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

by U.S. Medicine

September 7, 2011

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.

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

Effectiveness Outweighs Side-Effects

Arbiser is campaigning for the compound’s expanded use in the Atlanta VAMC. “When a primary-care provider sees a patient with an itchy rash, they should try gentian violet. And if that doesn’t work, then send them to us. I think a lot would respond to gentian violet and wouldn’t need further supervision by dermatologists,” Arbiser said. “I also recommend it for emergency room personnel. If someone comes in with a bad case of poison ivy, gen violet works great for that.”

Despite being a versatile and inexpensive treatment, there are still a few barriers keeping physicians and patients from embracing gentian violet. The first is that few physicians who went through medical school in the last 40 years know about it.

 “It has a reputation as being an old-time medicine,  something that’s fallen by the wayside,” Arbiser said. “But, now that we find out how it works and how we can scientifically apply it, I think it’s time for it to make a comeback. Especially when we’re talking about containing healthcare costs.”

The other barrier is its color; gentian violet stains whatever it touches purple. Mothers who have used the drug to treat thrush complain of how it stains the baby’s mouth and saliva purple, which in turn will stain clothes purple. The purple will eventually wash off but could be a deterrent to its use.

“One of the side-effects that is listed with gentian violet is that the violet color will sometimes persist like a tattoo, but this is very rare and we haven’t seen it,” Arbiser said.

Compared with the side-effects of drugs like topical steroids, which thin out the skin after years of use, purple staining seems mild, Arbiser noted. Also, gentian violet has been found to work instantly. For people who experience severe rashes or eczema, instant relief from the painful itching can trump any side-effect.

“If you’re really itchy, you’re grateful to have something that works and works so quickly,” Arbiser said.

Currently, there are no ongoing studies with gentian violet, Arbiser said, but he hopes that will change. “I hope to do a nationwide study of gentian violet, comparing it against these other treatments. Then we can really see how effective and affordable it is.”

Editor’s note: Not all good ideas come from the highest levels of the VA. At VA medical centers around the country, clinicians in the trenches have developed novel ways to improve patient care, often cost-effectively. This is the first in a periodic series of articles about some of those concepts and the clinicians who have championed them. Do you know about an InnoVAtion we should cover? If so, please email me at [email protected] and let me know about it.

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