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Aloe (Aloe vera)


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Aloe (Aloe vera)

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 anthroquinone glycosides (found in aloe latex). However, aloe's therapeutic value compared with other approaches to constipation remains unclear.

There is promising preliminary support from in vitro, animal, and human studies that topical aloe gel has immunomodulatory properties which may improve wound healing and skin inflammation.

Synonyms

Acemannan, Aloe africana, Aloe arborescens Miller, Aloe barbadesis, Aloe capensis, Aloe ferox, aloe latex, aloe mucilage, Aloe perfoliata, Aloe perryi baker, Aloe spicata, Aloe vulgari, Barbados aloe, bitter aloe, Burn Plant, Cape Aloe, Carrisyn, hirukattali, Curaçao aloe, elephant's gall, First-Aid Plant, Ghai kunwar, Ghikumar, Hsiang-Dan, 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, Savila, Socotrine aloe, subr, True Aloe, Venezuela Aloe, Za'bila, Zanzibar Aloe.

Evidence

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.

Uses based on scientific evidence 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* Constipation (laxative) Dried latex from the inner lining of aloe leaves has been used traditionally as a laxative taken by mouth. 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. Further study is needed to establish dosing and to compare the effectiveness and safety of aloe with other commonly used laxatives. A Seborrheic dermatitis (seborrhea, dandruff) One study using 30% aloe lotion suggests effectiveness for treating seborrheic dermatitis when applied to the skin twice daily for 4-6 weeks. Further study is needed in this area before a strong recommendation can be made. B 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. However, there may have been problems with the way this study was conducted. Additional research is needed in this area before a strong recommendation can be made. B Genital herpes 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). Although seemingly well designed, there may have been problems with the way these studies were conducted. Additional research is needed in this area before a strong recommendation can be made. B Skin burns Preliminary evidence suggests that aloe may be effective in promoting healing of mild to moderate skin burns. However, the existing studies are small and poor in quality, and therefore no clear conclusion can be drawn. Further study is needed in this area. C 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 is lacking. Results from two human studies are inconclusive. C Canker sores (aphthous stomatitis) There is weak evidence from two studies that treatment of recurrent aphthous ulcers of the mouth with aloe gel may reduce pain and increase the amount of time between the appearance of new ulcers. Further study is needed before a recommendation can be made. C Diabetes (type 2) 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. C 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. C Cancer prevention There is preliminary evidence from a small case-control study that oral aloe may reduce the risk of developing lung cancer. Further study is needed in this area to clarify if it is aloe itself or other factors that may cause this benefit. C Pressure ulcers One well-designed human trial found no benefit of topical acemannan hydrogel (a component of aloe gel) in the treatment of pressure ulcers. D Infected surgical wounds In one study, application of aloe gel to surgical wounds after abdominal surgery was found to prolong wound-healing time. Further study is needed, since wound healing is a popular use of topical aloe. Aloe cannot be recommended for application to infected surgical wounds at this time. 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 against this use (it may not work);

F : Strong scientific evidence against this use (it likely does not work).

Uses based on tradition or theory The below uses are based on tradition or scientific theories. 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. Alopecia (hair loss), antimicrobial, arthritis, asthma, bacterial skin infections, bowel disorders, chemoprotectant, chronic fatigue syndrome, chronic leg wounds, congestive heart failure, damaged blood vessels, elevated cholesterol or other lipids, frostbite, heart disease prevention, hepatitis, kidney or bladder stones, leukemia, lichen planus stomach ulcers, parasitic worm infections, scratches or superficial wounds of the eye, skin protection during radiation therapy, sunburn, systemic lupus erythematosus, tic douloureux, untreatable tumors, vaginal contraceptive, wound healing after cosmetic dermabrasion, yeast infections of the skin.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels and discuss doses with a qualified healthcare provider before starting therapy.

Standardization

Standardization involves measuring the amount of certain chemicals in products to try to make different preparations similar to each other. It is not always known if the chemicals being measured are the "active" ingredients.

Standardized aloe products are not widely available. Although this is likely not a concern for the use of aloe gel to the skin, it may pose dangers with oral aloe (due to potential lowering of blood sugar levels). Oral aloe preparations often contain 10-30mg hydroxyanthracene derivatives per daily dose, calculated as anhydrous aloin.

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 using aloe on the skin causes absorption of chemicals into the body that may cause significant side effects. Skin products are available that contain aloe alone or aloe combined with other active ingredients.

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.

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.

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 (50mg), 150mg of the dried juice/day of aloe has been found effective as a laxative in research.

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

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

Intravenous/Intramuscular:

Four cases of death have been associated with Aloe vera injections under unclear circumstances. Oral or injected use is not recommended due to lack of safety data.

Children (younger than 18 years)

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

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.

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

People with known allergy to garlic, onions, tulips, or other plants of the Liliaceae family may have allergic reactions to aloe. Individuals using aloe gel for prolonged times have developed allergic reactions including hives and eczema-like rash.

Side Effects and Warnings

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.

The use of aloe or aloe latex by mouth for laxative effects can cause cramping or diarrhea. 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.

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 providers 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 provider, and medication adjustments may be necessary.

Avoid aloe vera injections, which have been associated with cases of death under unclear circumstances.

Pregnancy and Breastfeeding

Although topical (skin) use of aloe is unlikely to be harmful during pregnancy or breastfeeding, oral (by mouth) use 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.

References

    Natural Standard developed the above evidence-based patient information based on a systematic review of more than 250 scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. References about effectiveness are listed below.

    Bosley C, Smith J, Baratti P, et al. A phase III trial comparing an anionic phospholipid-based (APP) cream and aloe vera-based gel in the prevention and treatment of radiation dermatitis. Int J Radiat Oncol Biol Phys 2003;57 (2 Suppl) :S438.

    Choi S, Kim KW, Choi JS, et al. Angiogenic activity of beta-sitosterol in the ischaemia/reperfusion-damaged brain of Mongolian gerbil. Planta Med 2002;68(4):330-335.

    Chung JG, Li YC, Lee YM, et al. Aloe-emodin inhibited N-acetylation and DNA adduct of 2-aminofluorene and arylamine N-acetyltransferase gene expression in mouse leukemia L 1210 cells. Leuk Res 2003;27(9):831-840.

    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.

    Ferro VA, Bradbury F, Cameron P, et al. In vitro susceptibilities of Shigella flexneri and Streptococcus pyogenes to inner gel of Aloe barbadensis Miller. Antimicrob Agents Chemother 2003;47(3):1137-9.

    Furukawa F, Nishikawa A, Chihara T, Shimpo K, Beppu H, Kuzuya H, Lee IS, Hirose M. Chemopreventive effects of Aloe arborescens on N-nitrosobis(2-oxopropyl)amine-induced pancreatic carcinogenesis in hamsters. Cancer Lett 2002;178(2):117-22.

    Grover JK, Yadav S, Vats V. Medicinal plants of India with anti-diabetic potential. J Ethnopharmacol 2002;81(1):81-100.

    Heggie S, Bryant GP, Tripcony L, et al. A Phase III study on the efficacy of topical aloe vera gel on irradiated breast tissue. Cancer Nurs 2002;25(6):442-51.

    Kaufman T, Kalderon N, Ullmann Y, et al. Aloe vera gel hindered wound healing of experimental second-degree burns: a quantitative controlled study. J Burn Care Rehabil 1988;9(2):156-159.

    Montaner JS, Gill J, Singer J, et al. Double-blind placebo-controlled pilot trial of acemannan in advanced human immunodeficiency virus disease. J Acquir Immune Defic Syn Hum Retrovirol 1996;12:153-157.

    Olsen DL, Raub W Jr., Bradley C, et al. The effect of aloe vera gel/mild soap versus mild soap alone in preventing skin reactions in patients undergoing radiation therapy. Oncol Nurs Forum 2001;28(3):543-547.

    Schmidt JM, Greenspoon JS. Aloe vera dermal wound gel is associated with a delay in wound healing. Obstet Gynecol 1991;78(1):115-117.

    Syed TA, Afzal M, Ashfaq AS. Management of genital herpes in men with 0.5% Aloe vera extract in a hydrophilic cream: a placebo-controlled double-blind study. J Derm Treatment 1997;8(2):99-102.

    Syed TA, Ahmad SA, Holt AH, et al. Management of psoriasis with Aloe vera extract in a hydrophilic cream: a placebo-controlled, double-blind study. Trop Med Int Health 1996;1(4):505-509.

    Syed TA, Cheema KM, Ahmad SA, et al. Aloe vera extract 0.5% in hydrophilic cream versus aloe vera gel for the measurement of genital herpes in males: a placebo-controlled, double-blind, comparative study. J Eur Acad Derm Veneriol 1996;7(3):294-295.

    Thomas DR, Goode PS, LaMaster K, et al. Acemannan hydrogel dressing versus saline dressing for pressure ulcers: a randomized, controlled trial. Adv Wound Care 1998;11(6):273-276.

    Vardy AD, Cohen AD, Tchetov T. A double-blind, placebo-controlled trial of Aloe vera ( A. barbadensis ) emulsion in the treatment of seborrheic dermatitis. J Derm Treatment 1999;10(1):7-11.

    Vogler BK, Ernst E. Aloe vera: a systematic review of its clinical effectiveness. Br J Gen Pract 1999;49(447):823-828.

    Williams MS, Burk M, Loprinzi CL, et al. Phase III double-blind evaluation of an Aloe vera gel as a prophylactic agent for radiation-induced skin toxicity. Int J Radiation Oncol Biol Phys 1996;36(2):345-349.

January 01, 2004

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