Colorful dyes and other vibrant topical creams as treatments for dermatological conditions

  • Gaurav Agnihotri
  • Sumul Gandhi
  • Peter A. LioEmail author
Review Article


This review summarizes the mechanisms, applications, and adverse effects of colorful dyes, such as Castellani’s paint, gentian violet, and potassium permanganate, as well as two other vibrant topical creams—vitamin B12 and indigo naturalis. Certain dyes such as Castellani’s paint, gentian violet, and potassium permanganate were once commonplace topical therapies for cutaneous infections; these dyes are brightly colored on application and have been suggested to be efficacious and well tolerated through case studies as well as controlled studies. Moreover, topical vitamin B12 and topical indigo naturalis creams for atopic dermatitis and psoriasis have been extensively studied through multiple controlled trials and may also be effective, with minimal adverse effects. Understanding the composition and mechanism of action has helped guide the development of these therapies.


Compliance with ethical standards


No sources of funding were received to prepare this article.

Conflict of interest

Gaurav Agnihotri and Sumul Gandhi report no conflicts of interest. Peter A. Lio has served as a consultant or advisor to Abbvie, Altus, AOBiome, Dermavant, Dermira, Eli Lilly, Exeltis, Franklin BioScience, Galderma, IntraDerm, Johnson and Johnson, La Roche-Psay, Menlo, Micreos, Mission, Pfizer, Pierre Fabre, Realm, Regeneron/Sanofi-Genzyme, Theraplex, UCB, and Unilever; has served as a speaker for Pfizer, Regeneron/Sanofi-Genzyme, La Roche-Posay, and Pierre Fabre; and has been an investigator and received research grants/funding from AOBiome, Regeneron/Sanofi-Genzyme, and Abbvie.


  1. 1.
    Shah MK. Castellani’s paint. Indian J Dermatol Venereol Leprol. 2003;69(5):357–8.Google Scholar
  2. 2.
    Litt JZ. Alternative topical therapy. Dermatol Clin. 1989;7(1):43–52.Google Scholar
  3. 3.
    Castellani A. Carbol-fuchsin paints in the treatment of certain cases of epidermophytosis. Am Med. 1928;34:351–6.Google Scholar
  4. 4.
    Seale ER, Clark WA. Treatment of intertriginous moniliasis. South Med J. 1948;41(10):926–30.Google Scholar
  5. 5.
    Babakurban ST, Topal O, Aydin E, et al. Therapeutic effect of Castellani’s paint in patients with an itchy ear canal. J Laryngol Otol. 2016;130(10):934–8.Google Scholar
  6. 6.
    Sugathan P, Najeeba R, Neelakantam, et al. An unusual side effect of Castellani’s paint. Indian J Dermatol Venereol Leprol. 1990;56:317–8.Google Scholar
  7. 7.
    Riyaz N. Castellani’s paint. Indian J Dermatol Venereol Leprol. 2004;70(2):119.Google Scholar
  8. 8.
    Field LM. Castellani’s paint without fuchsin. Arch Dermatol. 1979;155(11):1287.Google Scholar
  9. 9.
    Arnold HL Jr. Castellani’s paint without fuchsin. Arch Dermatol. 1979;155(11):1287.Google Scholar
  10. 10.
    Balabanova M, Popova L, Tchipeva R. Dyes in dermatology. Clin Dermatol. 2003;21(1):2–6.Google Scholar
  11. 11.
    Maley AM, Arbiser JL. Gentian violet: a 19th century drug re-emerges in the 21st century. Exp Dermatol. 2013;22(12):775–80.Google Scholar
  12. 12.
    Docampo R, Moreno SNJ. The metabolism and mode of action of gentian violet. Drug Metab Rev. 1990;22:161–6.Google Scholar
  13. 13.
    Bakker P, Van Doorne H, Gooskens V, et al. Activity of gentian violet and brilliant green against some microorganisms associated with skin infections. Int J Dermatol. 1992;31(3):210–3.Google Scholar
  14. 14.
    Wainwright, M. Dyes for the medical industry. In: Clark M, editor. Handbook of textile and industrial dyeing. Woodhead Publishing; Cambridge, 2011.
  15. 15.
    Riley K, Flower AH. A comparison of the inhibitory effect of Castellani’s paint and of gentian violet solution on the in vitro growth of Candida albicans. J Invest Dermatol. 1950;15(5):355–62.Google Scholar
  16. 16.
    Taguchi S, Saji M, Sakisaka M, et al. Studies of selective bactericidal effects of various dye preparations on MRSA. Chemotherapy. 1993;41:935–40.Google Scholar
  17. 17.
    Saji M. Effect of gentiana violet against methicillin-resistant Staphylococcus aureus (MRSA) [in Japanese]. Kansenshogaku Zasshi. 1992;66(7):914–22.Google Scholar
  18. 18.
    Saji M, Taguchi S, Hayama N, et al. Effect of gentian violet on the elimination of methicillin-resistant Staphylococcus aureus (MRSA) existing in the decubitus region [in Japanese]. Nihon Ronen Igakkai Zasshi. 1993;30(9):795–801.Google Scholar
  19. 19.
    Brockow K, Grabenhorst P, Abeck D, et al. Effect of gentian violet in Staphylococcus aureus-colonized atopic eczema. Dermatology. 1999;199(3):231–6.Google Scholar
  20. 20.
    Wald ER, Snyder MJ, Gutberlet RL. Group B beta-hemolytic streptococcal colonization: acquisition, persistence, and effect of umbilical cord treatment with triple dye. Am J Dis Child. 1977;131(2):178–80.Google Scholar
  21. 21.
    Zupan J, Garner P, Omari A. Topical umbilical cord care at birth. Cochrane Database Syst Rev. 2004;(3):CD001057.Google Scholar
  22. 22.
    Faber HK, Dickey LB. The treatment of thrush with gentian violet. JAMA. 1925;85(12):900–1.Google Scholar
  23. 23.
    White DJ, Johnson EM, Warnock DW. Management of persistent vulvo vaginal candidosis due to azole-resistant Candida glabrata. Genitourin Med. 1993;69(2):112–4.Google Scholar
  24. 24.
    Nyst MJ, Perriens JH, Kimputu L, et al. Gentian violet, ketoconazole and nystatin in oropharyngeal and esophageal candidiasis in Zairian AIDS patients. Ann Soc Belg Med Trop. 1992;72(1):45–52.Google Scholar
  25. 25.
    Mukherjee PK, Chen H, Patton LL, et al. Topical gentian violet compared to nystatin oral suspension for the treatment of oropharyngeal candidiasis in HIV-1-infected participants. AIDS. 2017;31(1):81–8.Google Scholar
  26. 26.
    Bhandarkar SS, MacKelfresh J, Fried L, et al. Targeted therapy of oral hairy leukoplakia with gentian violet. J Am Acad Dermatol. 2008;58(4):711–2.Google Scholar
  27. 27.
    Slotkowski EL, Redondo D. Mucosal irritation following the use of gentian violet. Am J Dis Child. 1966;112(1):40–2.Google Scholar
  28. 28.
    Verbov J. Oral irritation with gentian violet. Br Med J. 1976;2(6036):639.Google Scholar
  29. 29.
    Arbiser JL. Gentian violet is safe. J Am Acad Dermatol. 2009;61(2):359.Google Scholar
  30. 30.
    World Health Organization. WHO model list of essential medicines, 20th list. Geneva: World Health Organization; 2017. Available at: Accessed 30 Apr 2019.
  31. 31.
    World Health Organization. WHO model prescribing information: drugs used in skin diseases. Geneva: World Health Organization; 1997.Google Scholar
  32. 32.
    Hu N, Wu XH, Liu R, et al. Novel application of vacuum sealing drainage with continuous irrigation of potassium permanganate for managing infective wounds of gas gangrene. J Huazhong Univ Sci Technol Med Sci. 2015;35(4):563–8.Google Scholar
  33. 33.
    Burns T, Breathnach S, Cox N, et al. Rook’s textbook of dermatology. 8th ed. Oxford: Wiley-Blackwell Scientific Publications; 2010.Google Scholar
  34. 34.
    Delgado-Enciso I, Madrigal-Perez VM, Lara-Esqueda A, et al. Topical 5% potassium permanganate solution accelerates the healing process in chronic diabetic foot ulcers. Biomed Rep. 2018;8(2):156–9.Google Scholar
  35. 35.
    Stücker M, Pieck C, Stoerb C, et al. Topical vitamin B12: a new therapeutic approach in atopic dermatitis—evaluation of efficacy and tolerability in a randomized placebo-controlled multicentre clinical trial. Br J Dermatol. 2004;150(5):977–83.Google Scholar
  36. 36.
    Howe EE, Dooley CL, Geoffroy RF, et al. Percutaneous absorption of vitamin B12 in the rat and guinea pig. J Nutr. 1967;92(2):261–6.Google Scholar
  37. 37.
    Yamashiki M, Nishimura A, Kosaka Y. Effects of methylcobalamin (vitamin B12) on in vitro cytokine production of peripheral blood mononuclear cells. J Clin Lab Immunol. 1992;37(4):173–82.Google Scholar
  38. 38.
    Sakane T, Takada S, Kotani H, et al. Effects of methyl-B12 on the in vitro immune functions of human T lymphocytes. J Clin Immunol. 1982;2(2):101–9.Google Scholar
  39. 39.
    Hanifin JM. Atopic dermatitis: new therapeutic considerations. J Am Acad of Dermatol. 1991;24(6 Part 2):1097–101.Google Scholar
  40. 40.
    Nistico SP, Del Duca E, Tamburi F, et al. Superiority of a vitamin B12-barrier cream compared with standard glycerol-petrolatum-based emollient cream in the treatment of atopic dermatitis: a randomized, left-to-right comparative trial. Dermatol Ther. 2017;30(5):e12523.Google Scholar
  41. 41.
    Januchowski R. Evaluation of topical vitamin B12 for the treatment of childhood eczema. J Altern Complement Med. 2009;15(4):387–9.Google Scholar
  42. 42.
    Stankler L. The vitamin B12 level in psoriatic skin and serum. Br J Dermatol. 1969;81(12):911–8.Google Scholar
  43. 43.
    Del Duca E, Farnetani F, De Carvalho N, et al. Superiority of a vitamin B12-containing emollient compared to a standard emollient in the maintenance treatment of mild-to-moderate plaque psoriasis. Int J Immunopathol Pharmacol. 2017;30(4):439–44.Google Scholar
  44. 44.
    Stücker M, Memmel U, Hoffmann M, et al. Vitamin B12 cream containing avocado oil in the therapy of plaque psoriasis. Dermatology. 2001;203(2):141–7.Google Scholar
  45. 45.
    Jansen T, Romiti R, Kreuter A, et al. Rosacea fulminans triggered by high-dose vitamins B6 and B12. J Eur Acad Dermatol Venereol. 2001;15(5):484–5.Google Scholar
  46. 46.
    Lin YK, See LC, Huang YH, et al. Comparison of indirubin concentrations in indigo naturalis ointment for psoriasis treatment: a randomized, double-blind, dosage-controlled trial. Br J Dermatol. 2017;178(1):124–31.Google Scholar
  47. 47.
    Chiang YR, Li A, Leu YL, et al. An in vitro study of the antimicrobial effects of indigo naturalis prepared from Strobilanthes formosanus Moore. Molecules. 2013;18(11):14381–96.Google Scholar
  48. 48.
    Lin YK, Chen HW, Leu YL, et al. Indigo naturalis upregulates claudin-1 expression in human keratinocytes and psoriatic lesions. J Ethnopharmacol. 2013;145(2):614–20.Google Scholar
  49. 49.
    Lin YK, Leu YL, Yang SH, et al. Anti-psoriatic effects of indigo naturalis on the proliferation and differentiation of keratinocytes with indirubin as the active component. J Dermatol Sci. 2009;54(3):168–74.Google Scholar
  50. 50.
    Hsieh WL, Lin YK, Tsai CN, et al. Indirubin, an acting component of indigo naturalis, inhibits EGFR activation and EGF-induced CDC25B gene expression in epidermal keratinocytes. J Dermatol Sci. 2012;67(2):140–6.Google Scholar
  51. 51.
    Kim MH, Choi YY, Yang G, et al. Indirubin, a purple 3,2-bisindole, inhibited allergic contact dermatitis via regulating T helper (Th)-mediated immune system in DNCB-induced model. J Ethnopharmacol. 2013;145(1):214–9.Google Scholar
  52. 52.
    Gamret AC, Price A, Fertig RM, et al. Complementary and alternative medicine therapies for psoriasis: a systematic review. JAMA Dermatol. 2018;154(11):1330–7.Google Scholar
  53. 53.
    Cheng HM, Wu YC, Wang Q, et al. Clinical efficacy and IL-17 targeting mechanism of Indigo naturalis as a topical agent in moderate psoriasis. BMC Complement Altern Med. 2017;17(1):439.Google Scholar
  54. 54.
    Lin YK, Chang CJ, Chang YC, et al. Clinical assessment of patients with recalcitrant psoriasis in a randomized, observer-blind, vehicle-controlled trial using indigo naturalis. Arch Dermatol. 2008;144(11):1457–64.Google Scholar
  55. 55.
    Lin YK, See LC, Huang YH, et al. Comparison of refined and crude indigo naturalis ointment in treating psoriasis: randomized, observer-blind, controlled, intrapatient trial. Arch Dermatol. 2012;148(3):397–400.Google Scholar
  56. 56.
    Hengge UR, Ruzicka T, Schwartz RA, et al. Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol. 2006;54(1):1–5.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.University of Illinois at Chicago College of MedicineChicagoUSA
  2. 2.Quincy Medical GroupQuincyUSA
  3. 3.Department of Dermatology, Feinberg School of MedicineNorthwestern UniversityChicagoUSA

Personalised recommendations