InnoVAtions: Colorful 19th Century Drug Found Effective for Eczema at Atlanta VAMC

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WASHINGTON — Gentian violet (pronounced jen-shen) is not a compound familiar to most modern medical practitioners. Developed in the middle of the 19th century, this combination of pararosanilines used as a component in dyes was eventually discovered to have antiseptic properties. Through the early part of the 20th century, it was prescribed by physicians for simple infections and commonly used by mothers to treat thrush in infants.

Because of the compound’s tendency to stain whatever it touches a vibrant purple, and because of the advent of newer antibiotics, gentian violet has fallen out of favor. However, a VA dermatologist is determined to bring it back, not only for antiseptic usage but also for previously unknown anti-inflammatory properties.

Reviving An Old Treatment

In 2005, Jack Arbiser, MD, PhD, chief of dermatology at the Atlanta VA Medical Center, and his colleagues were looking for compounds similar to already-existing inhibitors to the NADPH oxydase family of enzymes. Such inhibitors have been shown to have anti-inflammatory effects, and Arbiser wanted an already-approved alternative to the existing drugs. Gentian violet, he found, was chemically similar to the drugs he was using in the laboratory.  

“Because it was already approved for use, we could start using it in people immediately. Physicians have been using it for over 100 years, and it has an extensive safety record,” Arbiser said. “We started using it for a lot of inflammatory diseases, especially eczema.”

Also, many inflammatory disorders involve excess blood-vessel growth, and Arbiser and his colleagues discovered using animal studies that gentian violet blocked blood vessel growth in tumors — a finding he eventually published in the Journal of Investigative Dermatology.

Because it both blocks blood-vessel growth and kills bacteria, gentian violet has become a first-line treatment for eczema in Arbiser’s department. He has also used it to treat other disorders, including lupus, contact dermatitis and, most recently, nail fungus.

“Right now, we’re using oral drugs to treat nail fungus, which are expensive and have lots of side-effects,” Arbiser said.  “Gentian violet is safe, and it looks like it’s effective, from what we’ve seen. We think that, with it, we can offer a safer treatment for our veterans, and a cheaper one as well.”

A bottle of gentian violet costs between $5 and $15 and can last for years. The topical steroids commonly used to treat eczema cost between $50 and $100 and do not last nearly as long. The oral treatment for nail fungus costs between $1,000 and $2,000 and involves the need for blood tests.

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