ALOE VERA
COMMON NAMES
Aloe vera, 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, Curacao 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.
BOTANY
Aloes, of which there are 500 species, belong to the family Liliaceae. The name, meaning "bitter and shiny substance," derives from the Arabic "alloeh." Indigenous to the Cape of Good Hope, these perennial succulents grow throughout most of Africa, southern Arabia and Madagascar, and are cultivated in Japan, North and South America, and in the Caribbean and Mediterranean regions. They do not grow in rain forests or arid deserts. Often attractive ornamental plants, their fleshy leaves are stiff and spiny along the edges and grow in a rosette. Each plant has 15 to 30 tapering leaves, each up to 0.5 meters long and 8 to 10 cm wide. Beneath the thick cuticle of the epidermis lies the chlorenchyma. Between this layer and the colorless mucilaginous pulp containing the aloe gel are numerous vascular bundles and inner bundle sheath cells, from which a bitter yellow sap exudes when the leaves are cut.
HISTORY
Drawings of aloe have been found in the wall carvings of Egyptian temples erected in the fourth millennium BC. Called the "Plant of Immortality," it was a traditional funerary gift for the pharaohs. The Egyptian Book of Remedies (ca. 1500 BC) notes the use of aloe in curing infections, treating the skin, and preparing drugs that were chiefly used as laxatives. The Bible (John 19:39-40) says that Nicodemus brought a mixture of myrrh and aloes for the preparation of Christ's body. Alexander is said to have conquered the island of Socotra to obtain control of it. The Greek physician Dioscorides, in 74 AD, recorded its use to heal wounds, stop hair loss, treat genital ulcers, and eliminate hemorrhoids. In the 6th century AD, Arab traders carried it to Asia. From the Mediterranean region, it was carried to the New World in the 16th century by the Spaniards. In the modern era, its clinical use began in the 1930s as a treatment for roentgen dermatitis.
USAGE
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.
Constipation (laxative)
There is a strong scientific evidence for this use.
Dried Aloe latex from the inner lining of aloe leaves has been used traditionally as a potent laxative taken by mouth. A combination herbal remedy containing aloe was found to be an effective laxative, the aloinosides exert strong purgative effects by irritating the large intestine. Only the dried latex is approved for internal use as a cathartic. In some cases, A. vera is sold as a food supplement, allegedly with FDA approval. FDA has only approved A. perryi, A. vera, A. ferox, and certain hybrids for use as natural food flavorings.
The most common use of the gel remains in the treatment of minor burns and skin irritation.
The activity of aloe in treating burns may stem from its moisturizing effect, which prevents air from drying the wound.
Studies of the antibacterial activity of aloe have yielded conflicting results. Aloe has been found to be more effective than sulfadiazine and salicylic acid creams in promoting wound healing and as effective as silver sulfadiazine in reducing wound bacterial counts.
Aloe-emodin is antileukemic in vitro. The US Department of Agriculture has approved A. vera as an adjunctive treatment for fibrosarcomas in dogs and cats.
Other health claims are generally poorly documented.
A. vera extract 0.5% in a hydrophilic cream was shown in a placebo-controlled study to shorten time to healing in male patients with first episodes of genital herpes.
A gel containing A. vera extract 0.125%, allantoin 0.35%, and silicon dioxide was found effective in decreasing the duration of lesions associated with aphthous stomatitis.
Lyophilized A. barbadensis combined with zinc acetate has been studied in rabbits for use as a vaginal contraceptive.
A small study has found that parenteral administration of aloe extract protects the liver from chemical injury.
Seborrheic dermatitis (seborrhea, dandruff)
Psoriasis vulgaris
Genital herpes
Skin burns
Radiation dermatitis
Canker sores (aphthous stomatitis)
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.
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.
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.
Pressure ulcers
Infected surgical wounds
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.
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.
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.
SUMMARY
Aloe products derived from the latex of the outer skin are strong cathartics to be used with caution. Compounds derived from the inner gel intended for internal administration have not been shown to exert any consistent therapeutic effect. The effective topical use of the gel in the treatment of minor burns and wounds has not been established, although several human trials indicate a potential therapeutic benefit. Use of A. veracream has been placed in the protocol for frostbite treatment.
PATIENT INFORMATION — Aloe
Uses: Aloe appears to inhibit infection and promote healing of minor burns and wounds, frostbite, and possibly of skin affected by diseases such as psoriasis and seborrheic dermatitis. Dried aloe latex is used, with caution, as a drastic cathartic.
Side Effects: There has been 1 report that using the gel as standard wound therapy delayed healing. The gel may cause burning sensations in dermabraded skin, and redness and itching can also occur. Use caution with cosmetic products containing A. vera gel.
Dosing: As a gel, A. vera may be applied externally ad lib. The resin product is cathartic at doses of 250 mg and is not recommended for internal use.
COMMON NAMES
Aloe vera, 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, Curacao 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.
BOTANY
Aloes, of which there are 500 species, belong to the family Liliaceae. The name, meaning "bitter and shiny substance," derives from the Arabic "alloeh." Indigenous to the Cape of Good Hope, these perennial succulents grow throughout most of Africa, southern Arabia and Madagascar, and are cultivated in Japan, North and South America, and in the Caribbean and Mediterranean regions. They do not grow in rain forests or arid deserts. Often attractive ornamental plants, their fleshy leaves are stiff and spiny along the edges and grow in a rosette. Each plant has 15 to 30 tapering leaves, each up to 0.5 meters long and 8 to 10 cm wide. Beneath the thick cuticle of the epidermis lies the chlorenchyma. Between this layer and the colorless mucilaginous pulp containing the aloe gel are numerous vascular bundles and inner bundle sheath cells, from which a bitter yellow sap exudes when the leaves are cut.
HISTORY
Drawings of aloe have been found in the wall carvings of Egyptian temples erected in the fourth millennium BC. Called the "Plant of Immortality," it was a traditional funerary gift for the pharaohs. The Egyptian Book of Remedies (ca. 1500 BC) notes the use of aloe in curing infections, treating the skin, and preparing drugs that were chiefly used as laxatives. The Bible (John 19:39-40) says that Nicodemus brought a mixture of myrrh and aloes for the preparation of Christ's body. Alexander is said to have conquered the island of Socotra to obtain control of it. The Greek physician Dioscorides, in 74 AD, recorded its use to heal wounds, stop hair loss, treat genital ulcers, and eliminate hemorrhoids. In the 6th century AD, Arab traders carried it to Asia. From the Mediterranean region, it was carried to the New World in the 16th century by the Spaniards. In the modern era, its clinical use began in the 1930s as a treatment for roentgen dermatitis.
USAGE
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.
Constipation (laxative)
There is a strong scientific evidence for this use.
Dried Aloe latex from the inner lining of aloe leaves has been used traditionally as a potent laxative taken by mouth. A combination herbal remedy containing aloe was found to be an effective laxative, the aloinosides exert strong purgative effects by irritating the large intestine. Only the dried latex is approved for internal use as a cathartic. In some cases, A. vera is sold as a food supplement, allegedly with FDA approval. FDA has only approved A. perryi, A. vera, A. ferox, and certain hybrids for use as natural food flavorings.
The most common use of the gel remains in the treatment of minor burns and skin irritation.
The activity of aloe in treating burns may stem from its moisturizing effect, which prevents air from drying the wound.
Studies of the antibacterial activity of aloe have yielded conflicting results. Aloe has been found to be more effective than sulfadiazine and salicylic acid creams in promoting wound healing and as effective as silver sulfadiazine in reducing wound bacterial counts.
Aloe-emodin is antileukemic in vitro. The US Department of Agriculture has approved A. vera as an adjunctive treatment for fibrosarcomas in dogs and cats.
Other health claims are generally poorly documented.
A. vera extract 0.5% in a hydrophilic cream was shown in a placebo-controlled study to shorten time to healing in male patients with first episodes of genital herpes.
A gel containing A. vera extract 0.125%, allantoin 0.35%, and silicon dioxide was found effective in decreasing the duration of lesions associated with aphthous stomatitis.
Lyophilized A. barbadensis combined with zinc acetate has been studied in rabbits for use as a vaginal contraceptive.
A small study has found that parenteral administration of aloe extract protects the liver from chemical injury.
Seborrheic dermatitis (seborrhea, dandruff)
Psoriasis vulgaris
Genital herpes
Skin burns
Radiation dermatitis
Canker sores (aphthous stomatitis)
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.
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.
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.
Pressure ulcers
Infected surgical wounds
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.
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.
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.
SUMMARY
Aloe products derived from the latex of the outer skin are strong cathartics to be used with caution. Compounds derived from the inner gel intended for internal administration have not been shown to exert any consistent therapeutic effect. The effective topical use of the gel in the treatment of minor burns and wounds has not been established, although several human trials indicate a potential therapeutic benefit. Use of A. veracream has been placed in the protocol for frostbite treatment.
PATIENT INFORMATION — Aloe
Uses: Aloe appears to inhibit infection and promote healing of minor burns and wounds, frostbite, and possibly of skin affected by diseases such as psoriasis and seborrheic dermatitis. Dried aloe latex is used, with caution, as a drastic cathartic.
Side Effects: There has been 1 report that using the gel as standard wound therapy delayed healing. The gel may cause burning sensations in dermabraded skin, and redness and itching can also occur. Use caution with cosmetic products containing A. vera gel.
Dosing: As a gel, A. vera may be applied externally ad lib. The resin product is cathartic at doses of 250 mg and is not recommended for internal use.
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