Aloe (Aloe vera)
Contents of this page:
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- Background
- Synonyms
- Evidence
- Dosing
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- Safety
- Interactions
- Methodology
- Selected references
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Aloe |
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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 laboratory, animal, and human studies that
topical aloe gel has immunomodulatory properties that may improve
wound healing and skin inflammation.
Synonyms
- Acemannan, Aloe africana ,
Aloe arborescens Miller, Aloe barbadensis ,
Aloe barbadesis , Aloe capensis , aloe-coated gloves,
Aloe ferox , aloe latex, aloe mucilage, Aloe perfoliata ,
Aloe perryi Baker, Aloe saponaria , Aloe
spicata , Aloe vulgari , Barbados aloe, bitter aloe,
burn plant, Cape aloe, Carrisyn, Curaçao aloe, elephant's gall,
first-aid plant, Ghai kunwar, Ghikumar, hirukattali, 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 |
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.
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B |
| Genital herpes
Limited evidence from
human studies suggests that extract from Aloe vera in a
hydrophilic cream may be an effective treatment of genital
herpes in men (better than aloe gel or placebo). Additional
research is needed in this area before a strong recommendation
can be made.
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B |
| Psoriasis vulgaris
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 strong recommendation
can be made.
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B |
| Seborrheic dermatitis (seborrhea, dandruff)
Early study of aloe
lotion suggests effectiveness for treating seborrheic dermatitis
when applied to the skin. Further study is needed in this area
before a strong recommendation can be made.
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B |
| Cancer prevention
There is early
evidence 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 |
| Canker sores (aphthous stomatitis)
There is weak evidence
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
firm recommendation can be made.
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C |
| Diabetes (type 2)
Study results are
mixed. More research is needed to explore the effectiveness and
safety of aloe in diabetics.
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C |
| Dry skin
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.
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C |
| HIV infection
Without further human
trials, the evidence cannot be considered convincing either in
favor or against this use of aloe.
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C |
| Lichen planus
Limited study suggests
that aloe may be a helpful, safe treatment for lichen planus,
which is a chronic inflammatory disease that affects the lining
of the mouth. Additional study is needed.
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C |
| Skin burns
Early evidence
suggests that aloe may aid healing of mild to moderate skin
burns. Further study is needed in this area.
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C |
| Skin ulcers
Early studies suggest
aloe may help heal skin ulcers. High-quality studies comparing
aloe alone with placebo are needed.
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C |
| Ulcerative colitis (including inflammatory bowel
disease)
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.
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C |
| Wound healing
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 study is needed, since wound healing is a
popular use of topical aloe.
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C |
| Mucositis
There is early
evidence that oral aloe vera does not prevent or improve
mucositis (mouth sores) associated with radiation therapy.
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D |
| Pressure ulcers
Early well-designed
studies in humans found no benefit of topical acemannan hydrogel
(a component of aloe gel) in the treatment of pressure ulcers.
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D |
| 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 skin irritation caused by
prolonged exposure to radiation, although scientific evidence
suggests a lack of benefit in this area.
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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;
F: Strong scientific evidence against this use.
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, antifungal, antimicrobial, antioxidant, antitumor, antiviral,
arthritis (osteoarthritis, rheumatoid arthritis), asthma, bacterial skin
infections, birth control, blood vessel disorders, bowel disorders,
chronic fatigue syndrome, congestive heart failure, frostbite,
gingivitis, hair loss, heart disease prevention, hepatitis, high
cholesterol, human papilloma virus (HPV), itchiness (skin), kidney or
bladder stones, leukemia, lichen planus (a skin condition), parasitic
worm infections, Parkinson's disease, periodontal surgical rinse,
scratches or superficial wounds of the eye, stomach acid reduction,
sunburn, systemic lupus erythematosus (SLE), tic douloureux (trigeminal
neuralgia, severe facial pain), untreatable tumors, vaginal
contraceptive, 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.
Adults (18 years and older)
- Pure Aloe vera gel
is often used liberally on the skin three to four times per day for
the treatment of sunburn and other minor burns. Creams and lotions
are also available. 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.
- The dose often recommended
for constipation is the minimum amount to maintain a soft stool,
typically 0.04-0.17 gram of dried juice (corresponds to 10-30
milligrams hydroxyanthraquinones) by mouth. As an alternative, in
combination with celandine (300 milligrams) and psyllium (50
milligrams), 150 milligrams of the dried juice per day of aloe has
been found effective as a laxative in research.
- Cases of death have been
associated with Aloe vera injections under unclear
circumstances. Injected use is not recommended due to a lack of
safety data.
- Other uses of aloe from
scientific studies include the treatment of genital herpes (cream
applied to lesions for five consecutive days per week for up to two
weeks) and psoriasis (cream applied to skin three times per day for
five consecutive days per week for up to four weeks).
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
- 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. Aloe injections have caused severe reactions
and should be avoided.
Side Effects and Warnings
- The use of aloe on surgical
wounds has been reported to slow healing; redness and burning has
been reported 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. There is a report of hepatitis
(liver inflammation) with the use of oral 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 professionals should watch for changes in potassium and
other electrolytes in individuals who take aloe by mouth for more
than a few days.
- 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. People with thyroid disorders, kidney disease, heart
disease, or electrolyte abnormalities should also use oral aloe only
under medical supervision.
- 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.
Interactions
Most herbs and supplements have not been
thoroughly tested for interactions with other herbs, supplements, drugs,
or foods. The interactions listed below are based on reports in
scientific publications, laboratory experiments, or traditional use. 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.
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. Patients taking drugs for diabetes
by mouth or injection should be monitored closely by a qualified
healthcare professional. Medication adjustments may be necessary. In
addition, insulin may add to the decrease in blood potassium levels
that can occur with aloe.
- Due to the lowering of
potassium levels that may occur when aloe is taken by mouth, the
effectiveness of heart medications such as digoxin and digitoxin,
and of other medications used for heart rhythm disturbances, may be
reduced. The risk of adverse effects may be increased with these
medications due to low potassium levels.
- Caution should be used in
patients taking loop diuretics, such as Lasix® (furosemide), or
thiazide diuretics, such as hydrochlorothiazide (HCTZ), that
increase the elimination of both fluid and potassium in the urine.
Combined use may increase the risk of potassium depletion and of
dehydration.
- Use of aloe with laxative
drugs may increase the risk of dehydration, potassium depletion,
electrolyte imbalance, and changes in blood pH. Due to its laxative
effect, aloe may also reduce the absorption of some drugs.
- Application of aloe to skin
may increase the absorption of steroid creams such as
hydrocortisone. In addition, oral use of aloe and steroids such as
prednisone may increase the risk of potassium depletion.
- There is one report of excess
bleeding in a patient undergoing surgery receiving the anesthetic
drug sevoflurane, who was also taking aloe by mouth. It is not clear
that aloe or this specific interaction was the cause of bleeding.
- Preliminary reports suggest
that levels of AZT, a drug prescribed in HIV infection, may be
increased by intake of aloe.
- Drugs used for cancer and for
hormone activity (hormone replacement therapy, birth control pills)
may also interact with aloe.
Interactions with Herbs and Dietary Supplements
- Based on the laxative
properties of oral aloe, prolonged use may result in potassium
depletion. Aloe may increase the potassium-lowering effects of other
herbs such as licorice ( Glycyrrhiza glabra ). Theoretically,
use of oral aloe and other laxative herbs such as senna may increase
the risk of dehydration, potassium depletion, electrolyte imbalance,
and changes in blood pH.
- Oral aloe can reduce blood
sugar. Caution is advised when using herbs or supplements such as
bitter melon that may also lower blood sugar. Blood glucose levels
may require monitoring, and doses may need adjustment.
- Herbs and supplements used
for cancer or the heart may interact with aloe. Phytoestrogens such
as soy, as well as antivirals may also interact with aloe. Aloe may
increase the absorption of vitamin C and vitamin E.
Methodology
- This information is based on
a professional level monograph edited and peer-reviewed by
contributors to the Natural Standard Research Collaboration
(www.naturalstandard.com).
Selected references
- 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.
- 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.
- 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.
- Kim EJ, Kim HJ, Kim SG, et al. Aloe-induced
Henoch-Schonlein purpura. Nephrology (Carlton). 2007;12(1):109.
- 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.
4-1-2004;19(7):739-747.
- Lee A, Chui PT, Aun CS, et al. Possible
interaction between sevoflurane and Aloe vera. Ann Pharmacother.
2004;38(10):1651-1654.
- 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.
- Natural Standard Research Collaboration, Chief
Editors: Ulbricht C, Basch E, Natural Standard Herb and Supplement
Reference - Evidence-Based Clinical Reviews, USA: Elsevier/Mosby,
2005.
- Rabe C, Musch A, Schirmacher P, et al. Acute
hepatitis induced by an Aloe vera preparation: a case report. World
J Gastroenterol. 1-14-2005;11(2):303-304.
- Schmidt JM, Greenspoon JS. Aloe vera dermal
wound gel is associated with a delay in wound healing. Obstetrics &
Gynecology 1991;78(1):115-117.
- 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.
9-1-2004;60(1):171-177.
- 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. Journal of the European Academy of
Dermatology & Venerology 1996;7(3):294-295.
- 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.
- 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.
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