Breast candidiasis: avoid gentian violet (ANSM alert)

Gentian violet is a synthetic chemical molecule (methylrosanilinium chloride), colorant, sometimes applied topically to treat certain candidiasis of the nipple. However, if it is ingested by a newborn during breastfeeding – used for more than 7 days at too high doses – this substance can be dangerous. Indeed, according to the European classification of substances and mixtures, this molecule is harmful if ingested and potentially carcinogenic.

This is why the ANSM does not recommend the use of gentian violet as a first-line treatment for breast candidiasis in breastfeeding women: it recommends the use of antifungal drugs, after confirmation of the diagnosis by a doctorfavoring a topical antifungal before an antifungal administered systemically.

Moreover, in the absence of a consensus on the management of breast candidiasis, it is important to establish a differential diagnosis and to manage the pain before any treatment of candidiasis.

If antifungal treatments fail, and only then, the prescription of a magistral or hospital preparation based on gentian violet can be considered. The concentration of the aqueous solution of gentian violet must not exceed 1.65 mg per 100 g of solvent (ethanol to be banned in breastfeeding women); therefore, the volume of the vial dispensed by the pharmacy is maximum the 10 mL. The processing time is limited to 7 days.

If symptoms persist, other treatment should be considered.

If contaminated, the child should be treated at the same time as the mother: pharmaceutical specialties exist for the management of oral thrush in children.