Aloe (Aloe vera)

• Background
• Related terms
• Evidence
• Dosing
• Safety
• Methodology
• Selected references

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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 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.

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.

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.

Grading rationale

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.

Alzheimer's disease, anthelmintic, antifungal, antioxidant, antitumor, antiviral, arthritis (osteoarthritis, rheumatoid arthritis), asthma, bacterial skin infections, cancer, Candidal skin infections, chemoprotectant, chronic fatigue syndrome, congestive heart failure, corneal abrasions/ulcers, coronary artery disease prevention, diabetic ulcers, duodenal ulcer, frostbite, functional bowel disorders, gastric ulcer, gingivitis, hair loss, hemorrhoids, helminthic infections, hepatitis, human papilloma virus, hyperlipidemia, itchiness, leukemia, parasites, Parkinson's disease, peptic ulcer, periodontal surgical rinse, radioprotection, skin conditions, skin inflammation, stomach acid reduction, stomach ulcers, systemic lupus erythematosus, tic douloureux, untreatable advanced solid neoplasms, urolithiasis (bladder stones), uterine stimulant, vaginal contraceptive.

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.

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 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.

Methodology

This patient information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Monograph methodology

Selected references

1. Dal'Belo SE, Gaspar LR, Maia Campos PM. Moisturizing effect of cosmetic formulations containing Aloe vera 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 Aloe vera 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. Aloe vera 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 Aloe vera 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 Aloe vera 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 Aloe vera . 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 Aloe vera 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 Aloe vera 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 Aloe vera 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. Aloe vera 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 Aloe vera 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.

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