Aloe Vera

Aloe Gel (aloe Vera) - Medicinal Uses, Interactions, Dosage
By Peter Thomas
Aloe Gel (Aloe vera)


The succulent, cactus-like plant, one of over 300 Aloe species, was previously known as Aloe barbadensis and Aloe vulgaris. Aloe gel is a clear viscous liquid obtained from the inner portion of the long, fleshy leaves.

Uses:

Topically, aloe gel is commonly used for minor abrasions, burns, wounds, and a variety of dermatologic disorders. Aloe gel is a common household remedy in many cultures, and is an ingredient in numerous commercial skin lotions, sun blocks, and cosmetics. Therapeutic claims also have been made for oral ingestion of the gel, including benefits for diabetes, peptic ulcer, cancer, AIDS, and inflammatory bowel disease, and as a general tonic.

Aloe gel is distinct from, and often confused with, the bitter yellow liquid derived from the outer rind of the leaf. This bitter exudate is variably referred to as aloe juice, sap, latex, or simply aloes; it contains anthraquinone glycosides that have strong laxative properties when taken orally. Dried aloes is a powerful cathartic drug similar to senna and cascara, but has largely been superceded by gentler laxatives.

Pharmacology:

Active chemical constituents from the gel include mucilaginous polysaccharides (e.g., glucomannans, acemannan), beta-sitosterol, lectins, fatty acids, and enzymes. The polysaccharides and high water content make aloe gel an effective moisturizing agent or emolient, which accounts for its use in many cosmetics.

The activity of aloe gel has been investigated in hundreds of in vitro and animal studies. Although not all study results were positive in animal models, topical and injectable aloe gel have been found to inhibit acute inflammation, speed the healing of wounds and burns, increase wound strength, and enhance tissuesurvival in frostbite. The proposed cellular mechanisms for aloe gel's activity on wound healing are numerous, although the clinical effects are not necessarily correlated with these actions. Studies have demonstrated an increase in fibroblast and collagen proliferation, stimulation of new capillaries, and reduced thromboxane production. Although inflammation is reduced, immune stimulation (increased antigenic, macrophage, and natural killer cell activity) has also been demonstrated in vitro and in animal models, primarily with injectable acemannan, which is also used clinically. In addition, the fresh gel (but not commercial preparations) inhibited tumor cell growth in vitro, and injectable acemannan also reduced tumor growth and mortality in animal models of cancer.

Aloe extracts have in vitro antibacterial, antifungal, and antiviral activity, including activity against herpes and HIV viruses. Oral administration of the gel in several animal studies has produced inconsistent results on blood glucose concentrations and gastric ulcers. Hypoglycemic activity may be greater for the bitter aloe juice exudate.

Clinical Trials:

Many potential uses of aloe gel are based on case reports and uncontrolled trials. In a systematic review of the worldwide literature, only 10 controlled clinical trials of gel were found; six were randomized controlled trials (RCTs) and four were double-blinded.

Topical Use -
Two controlled trials have investigated the effects of aloe gel on wounds and burns; both trials compared aloe and standard dressings on opposite sides of the wound. After fullface dermabrasion of 18 patients for acne vulgaris, healing was reported to occur 72 hours faster on the side of the face with the aloe gel saturated dressing (total healing time in the control group was about 10 days). Similarly, in 27 patients with partial-thickness burns, healing was faster with the aloe dressing than the vaseline dressing (11.9 versus 18.2 days, respectively; P < 0.002). Although both studies showed significant results, neither study was randomized or blinded.

In contrast, acemannan was not effective for open wounds from gynecologic surgery that required healing by secondary intention. In this unblinded RCT, open surgical wounds in 40 patients actually took longer to heal using the aloe gel extract (83 days) compared to standard care (53 days). For prevention of radiation induced skin injury in women receiving radiation for breast cancer, two RCTs from the same investigators (one double-blinded with 194 patients) found that a 98% gel was no more effective than placebo or standard care. In two double-blind RCT's for the treatment of aphthous ulcers, one found no consistent benefits using different gels containing a 0.125% aloe extract, and the other found faster healing times with an acemannan hydro gel product compared to a placebo (5.89 vs. 7.80 days; P = 0.003). In an unblinded RCT of 30 patients with



uninfected pressure ulcers, an acemannan hydrogel dressing was equivalent to, but no more effective than, a moist saline gauze applied daily,.

Positive results were best documented in double-blinded RCT's for seborrheic dermatitis, psoriasis, and genital herpes. In 44 adult patients with seborrheic dermatitis, clinical resolution or substantial improvement was significantly more frequent with a 30% aloe extract emulsion than a bland aqueous control cream, as assessed by patients (62% vs. 25%; P = 0.03) and dermatologists (58% vs. 15%; P = 0.009).16 In 60 patients with mild-moderate psoriasis, a 0.5% aloe cream helped heal plaques in 83% of patients in 4 weeks, compared to 7% using placebo. In a study of 120 male patients with first-onset genital herpes, mean dura­tion of healing was 4.8 days for a 0.5% aloe extract cream, 7 days for a 0.5% gel, and 14 days for a placebo cream. The percentages of "cured" patients were 70%, 45%, and 7.5%, re­spectively, at 2 weeks. A similar study by the same investigators in 60 patients showed almost identical results. Note that the three studies for psoriasis and herpes (with rather remarkable results) were all performed by the same research group.

. Oral Use-Ingesting 10-20 ml of daily was reported to reduce triglycerides and total and LDL cholesterol compared to placebo in 60 patients over 3 months. However, it is not clear if this study (published in abstract form) was randomized or blinded.

One tablespoon b.Ld. of gel extract was reported to reduce blood glucose levels (from 250 to 141 mg/dl) compared to placebo (unchanged) in 72 new-onset diabetics after 42 days. A similar study by the same group found identical benefits in treated diabetics. Triglyceride levels also decreased significantly, with­out a change in total cholesterol. However, these studies are diffi­cult to accept. Both were single-blinded and not randomized, and

in the treated diabetic control group, glibenclamide (glyburide) 20 mg/day had no effect on blood glucose when used alone.

Although preliminary studies of acemannan initially suggested benefits in AIDS patients, a well-designed double-blind RCT in 63 patients given an oral dose of 1600 mg/day for 1 year found no effects on CD 4 counts or viralloads.

Adverse Effects:

Topically applied aloe gel is generally well tolerated, with occasional reports of stinging sensation, mild itching, or hypersensitivity reactions. There are no reported adverse effects with oral ingestion of the gel.

Interactions:

There are no recognized drug interactions with topical or oral administration of aloe gel.

Cautions:

Unlike pure gel, total leaf extracts (sometimes referred to as aloe "juice") or contaminated gel products may contain anthraquinones from the bitter sap. Excessive oral ingestion of anthraquinones can result in severe intestinal cramping, diarrhea, hypokalemia, and other toxicities of laxative abuse. While topical application by pregnant or lactating women is considered safe, oral consumption should be avoided due to lack of data.

Preparations & Doses:

The gel is usually applied topically 2-4 times daily or as needed. When using the fresh plant, a leaf can be cut and the gel of the inner leaf applied directly to the injury. Pure aloe gel is available commercially for topical use, but more cosmetically acceptable products are also available; these are typically marketed in percentage strengths such as 0.5% (i.e., 0.5 g of 100% gel is contained in 100 ml or g of lotion, cream, or other preparation). Recommended oral doses of aloe gel (in concentrations up to 100%) vary widely; typical oral doses of liquid products are 30 ml 1-3 times daily. The gel is also marketed in solid extract forms. Careful processing of the gel is necessary to avoid contamination with anthraquinones, and stabilization is needed to reduce degradation of the active components, which occurs quickly.

Summary Evaluation

Although widely applied as an easy-to-use household remedy, objective evidence that aloe gel can enhance the healing of abrasions and burns is limited. Nevertheless, simple emollient and occlusive properties may be soothing. Consistent healing benefits were not demonstrated in studies of open surgical wounds and in studies examining prevention of radiation-induced dermatitis, aphthous ulcers, and pressure sores. Benefits have been reported for seborrheic dermatitis, psoriasis, and genital herpes, but these results need verification. Oral administration of acemannan is not effective for AIDS. Benefits have been reported for diabetes, but claims for the oral use of aloe gel for any indication have not been confirmed in reliable, controlled studies.
Peter Thomas is a writer, who writes many great articles on home remedies, herbal remedies and ayurvedic medicines for common ailments and diseases. These articles also include the causes, symptoms and treatment options availaible.

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