stratified by CD4 cell counts and antiretroviral therapy status at study entry, were randomized to receive either gentian violet (0.00165%, BID) or NYS (500 000 units, QID) for 14 days., Main Outcome Measure(s): Cure or improvement after 14 days of treatment. Signs and symptoms of oropharyngeal candidiasis were evaluated in an evaluator-blinded manner., Results: The study was closed early per Data Safety Monitoring Board after enrolling 221 participants (target = 494). Among the 182 participants eligible for efficacy analysis, 63 (68.5%) in the gentian violet arm had cure or improvement of oropharyngeal candidiasis versus 61 (67.8%) in the NYS arm, resulting in a nonsizable difference of 0.007 (95% confidence interval: -0.129, 0.143). There was no sizable difference in cure rates between the two arms (-0.0007; 95% confidence interval: -0.146, 0.131). No gentian violet-related adverse events were noted. No sizable differences were identified in tolerance, adherence, quality of life, or acceptability of study drugs. In gentian violet arm, 61 and 39% of participants reported 'no' and 'mild-to-moderate' staining, respectively. Cost for medication procurement was significantly lower for gentian violet versus NYS (median $2.51 and 19.42, respectively, P = 0.01)., Conclusion: Efficacy of gentian violet was not statistically different than NYS, was well tolerated, and its procurement cost was substantially less than NYS.

A neonate developed oral lesions during treatment of thrush with gentian violet. The medication was applied by his mother according to the instructions on the bottle she bought over the counter. The literature is briefly reviewed and it is suggested that the availability of this solution without medical supervision should be reconsidered.

Background: Sterile surgical marker pens are commonly used in cartilage repair surgery to aid in the placement of periosteal patches or collagen membranes in autologous chondrocyte implantation., Purpose: To investigate the effects that methylene blue and crystal violet marker pen ink have on human chondrocytes when cultured on collagen membranes in vitro., Study Design: Controlled laboratory study., Methods: Human chondrocytes were applied to Chondro-Gide collagen membranes at a volume of 12 million cells. In the first experiment, 2 sterile marker pens, one containing methylene blue and the other crystal violet inks, were used to mark membranes immediately before the addition of cells. In the second experiment, the same marker pens marked the membranes after 7 days of cell culture. In each experiment, 3 groups of membrane were tested for each pen. Group A consisted of no ink mark, group B had only the uppermost "smooth" layer marked, and group C had the lower "porous" layer marked. All membranes were then cultured in standard growth media for 24 hours. Cell viability was assessed at 24 hours on all membranes using a live/dead-cell viability assay. Cell viability was quantified with florescent microscopy with mean percentage of live cells in each marker pen group compared with control membranes using the Student t test (P < .05)., Results: Control membranes (group A) with no ink showed cell viability approaching 100%. A statistically significant reduction in cell viability with both methylene blue (23.1%; P < .0001) and crystal violet (18.9%; P < .0001) was found adjacent to the ink mark on the smooth side (group B) and on the porous side remote from the ink (group C) in both experiments (<30%; P < .0001). A reduction in cell viability was noted on the smooth side remote from the ink mark but did not reach statistical significance. Marked cell death was seen with both dyes (<15%; P < .0001) adjacent to the ink on the porous side., Conclusion: Chondrocyte viability is significantly reduced when cells are cultured in vitro on collagen membranes marked with methylene blue and crystal violet pen ink., Clinical Relevance: Surgeons should be aware of the potential negative effect of marker pens in cell-based therapies.

Gentian violet (GV) is recommended for initial treatment of oral candidiasis in HIV-infected patients in resource-limited settings. Currently GV is not used because of its staining effects. In this study, we investigated the staining capacity of three different concentrations of GV to determine a concentration that does not cause staining. The selected concentration that did not cause staining was evaluated for its physical stability and antifungal activity. Fifteen healthy participants were randomized to rinse twice daily for 14 days with one of three GV concentrations: 0.1%, 0.0085%, or 0.00165%. Oral examination and intra-oral photographs were performed at baseline and at the end of therapy. Participants responded to a questionnaire to assess adverse events. Antifungal activity was evaluated using the Clinical and Laboratory Standard Institute methodology. GV at a concentration of 0.00165% did not stain the oral mucosa and was well tolerated. GV at a concentration of 0.00165% was stable and possessed antifungal activity when stored at certain temperatures for different time periods. Gentian violet solution at the concentration of 0.00165% does not stain the oral mucosa, is stable and possesses potent antifungal activity.

This workshop reviewed aspects of the following: oral fungal disease in HIV-infected patients and the predictive value of oral mucosal disease in HIV progression; the role of the oral biofilms in mucosal disease; microbial virulence factors and the pseudomembranous oral mucosal disease process; the role that oral mucosal disease may have in HIV transmission; and the available topical antifungal treatment. This article summarizes the ensuing discussions and raises pertinent problems and potential research directions associated with oral fungal disease in HIV-infected patients, including the frequency of oral candidosis, the role of the intraoral biofilm in the development of oral mucosal disease, and host-pathogen interactions, as well as the development of the fetal oral mucosa, neonatal nutrition, and the role of oral candidosis in this setting. Finally, discussions are summarized on the use of inexpensive effective antifungal mouthwashes in resource-poor countries, the potential stigmata that may be associated with their use, as well as novel topical medications that may have clinical applicability in managing oral candidal infections in HIV-infected patients.

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.

Purpose: 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., Methods: 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., Results: 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)., Conclusions: 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.

Objective: Radiotherapy-induced moist desquamation is a significant problem but there is a paucity of randomised data on which to base treatment decisions. The current prospective randomised trial compared gentian violet (GV) to a hydrogel dressing in this context., Method: Thirty patients undergoing radiotherapy to the head and neck region or breast who had developed moist desquamation in the radiotherapy field were randomised to treatment with 0.5% aqueous gentian violet (GV) (n=16) or a hydrogel dressing (n=14). The area of desquamation was regularly measured until healing or withdrawal from the study., Results: The likelihood of healing with the hydrogel was greater than GV with a hazard ratio for healing of 7.95 (95% CI 2.20-28.68; p=0.002). The median time to healing for hydrogel was 12 days but had not been reached for GV by 30 days. Over the first 14 days the median'area under curve' of moist desquamation for GV was 82.6 cm2 (range 31.8-320.7 cm2) and that for hydrogel 20.0 cm2 (range 3.8-301.0 cm2) (difference significant at p=0.003). Ten of 16 patients treated with GV withdrew from the study (due to stinging in five and failure to heal in five) compared with two of the 14 treated with hydrogel (difference significant at p=0.021)., Conclusion: Hydrogel dressings are more likely to heal radiotherapy-induced moist desquamation and are better tolerated than GV.

Shoulder arthroscopy is used widely to treat a variety of shoulder pathologies. These include various diagnostic and stabilization procedures such as Bankart repair, treating SLAP lesions, capsular plication, and rotator cuff repair. Sutures are commonly used, particularly in stabilization procedures, with or without the use of suture anchors. Suture management is one of the prerequisites for a successful arthroscopic stabilization procedure. We describe a simple method of aiding suture management. In cases using the suture anchor, the preloaded suture is firstly removed from the anchor, and approximately half the length of the suture is stained with methylene blue. The suture is then reinserted into the same suture anchor. The suture anchor is used in the usual manner. During shoulder arthroscopy, one end of the suture is pulled, if necessary, to determine the direction of the thread, which is readily shown by the methylene blue. This simple maneuver helps the surgeon identify the desired direction of the thread and avoid the common problems of pulling out the suture and twisting the sutures.

Chemical cystitis due to intravesical instillation of gentian violet or crystal violet is rare and all of the reported cases have been in adults using undiluted solution, which resulted in long-term sequelae. This is a case report on a 16-month-old boy with hemorrhagic cystitis after the instillation of diluted gentian violet into the bladder to rule out bladder injury during inguinal herniorrhaphy. Although he was completely recovered with conservative therapy, gentian violet, even when diluted, should not be used on the urinary tract.

Two patients developed chondrolysis following injection of 0.4% aqueous gentian violet into the glenohumeral joint to visualize a rotator cuff tear during surgery. In both cases, conventional radiographs revealed joint space narrowing 10-12 months after surgery. Histological examination of the humeral heads revealed loss of the articular cartilage.

A case of glenohumeral osteoarthritis in a 35-year-old female following a color test during rotator cuff repair is described. The patients had a tear in the rotator cuff involving the supraspinatus muscle and rotator interval. A color test with a 0.4% aqueous solution of gentian violet was performed during the operation and the ruptured cuff was not tightly sutured. The patient developed glenohumeral osteoarthritis 25 months postoperatively. Plain film radiographs showed joint space narrowing and bone sclerosis of the humeral head, but there was no evidence of osteophytes. This pathology was thought to have been caused by the aqueous gentian violet solution.

Although pyoctanin is widely used in medicine, there are hardly any reports of contact allergy to it. Most reports of side-effects refer to irritant reactions after topical application. We describe 2 patients who developed pyoctanin contact dermatitis after long-term application on damaged skin. Positive patch test results down to concentrations of 0.0025% and 0.05% aqueous pyoctanin solution, respectively, were found.

Accidental intra-arterial injection of a colouring agent (Bonney's blue) in a 28-year-old male patient induced acute ischaemia of the lower limb, resistant to standard therapy. Its successful treatment was finally obtained by intra-arterial infusion of nicardipine.

Acute respiratory signs and increased mortality due to suffocation occurred in a flock of 5-week-old male turkey poults following water administration of gentian violet. Gross lesions of laryngeal edema and occlusion of the tracheal opening with caseous plugs were present. Microscopic lesions in the tracheas consisted of vascular congestion, mucosal degeneration, and necrosis. The condition was reproduced experimentally in turkey poults by giving drinking water containing gentian violet.

We describe a patient who developed superficial necrosis of the glans penis from irritation after topical treatment with 1% gentian violet. The foregoing condition resolved after withdrawal of treatment. A differential diagnosis (sexually transmitted diseases, epidermoid carcinoma, etc.) is warranted on finding this type of lesion in the glans penis.

The case of a child is reported in whom a circumscribed necrotic skin reaction developed in the gluteal fold after application of 2% crystal violet (Pyoktanin) in aqueous solution. Similar cases are described after topical treatment with 1% solutions of dyes. For direct application to intertriginous areas, triphenylmethane dyes should be used in lower concentrations.

A case of bilateral keratoconjunctivitis caused by self-instillation of a 1% aqueous solution of gentian violet was complicated by a secondary uveitis and gram-negative conjunctivitis. The patient was treated with cycloplegics and specific antibiotics and after resolution of the bacterial infection, a mild topical corticosteroid was used. After six months the patient had completely recovered from the keratitis, but bilateral corneal vascularization, had unilateral posterior synechiae, corneal scarring, and cataract formation were present. Cationic dyes such as gentian violet appear to be toxic to the ocular surfaces and tend to produce severe intraocular inflammation.

The instillation of diluted Bonney's blue into the bladder during gynaecological operations has been quite common practice over the last 50 years. Bonney's blue is composed of a 1:1 mixture of brilliant green and crystal violet dissolved in ethanol (90%) or industrial methylated spirit. Before insertion into the bladder this solution must be diluted with water to a 0.5% solution. Failure to do this will result in a severe inflammatory reaction within the bladder. The degree of resultant damage depends upon the duration of exposure. Persistent pain is a feature of this condition, although the other symptoms (frequency and urgency) may settle in time. Two cases of chemical cystitis resulting from the use of undiluted Bonney's blue are described to illustrate the possible consequences. Both patients were awarded 6-figure sums as compensation.

In a patient suffering from chronic balanitis, necrotic lesions of the glans penis and the internal part of the prepuce occurred when treated with 1% gentian violet. Necrosis after treatment with gentian violet is a rarely seen complication which should be borne in mind.

From April 1 to October 31, 1985, postoperative surgical-wound infections due to rapidly growing mycobacteria developed in eight patients undergoing cosmetic plastic surgery performed by one surgeon. All infections followed either face-lift or augmentation-mammoplasty procedures performed in the surgeon's office; no infections occurred after surgical procedures performed at the hospital or after other surgical procedures performed at the office. An epidemiologic investigation implicated a gentian violet skin-marking solution as the source of the infections (P less than 0.001). Among patients exposed to the gentian violet, infection was significantly more likely to develop in those undergoing a face lift or augmentation mammoplasty than in those undergoing blepharoplasty (P less than 0.001). Additional risk factors for infection included the postoperative use of antibiotics and glucocorticoids. Mycobacterium chelonae, subspecies abscessus, was isolated from the gentian violet stock used by the surgeon and from five of the eight patients. Additional studies showed that the same organism was present in the gentian violet stock at the pharmacy that supplied the agent to the surgeon. After a sterile skin-marking agent was substituted for the contaminated agent, no further cases occurred.