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ifference between the cohorts. This suggests that patients

ttending our burns centre now suffer from twice the burden

f co-morbidity. Closer investigation of co-morbidities showed

n even increase in concurrent psychiatric co-morbidities in

he 2012 cohort (11.5% in 2002 and 17.2% in 2012).

In 2002, 3.1% of patients suffered from burns secondary to

heir other illnesses, with 31.2% of patients acquiring injuries

t work. On the other hand in 2012, 11.6% of patients sustained

urns as due to co-morbid conditions and 9.3% sustained

njuries at work, suggesting a shift in burn causes over the

ecade. Another difference between cohorts concerns depth

Letter to the Editor

Gentian violet – A blessing in disguise for thedeveloping world

Crystal violet or Gentian violet is a triarylmethane dye used as

a histological stain and in Gram’s method of classifying

bacteria. Crystal violet has antibacterial, antifungal, and

antihelmintic properties and was formerly important as a

topical antiseptic. It is used topically in various mouth ulcers,

b u r n s 3 9 ( 2 0 1 3 ) 1 3 2 1 – 1 3 2 7326

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Conflict of interest

f burn and TBSA. In 2002, the mean TBSA was 4.7%, compared

o 2.4% in 2012 ( p = 0.0144). In addition, a higher percentage of

ull thickness burns were seen in 2002 (37.5% full thickness vs

3.5% partial thickness), compared to the 2012 cohort (15.1%

ull thickness vs 57.0% partial thickness). This suggests that

atients are currently admitted to the burns centre with less

evere burns than a decade ago. Interestingly there was no

tatistical difference in the mean age of patients between 2002

nd 2012 (46.1 and 45.9 respectively).

Our study suggests that over the decade there has been an

ncrease in co-morbidities of patients presenting at our burns

entre, which brings challenges to burns care. With burns care

ow multi-disciplinary in approach, it is important to make

ure that appropriate support is sought from medical teams

nd other multi-disciplinary team members to ensure optimal

anagement of patients medical co-morbidities in order to

aximise potential outcomes following burns. Although a

evere burn is often the most pressing issue in these patients,

hanges in the burn population demonstrate how a holistic

pproach should be appreciated.

e f e r e n c e s

1] Ryan CM, Schoenfield DA, Thorpe WP, Sheriden RL, CassemEH, Tompkins RG. Objective estimates of the probability ofdeath from burn injuries. N Engl J Med 1998;338:362–6.

2] Palmu R, Isometsa E, Suominen K, Vuola J, Leppavuori A,Lonnqvist J. Self-inflicted burns: an eight year retrospectivestudy in Finland. Burns 2004;30:443–7.

Lyudmila Kishikova*

Samuel Odeyinde

Baljit Dheansa

Queen Victoria Hospital NHS Foundation Trust, Holtye Road, East

Grinstead, West Sussex, RH19 3DZ, United Kingdom

Corresponding author at: Brighton and Sussex Medical School,

SMS Teaching Building, University of Sussex, Brighton, East

Sussex, BN1 9PX, United Kingdom.

Tel.: +44 7929177442

E-mail address: l.kishikova1@uni.bsms.ac.uk (L. Kishikova)

0305-4179/$36.00

# 2013 Elsevier Ltd and ISBI. All rights reserved.

http://dx.doi.org/10.1016/j.burns.2013.03.001

T

brasions and superficial skin infections. In aqueous solutions

t dissociates into positive and negative ions that penetrate

hrough the wall and membrane of both Gram-positive and

ram-negative bacterial cells. Evidence also suggests that

entian violet dissipates the bacterial (and mitochondrial)

embrane potential by inducing permeability. This is fol-

owed by respiratory inhibition. This anti-mitochondrial

ctivity might explain gentian violet’s efficacy towards both

acteria and yeast with relatively mild effects on mammalian

ells [1,2].

Throughout the world, burns remain a huge health issue,

nd especially in developing countries due to its high cost of

reatment and management which results in increase

orbidity or mortality in severe cases [3]. Burn wounds are

terile immediately after being inflicted but are liable to be

olonized very rapidly by bacteria. Gentian violet being an

ntibacterial agent can be used to fight against bacterial

nfections in these cases. According to study of Harvard

edical School in which various agents are being assessed for

urns treatment, a two per cent solution of gentian violet, was

prayed on to the area, the dye stopped the bleeding from the

urface quickly and the eschar formed more rapidly as

ompared with other agents [4]. Another study in June 2000

hows the efficacy of gentian violet in healing wounds. The

ye does not only decrease the wound size but reduces pain as

ell, which suggest that it has a mild analgesic effect too [5]. A

tudy conducted in Philadelphia also suggest gentian violet to

e an effective agent for curing burn wounds, following results

re obtained when it is used in 1st and 2nd degree burns in

ombination with an antibiotic [6].

To date no case of acute gentian toxicity has been reported

n external use. However, there are evidence that it may cause

astrointestinal tract irritation on oral use, decrease white

lood cell count on IV and some evidence suggesting a

arcinogenic effect of triphenylmethane-classed dyes of

hich gentian violet is a member but in rodents not human

eings [7].

In view of mentioned studies, gentian violet has proved to

e an efficient agent for reducing bacterial growth as well as in

ealing wounds with mild analgesic effect. Thus, this cost

ffective agent’s use as a first aid agent in burns, though needs

o be further investigated; but once proven useful can be

eneficial especially in developing countries that have limited

esources and budgets allocated for health care.

he authors have no conflicts of interest or funding to disclose.

b u r n s 3 9 ( 2 0 1 3 ) 1 3 2 1 – 1 3 2 7 1327

r e f e r e n c e s

[1] Adams E. The antibacterial action of crystal violet. J PharmPharmacol 1967;19(December (12)):821–6.

[2] Tolba MK, Saleh AM. Studies on the mechanism of fungicidalaction of crystal violet on mycelial felts of Fusarium culmorum.Arch Mikrobiol 1963;47(December (2)):201–6.

[3] Ogundipe KO, Adigun IA, Solagberu BA. Economic burden ofdrug use in patients with acute burns: experience in adeveloping country. J Trop Med 2009;2009 (article ID 734712, 4pages).

[4] Cannon B, Cope O. Rate of epithelial regeneration: a clinicalmethod of measurement, and the effect of various agentsrecommended in the treatment of burns. Ann Surg1943;117(January (1)):85–92. PMCID: PMC1617469 (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1617469/).

[5] Mak SS, Molassiotis A, Wan WM, Lee IY, Chan E.S.. TheEffects of hydrocolloid dressing and gentian violet onradiation-induced moist desquamation wound healing.Cancer Nurs 2000;23(June (3)):220–9.

[6] Thompson CW. Topical application of penicillin: solution,gentian-violet and heat in the treatment of extensive 1st and2nd degree burns in children. J Natl Med Assoc1946;38(January (1)):11–4. PMCID: PMC2616807 (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2616807/).

[7] Docampo R, Moreno SN. The metabolism and mode of actionof gentian violet. Drug Metab Rev 1990;22(2–3):161–78.

Syed Arsalan Ali*,1

House # B-202, Habib Complex, Block L,

North Nazimabad,

Karachi, Pakistan

Gulrayz Ahmed1

D-31, Block 8, Gulshan e Iqbal, Karachi, Pakistan

Shaikh Hamiz-ul-Fawwad1

House # R-27, Sector 15 A-4, Bufferzone,

Karachi, Pakistan

Syeda Aimen Waqar1

A-480 Block ‘‘J’’ North Nazimabad, Karachi, Pakistan

Anum Saleem1

16-E Rainbow Appartments Block ‘‘M’’ North Nazimabad,

Karachi, Pakistan

*Corresponding author. Tel.: +92 3332378207;

fax: +92 2134265421

E-mail address: syedarsalanali1@gmail.com (S. Arsalan Ali)

gulrayzahmed@gmail.com(G. Ahmed)

hamiz321@hotmail.com(S. Hamiz-ul-Fawwad)

aimenwaqar_90@hotmail.com(S.A. Waqar)

anum_saleem1@hotmail.com(A. Saleem)

14th Year MBBS Students, Dow Medical College,

Dow University of Health Sciences, Karachi,

Pakistan.

0305-4179/$36.00

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http://dx.doi.org/10.1016/j.burns.2013.02.004