Aloe vera

Synonyms

Aloe africanaAloe arborescens Miller, Aloe barbadensis Lam.Aloe capensis, Aloe feroxAloe perfoliata, Aloe perryi Baker, Aloe saponaria, Aloe spicata, Aloe vulgari.

Vernacular Names:

Malaysia

Lidah Buaya, Jadam.

English

Barbados Aloe, Bitter Aloe, Burn Plant, Cape Aloe, Elephant's Gall, First-aid Plant, Jelly Leek Lily of the Desert, Medicine Plant, Mediterranean Aloe, Miracle Plant, Plant of Immortality, Plant of Life, True Aloe, Venezuela Aloe, Aloe Latex, Aloe Mucilage, Mocha Aloes, Zanzibar Aloe.

Chinese

Lu-Hui, Hsiang-Dan

Others

Carrisyn, Hirukattali, Curaçao Aloe, Ghai Kunwar, Ghikumar, Kumari, Lahoi, Laloi, Musabbar, Natal Aloes, Nohwa, Rokai, Sabilla, Savila, Socotrine Aloe, Subr, Za'bila.

General Information

Description

Aloe vera is a species of Aloe which is native to northern Africa. It is a very short-stemmed or stemless succulent plant growing to 80-100cm tall, spreading by offsets and root sprouts. The leaves are lanceolate, thick and fleshy, green to grey-green, with a serrated margin. The flowers are produced on a spike up to 90 cm tall, with a yellow tubular corolla 2-3cm long with each flower pendulous.

Plant Part Used

The gel is the part of the aloe plant used most commonly, both topically and orally. Aloe latex (also known as drug aloe) contains anthraquinone glycosides, constituents that have strong laxative effects, so it is rarely found in commercial laxative products.

Chemical Constituents

From the gel:

  • Polysaccharides: glucomannan and acemannan (the USAN-accepted name for long-chain polydispersed beta (1,4) -acetylated polymannose with interspersed 0-acetyl groups with a mannose monomer/acetyl ratio of approximately 1:1)
  • Other: Carboxypeptidase, magnesium, zinc, calcium, glucose, cholesterol, salicylic acid
  • Prostaglandin precursors (gamma-linolenic acid), vitamins A, C, E, lignins, saponins, plant sterols and amino acids
  • Most abundant constituent is water (99%)

From the latex leaf lining:

  • Anthraquinone glycosides: aloin, aloe-emodin, barbaloin (15% -30%)
  • C-glycosides and resins

Traditional Use:

Alopecia (hair loss), antimicrobial, arthritis, asthma, bacterial skin infections, bowel disorders, chronic fatigue syndrome, chronic leg wounds, congestive heart failure, damaged blood vessels, elevated cholesterol or other lipids, frostbite, heart disease prevention, hepatitis, inflammatory bowel disease (IBS), kidney or bladder stones, leukemia, lichen planus stomach ulcers, Merkel cell carcinoma, parasitic worm infections, protection against some chemotherapy side effects, scratches or superficial wounds of the eye, systemic lupus erythematosus (SLE), tumors, vaginal contraceptive, yeast infections of the skin.

Many of these traditional uses have not been scientifically tested, however, these indications have been used by traditional herbalists for hundreds if not thousands of years. Aloe vera may be of limited effectiveness in some of the above conditions, if prescribed on its own. However, herbalists rarely prescribe herbal treatments which consist only of one herb.

Pre-Clinical Data

Pharmacology

Pharmacology and Human Studies:

Burns

Aloe gel, made from the central part of the aloe leaf, is a common household remedy for minor cuts and burns as well as sunburns. It can be found in many commercial skin lotions and cosmetics. Aloe contains active compounds that stop pain and inflammation and stimulate skin growth and repair. For this reason, Aloe vera gel has gained tremendous popularity for relief of burns, with individual success in helping minor burns. In fact, preliminary research, in both animals and people, suggests that this folkloric use has some scientific validity. These results seem encouraging, but studies comparing aloe gel with standard medication may help determine whether the herb is as effective for the treatment of burns as more customary therapies [1].

While scientific research is slow to acknowledge the fact that Aloe vera gel is very soothing to burned skin and does promote healing, it should be remembered that depending on the severity of the burn, Aloe vera gel is often combined with Lavender oil and/or other essential oils and herbs (eg. Echinacea, Burdock, etc.) to promote the healing effect as well as offer protection of the burned skin from microbial attack [2] [3].

Herpes and Skin Conditions

Preliminary evidence also suggests that aloe gel may improve symptoms of genital herpes and certain skin conditions such as psoriasis [4] [5].

Limited evidence from human studies suggests that 0.5% extract from Aloe vera in a hydrophilic cream may be an effective treatment of genital herpes in men (better than aloe gel or placebo) [4].

Psoriasis vulgaris

Evidence from one human trial suggests that 0.5% extract from aloe in a hydrophilic cream is an effective treatment of psoriasis vulgaris [6]. However, the effect of a commercial Aloe vera gel on stable plaque psoriasis was modest and not better than placebo on a double-blind, placebo-controlled study done by Paulsen et al. [5].

Constipation

Aloe vera gel is often confused with another part of the aloe plant known as aloe juice, but the two substances are quite different. Aloe juice (also known as aloe latex or aloe sap) is a yellow, bitter liquid derived from the outer layer of the aloe leaf. It contains substances that, when taken by mouth, have very strong laxative effects. For example, in a study of 35 men and women with constipation, those who received capsules containing aloe latex, and other laxatives including psyllium (a natural substance high in fiber) experienced softer and more frequent stools compared to those who received placebo [6].

Dried latex from the inner lining of aloe leaves has been used traditionally as an orally taken laxative. Although few studies have been conducted to assess this effect of aloe in humans, the laxative properties of aloe components such as aloin are well supported by scientific evidence. A combination herbal remedy containing aloe was found to be an effective laxative, although it is not clear if this effect was due to aloe or to other ingredients in the product [1].

Diabetes

Preliminary studies suggest that aloe juice may help lower blood sugar levels in people with type 2 (adult onset) diabetes. Although further studies are need to fully assess the safety and effectiveness of aloe in the treatment of diabetes, it seems possible that the herb may prove to be a useful addition to the diet, exercise, and medication program for type 2 diabetics [7].

Laboratory studies show that aloe can stimulate insulin release from the pancreas and can lower blood glucose levels in mice. Results from two poorly conducted human trials suggest that oral aloe gel may be effective in lowering blood glucose levels, although a third, smaller study found no effect. More research is needed to explore the effectiveness and safety of aloe in diabetics [1].

Aloe vera gel and phytosterols derived from Aloe vera gel are suggested to have a long-term blood glucose level control effect and would be useful for the treatment of type 2 diabetes mellitus [8].

HIV infection

Acemannan, a component of aloe gel, has been shown in laboratory tests to have immune-stimulating and anti-viral activities. Results from early human studies are mixed, and due to weaknesses in the way these studies were designed, firm conclusions are not possible. Without further human trials, the evidence cannot be considered convincing either in favor or against this use of aloe [9].

Cancer prevention

Aloe-emodin (AE), a hydroxyanthraquinone present in Aloe vera leaves, has a specific in vitro and in vivo antineuroectodermal tumor activity [10].

Canker sores (aphthous stomatitis)

There is weak evidence from one study that treatment of recurrent aphthous ulcers of the mouth with aloe gel may reduce pain and increase the amount of time between the appearances of new ulcers [11].

Ulcerative colitis

There is limited but promising research of the use of oral aloe vera in ulcerative colitis, compared to placebo. It is not clear how aloe vera compares to other treatments used for ulcerative colitis [12].

Wound healing

Effects of aloe on wound healing are mixed. Some studies reported positive results while others showed no benefit or potential worsening of the condition [13][2]. In first and second degree burns, the healing process of burnt wound as well as post-skin grafting might be effective using aloe vera since it increases the rate of epithelialisation when compared with conventional treatments [46]. In addition, aloe vera also shows evaporative cooling capacities due to its analgesic properties [47].

Mucositis

There is preliminary evidence from a human trial that oral Aloe vera does not prevent or improve mucositis (mouth sores) associated with radiation therapy [14].

Pressure ulcers

No benefit was found on topical acemannan hydrogel (a component of aloe gel) in the treatment of pressure ulcers [15].

Radiation dermatitis

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 radiation-induced dermatitis, although scientific evidence suggests a lack of benefit in this area [3].

Antioxidant activity

The Aloe vera extract showed significant antioxidant activity which is significantly higher than that of BHT and alpha-tocopherol [16].

Antifungal activity

Aloe Vera fresh leaves showed significant antifungal activity based on fungicidal concentration against fungus growth of Botrytis gladiolorum, Fusarium oxysporum f.sp. gladioli, Heterosporium pruneti and Penicillium gladioli [48].

Antiacne activity

In combination with Ocimum gratissimum oil, the enhancing effect by aloe vera on the anti-acne properties induces synergistic effect which is more effective than the drug 1% Clindamycin in the treatment of Acne Vulgaris [45].

Dosage:

Adults (18 years and older)

Topical (on the skin):

General use: Pure Aloe vera gel is often used liberally on the skin. There are no reports that topical use of aloe causes absorption of chemicals into the body that lead to significant adverse effects. Skin products are available that contain aloe alone or aloe combined with other active ingredients.

Genital herpes: Hydrophilic cream of 0.5% (by weight) of a 50% ethanol extract, combined with liquid paraffin and castor oil, three times daily on lesions for five consecutive days per week, for up to two weeks has been studied [4].

Psoriasis vulgaris: Hydrophilic cream of 0.5% (by weight) of a 50% ethanol extract of aloe, combined with mineral and castor oils, three times daily for five consecutive days per week, for up to four weeks has been studied [5].

Oral (by mouth):

Constipation: The dose often recommended is the minimum amount to maintain a soft stool, typically 0.04-0.17g of dried juice (corresponds to 10-30mg hydroxyanthraquinones). As an alternative, in combination with celandin (300mg) and psyllium (50 mg), 150mg of the dried juice/day of aloe has been found effective as a laxative in research [6].

Diabetes (type 2): Aloe juice (5-15mL) twice daily has been used but safety and efficacy of this dose has not been proven.

HIV infection:  Acemannan (1000mg-1600mg) orally in four equal doses. Effectiveness and safety have not been proven by studies.

Children (younger than 18 years)

Topical (on the skin):

Topical use of aloe gel in children is common and appears to be well tolerated.

Toxicities

Ingestion of Aloe vera is associated with diarrhea, electrolyte imbalance, kidney dysfunction, and episodes of contact dermatitis, erythema, and phototoxicity have been reported from topical applications [17].

The anthraquinones aloe-emodin, emodin and rhein were found to be phototoxic in vitro. The probable mechanism may be through the involvement of singlet oxygen and stable photoproducts [18]. Aloe emodin was also found to generate singlet oxygen when irradiated with UV light and this photochemical mechanism is the most likely pathway responsible for the phototoxicity of Aloe emodin [19].

Animal studies

Acemannan showed no toxicity at 5% of a rat diet for 2 weeks or 2gm/kg to rats for 6 months or 1.5gm/kg to dogs for 3 months [20]. No significant toxicity were found with acemannan at 80mg/kg i.v. or 200mg/kg i.p. in mice, 15mg/kg i.v. or 50mg/kg i.p. in rats, and 10mg/kg i.v. or 50mg/kg i.p. in dogs. Increased macrophages and monocytes were observed (21). The LD50 values in mice vary from less than 250 to more than 1500mg/kg i.p. There was CNS depression in rats. Post mortem findings showed haemorrhagic lesions. Several rats died within 36 hours of injection, but no abortifacient activity was seen [22]. Medium Lethal Concentration (LC50 value of Aloe vera obtained from the brine shrimp larva (Artemia salina L.), was equivalent to the in vivo LD50 value in mice [23]. Aloe vera gel contains toxic low molecular weight compounds, and every effort must be made to limit the amount of these toxins in the commercially prepared Aloe vera gel products [24].

Genotoxicities and Mutagenicity Studies

Aloe-emodin mutagenic effects were observed only in vitro in the chromosome aberration test with Chinese hamster ovary cells and in the Salmonella reverse mutation test (frameshift mutations in strains TA 1537, TA 1538 and TA 98) [25]. Inhibition of the catalytic activity of topoisomerase II contributes to anthraquinone (emodin, danthron, and aloe-emodin) induced genotoxicity and mutagenicity [26].

Aloe vera does not cause adverse dermal toxicity [49].

Clinical Data

Clinical Trials

Wound healing

One non-randomised, un-blinded study assessed wound healing with polyethylene oxide wound gel or polyethylene oxide wound gel saturated with Aloe vera in 17 patients with acne vulgaris. Half-face treatments were carried out so that each patient received both treatments. By day 5, 90% of wounds were healed (complete re-epithelialisation) with Aloe vera compared with 40-50% without Aloe vera. Wound healing was 72 hours faster with Aloe vera [13].

One randomised, un-blinded trial assessed wound healing with standard wound care with or without Aloe vera dermal gel every 8-12 hours in 40 women after gynaecological surgery. All women had complications of wound healing after surgery. Details of the standard treatment were not provided and 50% of the women did not complete the trial. Mean healing time (to completely epithelised wound) was significantly longer with Aloe vera (83 days) than with standard treatment (53 days) [27].

Psoriasis

One randomised, double-blind trial assessed a topical 0.5% hydrophilic Aloe vera cream compared with placebo cream in 60 patients with mild to moderate chronic plaque-type psoriasis over four weeks. Patients were followed-up for 12 months. The rate of cure was significantly better with Aloe vera (83%) than with placebo (7%) with no relapses [4].

Radiation-induced skin injury

Two randomised trials assessed the effects of Aloe vera in women with radiation-induced skin injury associated with treatment for breast cancer. One trial was double -blind (194 patients) and found no significant difference in severity score between topical Aloe vera gel and placebo [28].

The other trial (108 patients) assessed usual care with or without topical Aloe vera gel; there was no significant difference between study treatments [28].

Genital herpes

Two randomised, double-blind trials compared topical Aloe vera cream (0.5% hydrophilic) or placebo three times daily for two weeks in 180 men with a first episode of genital herpes; one also assessed topical Aloe vera gel. Response rates in the two trials were almost identical. The proportions of patients cured in the two trials were 70% and 67% with Aloe vera cream, 45% with Aloe vera gel, and 7.5% and 7.0% with placebo. Aloe vera cream healing times were 4.8 and 4.9 day, 7.0 days with Aloe vera gel, and 14 and 12 days with placebo[5].

Diabetes mellitus

There were 58 controlled clinical trials involving individuals with diabetes or impaired glucose tolerance (42 randomised and 16 non-randomized trials) [7]. Of these 58 trials, the direction of the evidence for improved glucose control was positive in 76% (44 of 58). Very few adverse effects were reported.

Adverse Effects in Human:

The use of aloe on surgical wounds has been reported to slow healing and, in one case, to cause redness and burning after aloe juice was applied to the face after a skin-peeling procedure (dermabrasion). Application of aloe prior to sun exposure may lead to rash in sun-exposed areas [29].

The use of aloe or aloe latex by mouth for laxative effects can cause cramping or diarrhoea. Use for over seven days may cause dependency or worsening of constipation after the aloe is stopped. Ingestion of aloe for over one year has been reported to increase the risk of colorectal cancer. Individuals with severe abdominal pain, appendicitis, ileus (temporary paralysis of the bowel), or a prolonged period without bowel movements should not take aloe. There is a report of hepatitis (liver inflammation) with the use of oral aloe [30].

Electrolyte imbalances in the blood, including low potassium levels, may be caused by the laxative effect of aloe. This effect may be greater in people with diabetes or kidney disease. Low potassium levels can lead to abnormal heart rhythms or muscle weakness. People with heart disease, kidney disease, or electrolyte abnormalities should not take aloe by mouth. Healthcare professionals should monitor for changes in potassium and other electrolytes in individuals who take aloe by mouth for more than a few days.

Based on a small number of human studies, aloe taken by mouth may lower blood sugar levels. Caution is advised in patients with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Serum glucose levels may need to be monitored by a healthcare professional, and medication adjustments may be necessary.

Use in Certain Conditions:

Pregnancy / Breastfeeding

Although topical use of aloe is unlikely to be harmful during pregnancy or breastfeeding, oral use is not recommended due to theoretical stimulation of uterine contractions that can trigger miscarriage. 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. Nursing mothers should not take aloe latex either because the effects and safety for infants and children are not known [31].

Age Limitations

Neonates/Adolescents

Aloe taken orally should not be prescribed to children under 12 years of age. Caution is advised in patients with diabetes or hypoglycemia or kidney disease. However, topical use is common and tolerated.

Geriatrics

Caution is advised in patients with diabetes or hypoglycemia or kidney disease.

Interactions

Interactions with drugs

Aloe appeared to interact with the general anesthetic sevoflurane [32]. A preliminary study involving 18 people found that aloe vera increased the absorption of vitamins C and E [33]. Aloe latex will decrease the effectiveness of any medication taken at the same time, as it is a laxative, and will cause any ingested medication to move through the digestive system too quickly to be effective.

Anti-diabetic Medications

The combination of aloe vera and glyburide, a medication used to treat type 2 diabetes, may help control blood sugar and triglyceride (fat) levels in the blood [34][35]. People with diabetes who use aloe latex either alone or in combination with other medications must be monitored closely by health care providers to avoid potential complications from low blood sugar levels.

Anticancer Medications

Taken together, the herbal anthraquinone aloe-emodin can downregulate the anticancer activity of cisplatin by blocking the activation of ERK in tumor cells [36].

Hydrocortisone

Aloe gel may enhance the ability of hydrocortisone to reduce swelling [37].

Digoxin and Diuretics

Because oral aloe can decrease levels of potassium, aloe latex should not be used by individuals taking diuretics or digoxin (a medication used to treat irregular heart rhythms and congestive heart failure). These medications lower potassium levels in the body, so a combination of aloe and digoxin or diuretics can result in dangerously low levels of this important mineral [1].

Interactions with Other Herbs / Herbal Constituents

Low levels of potassium (due to oral aloe) could interfere with cardiac glycosides as well as affect other antiarrhythmic agents. Potassium deficiency can be exacerbated by simultaneous applications of thiazide diuretics, cortico-adrenal steroids or licorice root [38].

Contraindications

Contraindications

People with known allergy to garlic, onions, tulips, or other plants of the Liliaceae family may have allergic reactions to aloe [1].

Aloe is contraindicated (in individuals with) hemorrhoids, heart conditions, and kidney disorders. Likely unsafe for use during pregnancy because aloe can induce abortions and stimulate menstruation. Aloe is contraindicated when menstruating, due to possible stimulation of endometrial activity [43].

Aloe latex should not be taken internally if the following drugs are also taken: digoxin (Lanoxin), diuretics, steroids, drugs for irregular heartbeat, and drugs that cause potassium loss [39].

Aloe taken orally may cause blood sugar levels to become too low, especially if combined with blood sugar medications [1].

Case Reports

A 39-year-old liver transplant patient who took a laxative containing aloe for ten months, developed melanosis coli. One year after stopping the anthranoid, the pigments disappeared but a polypoid lesion appeared [40]. A 47-year-old South African, developed acute oliguric renal failure and liver dysfunction after ingestion of an herbal remedy, found by mass spectrometric and chromatographic analysis, to contain Cape aloes [41].

A review of a total of 108 trials examining 36 herbs and 9 vitamin/mineral supplements, involving 4,565 patients with diabetes revealed that these herbs are generally safe and plants like Aloe vera have positive preliminary results [7]. Data on atopic dermatitis and chronic venous insufficiency treated with Aloe vera gel and tea tree oil indicated that there is no compelling evidence for their effectiveness as reviewed from the various clinical studies [42]. Including Aloe vera, 45 plants and their products (active, natural principles and crude extracts) that have been used in the Indian traditional system of medicine have shown experimental or clinical evidence of anti-diabetic activity [43]. Beneficial aspects of medicinal plants on skin include: healing of wounds and burn injuries (especially Aloe vera) [44]. A new bioadhesive patch of Aloe vera hydrogel, tried for aphthous stomatitis, was found effective in more than 80% of cases with 90% compliance in adhesivity, acceptability and palatability of the formulation [11].

35% of patients with Irritable Bowel Syndrome showed response to treatment compared to placebo group of 22% showing treatment in one month duration [50].

Read More

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References

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  45. L. O. Orafidiya, E. O. Agbani, A. O. Oyedele, O. O. Babalola, O. Onayemi, F. F. Aiyedun. The effect of aloe vera gel on the anti-acne properties of the essential oil of Ocimum gratissimum Linn leaf – a preliminary clinical investigation. International Journal of Aromatherapy. 2004;1(14):15-21
  46. M. Ratree, C. Nathorn, N. Surachet, K. Chuenjid. The efficacy of aloe vera used for burn wound healing: A systematic review. Burns. 2007;6(33):713-718
  47. Leila Cuttle, Margit Kempf, Olena Kravchuk, Narelle George, Pei-Yun Liu, Hong-En Chang, Julie Mill, Xue-Qing Wang, Roy M. Kimble. The efficacy of Aloe vera, tea tree oil and saliva as first aid treatment for partial thickness burn injuries. Burns. 2008;8(34):1176-1182
  48. Oana Rosca-Casian, Marcel Parvu, Laurian Vlase, Mircea Tamas. Antifungal activity of Aloe vera leaves. Fitoterapia. 2007;3(78):219-222
  49. Abdolhossein Moghbel, Aliasghar Hematti, Abdolazim Ghalambor, Zahra Nazari Khorsgani, Homayoun Agheli, Shahram Allipanah. Wound healing and toxicity evaluation of Aloe Vera cream. Toxicology Letters. 2007;1(172):S233
  50. Davis K, Philpott S, Kumar D, Mendall M. Randomised double-blind placebo-controlled trial of aloe vera for irritable bowel syndrome. St Georges Hospital Medical School, London, UK.

 

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1. The effect of aloe vera gel on the anti-acne properties of the essential oil of Ocimum gratissimum Linn leaf – a preliminary clinical investigation

International Journal of Aromatherapy, Volume 14, Issue 1, 2004, Pages 15-21

L. O. Orafidiya, E. O. Agbani, A. O. Oyedele, O. O. Babalola, O. Onayemi, F. F. Aiyedun

 

2. The efficacy of aloe vera used for burn wound healing: A systematic review

    Burns, Volume 33, Issue 6, September 2007, Pages 713-718

    Ratree Maenthaisong, Nathorn Chaiyakunapruk, Surachet Niruntraporn, Chuenjid Kongkaew

 

3. The efficacy of Aloe vera, tea tree oil and saliva as first aid treatment for partial thickness burn injuries

    Burns, Volume 34, Issue 8, December 2008, Pages 1176-1182

    Leila Cuttle, Margit Kempf, Olena Kravchuk, Narelle George, Pei-Yun Liu, Hong-En Chang, Julie Mill, Xue-Qing Wang, Roy M. Kimble

 

4. Antifungal activity of Aloe vera leaves

    Fitoterapia, Volume 78, Issue 3, April 2007, Pages 219-222

    Oana Rosca-Casian, Marcel Parvu, Laurian Vlase, Mircea Tamas

 

5. Wound healing and toxicity evaluation of Aloe Vera cream

    Toxicology Letters, Volume 172, Supplement 1, 7 October 2007, Page S233

    Abdolhossein Moghbel, Aliasghar Hematti, Abdolazim Ghalambor, Zahra Nazari Khorsgani, Homayoun Agheli, Shahram Allipanah

 

6. Randomised double-blind placebo-controlled trial of aloe vera for irritable bowel syndrome.

    St Georges Hospital Medical School, London, UK.

    Davis K, Philpott S, Kumar D, Mendall M.