Steve McClain, MD

Gentian Violet is an old but still effective antiseptic treatment for macerated tinea and also, in some podiatrist's hands, diabetic foot ulcer.

The Egyptians likely deserve credit for discovering the use of native dyes for treating foot ulcer and much later in the mid-1500's, Ambroise Pare used saffron to suppress microbial growth. Modern chemical dyes became available in 1890 with the manufacture of aniline dyes and Gentian Violet among them has been in use since.

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In 1905, Castellani described use of a paint of Basic Fuchsin (red) in a paint of phenol, resorcinol alcohol and acetone for stubborn hyperkeratotic tinea, known as tinea imbricata. In 1931, Bettman described topical use of Brilliant Scarlet in ointment to prevent wound infections in plastic surgery. In 1934, Aldrich described treatment of serious burns using topical aqueous Triple Dye, composed of Gentian Violet, Brilliant Green (Malachite Green) and Proflavine hemisulfate, a yellow dye. In the pre-antibiotic era, dyes were mainstay disinfectants and antiseptics. For example, during that era, many surgeons preferred dye instead of Lister's carbolic acid on their hands as a final pre-surgical rinse before gloving.

Gentian Violet is also known as Crystal Violet, used in the laboratory for staining Gram positive bacteria and also many yeasts. It also stains many gram-negative bacteria, though not as avidly, which are also more easily decolorized. Gentian Violet avidly binds to fungal products around colorless carbohydrate hypha walls, as shown in the toenail fungus specimen stained above. Hyphae appear clear, outlined by Gentian Violet staining around well-defined, twisted hyphae resembling vines of English ivy growing up a tree trunk in the garden.

Gentian Violet, like many other aniline dyes, is a non-vital stain. That is, the dye is not taken up by living cells. The dye binds to dead cornified cells and microbes and their products and also to necrotic debris in ulcers. In treating ulcers, dyes bind preferentially to the cornified callous and to necrotic debris and microbial grudge, neither binding to living cells nor to dermal collagen. Thus, the dye acts as a general antiseptic, binding to and suppressing a wide variety of microbes, both bacterial and fungal and yeasts.

Cotton-tipped applicators may be used to apply dye in tinea, but strictly avoid using cotton applicators in ulcers since cotton fibers may bind to necrotic tissue and support microbial growth. When used to treat macerated tinea, Gentian Violet should be applied in a standard manner to ensure adequate dosing. Aldrich’s 1946 technique was to apply once or twice daily 6 or 7 coats, allowing to dry between coats.

Aldrich used Triple Dye to treat serious full-thickness burns involving up to 65% body surface area, without toxicity. Aldrich added Brilliant Green and Proflavine hemisulfate because he found some burn patients died from Gram-negative sepsis, complications of burns treated with Gentian Violet alone. Triple Dye later found use as an umbilical cord disinfectant in billions of newborns from 1970s to present, but has not to my knowledge been tried in podiatric care.

For those interested to receive samples of Triple Dye for office use, please email me. Supply is limited.
Intended for External Use Only.
Use like Gentian Violet.
Apply 6 or 7 coats,
Allow to dry between coats.
stevem@mcclainlab.com

 

Zone of Inhibition of Aspergillus growth around disk with Triple Dye. Photo by Brittany Hervey

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References

1. Aldrich RH. Treatment of Burns with Aniline Dyes. NEJM 217:911-914. 1937.

2. Aldrich RH, Treatment of Superficial Burns. Chapter 22 in Zintel and Mason.

3. Preoperative and Postoperative Surgery. 2nd Ed. p274-293. WB Saunders, Philadelphia. 1946.

McClain Laboratories, LLC is an anatomic pathology laboratory located in Smithtown, New York. We specialize in evaluation of tissue biopsies, with an expertise in skin, nail, and oral pathology for healthcare professionals nationwide. Gross and microscopic evaluations of specimens done at our laboratory feature: Color images on all reports Personalized imaging for research Review of prior biopsies Rapid turnaround time Specimen courier service Histology grant and research work Expert medical testimony

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