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Aloe (Aloe vera)

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Also listed as: Acemannan
Related terms
Background
Evidencetable
Tradition
Dosing
Safety
Interactions
Attribution
Bibliography

Related Terms
  • Acemannan, Aloe africana, Aloe arborescens Miller, Aloe barbadensis, Aloe barbadesis, Aloe capensis, Aloe ferox, aloe latex, aloe mucilage, Aloe perfoliata, Aloe perryi Baker, Aloe spicata, Aloe vulgari, aloe-coated gloves, babosa (Spanish), Barbados aloe, bitter aloe, burn plant, Cape aloe, Carrisyn®, hirukattali, Curaçao aloe, elephant's gall, first-aid plant, ghai kunwar (Indian), ghikumar (Indian), hsiang-dan (Chinese), jelly leek, kumari, lahoi, laloi, lily of the desert, Lu-Hui, medicine plant, Mediterranean aloe, miracle plant, mocha aloes, musabbar, natal aloes, nohwa, plant of immortality, plant of life, rokai, sabilla (Spanish), Savila, Socotrine aloe, subr, true aloe, Venezuela aloe, za'bila (Swahili), Zanzibar aloe.

Background
  • Transparent gel from the pulp of the meaty leaves of Aloe vera has been used topically for thousands of years to treat wounds, skin infections, burns, and numerous other dermatologic conditions. Dried latex from the inner lining of the leaf has traditionally been used as an oral laxative.
  • There is strong scientific evidence in support of the laxative properties of aloe latex, based on the well-established cathartic properties of anthraquinone glycosides (found in aloe latex). However, aloe's therapeutic value compared with other approaches to constipation remains unclear.
  • There is promising preliminary support from laboratory, animal, and human studies that topical aloe gel has immunomodulatory properties that may improve wound healing and skin inflammation.

Evidence Table

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *


Dried latex from the inner lining of aloe leaves has been used traditionally as a laxative taken by mouth. Further research is needed to establish dosing and to compare the effectiveness and safety of aloe with other commonly used laxatives.

B


Limited evidence suggests that extract from Aloe vera in a water-soluble cream may be an effective treatment of genital herpes in males. Additional research is needed in this area before a strong recommendation can be made.

B


Early evidence suggests that an extract from aloe in a hydrophilic cream may be an effective treatment of psoriasis vulgaris. Additional research is needed in this area before a conclusion can be made.

B


Early research on aloe lotion suggests effectiveness for treating seborrheic dermatitis when applied to the skin. Further research is needed in this area before a conclusion can be made.

B


There is early evidence that oral aloe may reduce the risk of developing lung cancer. Further research is needed in this area to clarify if it is aloe itself or other factors that may cause this benefit.

C


There is weak evidence that treatment of recurrent canker sores of the mouth with aloe gel may reduce pain and increase the amount of time between the appearance of new ulcers. Further research is needed before a firm conclusion can be made.

C


Limited evidence suggests that a dentifrice containing Aloe vera may be as effective as a fluoridated dentifrice for plaque and gingivitis control. Further research is necessary before conclusions can be drawn.

C


Study results are mixed in patients with type 2 diabetes. It has been reported that children with type 1 diabetes use aloe to supplement their insulin treatments, although this has not been studied clinically. More research is needed to explore the effectiveness and safety of aloe in diabetics.

C


Traditionally, aloe has been used as a moisturizer. Early low-quality studies suggest aloe may effectively reduce skin dryness. Higher-quality studies are needed in this area.

C


Without further human trials, the evidence cannot be considered convincing either in favor or against this use of aloe.

C


Lichen planus causes an itchy rash of small purplish bumps, often on the arms, legs, back, or inside the mouth. It can also affect the genital area, including the vagina. Limited research suggests that aloe may be a helpful, safe treatment for lichen planus that affects the mouth or vulva. Additional research is needed.

C


Early evidence suggests that aloe may aid healing of mild-to-moderate skin burns. Further research is needed in this area.

C


Early studies suggest aloe may help heal skin ulcers. High-quality studies comparing aloe alone in comparison with a placebo are needed.

C


There is limited but promising research of the use of oral Aloe vera in ulcerative colitis (UC), compared to placebo. It is not clear how Aloe vera compares to other treatments used for UC.

C


There is early evidence that oral Aloe vera does not prevent or improve mucositis (mouth sores) associated with radiation therapy.

D


Early well-designed studies in humans found no benefit of topical acemannan hydrogel (a component of aloe gel) in the treatment of pressure ulcers.

D


Reports in the 1930s of topical aloe's beneficial effects on skin after radiation exposure lead to widespread use in skin products. Currently, aloe gel is sometimes recommended for skin irritation caused by prolonged exposure to radiation, although scientific evidence suggests a lack of benefit in this area.

D


Study results of aloe on wound healing are mixed, with some studies reporting positive results and others showing no benefit or potential worsening of the condition. Further research is needed, since wound healing is a popular use of topical aloe.

D
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)


Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.


Dosing

Adults (18 years and older)

  • In general, pure Aloe vera gel is often used liberally on the skin 3-4 times daily for the treatment of sunburn and other minor burns. Creams and lotions are also available. Skin products are available that contain aloe alone or aloe combined with other active ingredients. For constipation, 0.04-0.17 grams of dried juice (corresponding to 10-30 milligrams of hydroxyanthraquinones) taken by mouth has been recommended. 150 milligrams of dried aloe juice taken by mouth daily for 28 days has also been used in combination with celandine and psyllium.
  • For constipation, 0.04-0.17 grams of dried juice (corresponding to 10-30 milligrams of the aloe constituents hydroxyanthraquinones) taken by mouth has been recommended. Dried aloe juice (150 milligrams) has been taken by mouth daily for 28 days in combination with celandine and psyllium.
  • For diabetes (type 2), 5-15 milliliters of aloe juice has been taken by mouth twice daily.
  • For dental plaque and gingivitis, a dentifrice containing Aloe vera has been used three times daily for 30 days.
  • For genital herpes, a hydrophilic cream of 0.5% (by weight) of a 50% ethanol extract, combined with liquid paraffin and castor oil, has been used on affected areas three times daily for five days in a row per week, for up to two weeks.
  • For HIV infection, 1,000-1,600 milligrams of the aloe constituent acemannan has been taken by mouth in four equal doses daily for 48 weeks.
  • For lichen planus, an Aloe vera gel has been applied twice daily to affected area(s) for eight weeks.
  • For psoriasis vulgaris, a water-soluble cream of 0.5% (by weight) of a 50% ethanol extract of aloe, combined with mineral and castor oils, has been used three times daily for five days in a row per week, for up to four weeks.
  • For skin burns, a 97.5% Aloe vera gel has been applied to affected area(s) for two days in a row.

Children (younger than 18 years)

  • Topical (skin) use of aloe gel in children is common and appears to be well tolerated. However, a dermatologist and pharmacist should be consulted before starting therapy. Aloe taken by mouth has not been studied in children and theoretically may have harmful effects, such as lowering blood sugar levels. Therefore, it is not recommended.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

  • Avoid with known allergy or hypersensitivity to Aloe vera, its constituents, or plants of the Liliaceae family (such as garlic, onions, and tulips). Prolonged use of aloe gel on the skin may cause hives, dermatitis, and red eyelids.

Side Effects and Warnings

  • Aloe taken by mouth may lower blood sugar levels. Caution is advised in patients with diabetes or hypoglycemia, glucose intolerance, and in those taking drugs, herbs, or supplements that affect blood sugar. Blood glucose levels may need to be monitored by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.
  • Use caution when aloe latex is taken by mouth short-term as a laxative.
  • Use caution when aloe latex is taken by mouth in patients with kidney disease, heart disease, or electrolyte abnormalities, due to theoretical risk of low blood potassium levels.
  • Use cautiously in patients with impaired liver function due to reports of hepatitis from taking aloe by mouth.
  • Because aloe contains estrogen-like chemicals, the effects of other agents believed to have estrogen-like properties may be altered.
  • Avoid taking aloe latex by mouth for prolonged periods as a laxative, due to theoretical risk of dehydration and electrolyte imbalance.
  • Avoid giving aloe latex by mouth to patients with ileus, acute surgical abdomen, bowel obstruction, fecal impaction, or appendicitis.
  • Avoid using aloe on the skin for wound healing due to a lack of effect.
  • Avoid Aloe vera injections, which have been associated with cases of death under unclear circumstances.
  • Aloe may cause ammonium acid urate stones; delayed wound healing; dry skin; excessive bleeding (one case); gastrointestinal distress (abdominal cramping and diarrhea); Henoch-Schonlein purpura; hepatitis; increased risk of colon cancer, low potassium, worsened constipation and/or dependency on laxatives (with long-term use); irregular heartbeat; itchiness; muscle weakness; photodermatitis; skin changes (redness, stinging, hardness, soreness, and fissures); or thyroid dysfunction.
  • Although use of aloe on the skin is unlikely to be harmful during pregnancy or breastfeeding, taking aloe by mouth is not recommended due to theoretical stimulation of uterine contractions. The dried juice of aloe leaves should not be consumed by breastfeeding mothers.
  • Avoid with known allergy or hypersensitivity to Aloe vera, its constituents, or plants of the Liliaceae family (such as garlic, onions, and tulips). Prolonged use of aloe gel on the skin may cause hives, dermatitis, and red eyelids.

Pregnancy and Breastfeeding

  • Although use of aloe on the skin is unlikely to be harmful during pregnancy or breastfeeding, taking aloe by mouth is not recommended due to theoretical stimulation of uterine contractions. It is not known whether active ingredients of aloe may be present in breast milk. The dried juice of aloe leaves should not be consumed by breastfeeding mothers.

Interactions

Interactions with Drugs

  • Aloe taken by mouth may lower blood sugar levels. Caution is advised when taken with medications that may also lower blood sugar, including insulin preparations or glibenclamide. Patients taking drugs for diabetes by mouth or injection should be monitored closely by a qualified healthcare professional. Medication adjustments may be necessary.
  • Because aloe contains estrogen-like chemicals, the effects of other agents believed to have estrogen-like properties may be altered.
  • Aloe may also interact with absorption of foods and agents taken by mouth, antiarrhythmic agents (including cardiac glycosides), anticancer drugs, antifungals, anti-inflammatories, antivirals, corticosteroids taken by mouth, gastrointestinal drugs, hormonal agents, hydrocortisone (taken by mouth or applied to the skin), laxatives, non-potassium-sparing diuretics (loop, thiazide), radioprotective drugs, sevoflurane, steroids, sunscreen, thyroid hormones, water-soluble drugs, or zidovudine (AZT).

Interactions with Herbs and Dietary Supplements

  • Aloe may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.
  • Because aloe contains estrogen-like chemicals, the effects of other agents believed to have estrogen-like properties may be altered.
  • Aloe may interact with absorption of foods and orally administered agents, anticancer agents, antifungals, anti-inflammatories, antioxidants, antivirals, cardiovascular agents, contraceptives, dermatologic agents, diuretics, gastrointestinal agents, hormonal agents, laxatives, licorice root (Glycyrrhiza glabra L.), radioprotective agents, steroids, sunscreen, thyroid agents, vitamins C and E, or water-soluble agents.

Attribution
  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. Dal'Belo SE, Gaspar LR, Maia Campos PM. Moisturizing effect of cosmetic formulations containing extract in different concentrations assessed by skin bioengineering techniques. Skin Res Technol 2006;12(4):241-6.
  2. de Oliveira SM, Torres TC, Pereira SL, et al. Effect of a dentifrice containing on plaque and gingivitis control. A double-blind clinical study in humans. J Appl Oral Sci 2008;16(4):293-296.
  3. Ernst E, Pittler MH, Stevinson C. Complementary/alternative medicine in dermatology: evidence-assessed efficacy of two diseases and two treatments. Am J Clin Dermatol 2002;3(5):341-348.
  4. Feily A, Namazi MR. in dermatology: a brief review. G Ital Dermatol Venereol 2009;144(1):85-91.
  5. Heggie S, Bryant GP, Tripcony L, et al. Phase III study on the efficacy of topical gel on irradiated breast tissue. Cancer Nurs 2002;25(6):442-451.
  6. Kim EJ, Kim HJ, Kim SG, et al. Aloe-induced Henoch-Schonlein purpura. Nephrology (Carlton). 2007;12(1):109.
  7. Langmead L, Feakins RM, Goldthorpe S, et al. Randomized, double-blind, placebo-controlled trial of oral gel for active ulcerative colitis. Aliment Pharmacol Ther 2004;19(7):739-747.
  8. Lee A, Chui PT, Aun CS, et al. Possible interaction between sevoflurane and . Ann Pharmacother 2004;38(10):1651-1654.
  9. Merchant TE, Bosley C, Smith J, et al. A phase III trial comparing an anionic phospholipid-based cream and aloe vera-based gel in the prevention of radiation dermatitis in pediatric patients. Radiat Oncol 2007;2:45.
  10. Paulsen E, Korsholm L, Brandrup FA. A double-blind, placebo-controlled study of a commercial gel in the treatment of slight to moderate psoriasis vulgaris. J Eur Acad. Dermatol Venereol 2005;19(3):326-331.
  11. Rabe C, Musch A, Schirmacher P, et al. Acute hepatitis induced by an preparation: a case report. World J Gastroenterol 2005;11(2):303-304.
  12. Rajar UD, Majeed R, Parveen N, et al. Efficacy of aloe vera gel in the treatment of vulval lichen planus. J Coll.Physicians Surg.Pak. 2008;18(10):612-614.
  13. Reuter J, Jocher A, Stump J, et al. Investigation of the anti-inflammatory potential of gel (97.5%) in the ultraviolet erythema test. Skin Pharmacol Physiol 2008;21(2):106-110.
  14. Richardson J, Smith JE, McIntyre M, et al. for preventing radiation-induced skin reactions: a systematic literature review. Clin Oncol (R Coll Radiol ) 2005;17(6):478-484.
  15. Su CK, Mehta V, Ravikumar L, et al. Phase II double-blind randomized study comparing oral versus placebo to prevent radiation-related mucositis in patients with head-and-neck neoplasms. Int J Radiat Oncol Biol Phys 2004;60(1):171-177.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.


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