Natural Standard® Patient Monograph, Copyright © 2014 (www.naturalstandard.com). All Rights Reserved. Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.

Background

Clear gel from the aloe leaves has been applied to the skin to treat wounds, skin infections, burns, and for many other skin conditions. Dried latex from the aloe leaf has been taken by mouth traditionally as a laxative.

There is good scientific evidence for use of aloe latex as a laxative. However, it is unclear if it is better than other therapies for constipation. A report of liver toxicity from ingesting aloe raises a question of safety.

Aloe may benefit genital herpes, inflammatory skin conditions, and dandruff. For numerous other conditions, aloe has an unclear or lack of benefit.

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)

For a chemotherapy adjuvant, 10 milliliters of a blend containing 300 grams of fresh aloe leaves, 500 grams of honey, and 40 milliliters of 40% alcohol has been taken three times daily by mouth every day either with or after chemotherapy administration.

For constipation, the dose suggested is 0.04-0.17 grams of dried juice (corresponding to 10-30 milligrams of hydroxyanthraquinones).

For dental plaque and gum disease, a toothpaste containing aloe has been used three times daily for 30 days.

For diabetes, a dose of 5-15 milliliters of aloe juice twice daily has been taken by mouth. One capsule containing 300 milligrams of aloe extract has been taken by mouth twice daily for two months. One tablespoon of aloe has been taken by mouth twice daily for 42 days.

For dry skin, a formulation with freeze-dried aloe extract was applied to the forearm for up to two weeks.

For genital herpes, a cream with aloe extract has been applied to lesions three times daily for five days per week, for up to two weeks.

For gum disease, aloe-containing toothpaste has been used daily for 24 weeks.

For heart disease, one 120 milliliter dose of a solution containing 1,200 milligrams of aloe has been taken by mouth.

For high cholesterol, 10-20 milliliters of aloe has been taken by mouth daily for 12 weeks. One capsule containing 300 milligrams of aloe extract has been taken by mouth twice daily for two months.

For HIV infection, a dose of 1,000-1,600 milligrams of acemannan (aloe extract) has been taken by mouth in four equal doses daily for 48 weeks. Additionally, 30-40 milliliters of aloe gruel has been taken by mouth daily for an unknown duration.

For inflammation (osteitis), a SaliCept patch, which contained acemannan (aloe extract), was applied to the tooth socket once and then again three days after the first treatment.

For inflammatory bowel disease (ulcerative colitis), aloe gel has been taken by mouth at a dose of 100 milliliters twice daily for four weeks.

For lichen planus, an aloe gel containing 70% aloe mucilage (sticky substance from aloe) has been applied to the skin twice daily for eight weeks. Additionally, 0.4 milliliters of 70% aloe solution has been held in the mouth for one minute up to three times daily for 12 weeks. Aloe mouthwash (two tablespoons swished for two minutes) on mouth lesions has been used four times daily for one month.

For liver disease, 0.05 grams of high-molecular-weight fractions of aloe has been taken by mouth three times daily for 12 weeks.

For mucositis (mouth ulcers), 15-20 milliliters of aloe solution has been used in the mouth 1-3 times daily for up to eight weeks while receiving radiotherapy.

For psoriasis (inflammatory skin condition), a cream containing aloe has been applied to the skin three times daily for five consecutive days per week, for up to four weeks. A commercial aloe gel has also been used.

For radiation-induced skin injury, participants receiving radiation therapy for breast cancer applied aloe gel twice daily to the skin, in combination with usual care.

For seborrheic dermatitis (seborrhea, dandruff), a 30% aloe mixture has been applied to the skin twice daily for 4-6 weeks.

For skin burns, a 97.5% aloe gel has been applied to an irradiated skin area on two subsequent days. A burn on one side of the body was treated with topical aloe cream twice daily until the burn healed. Aloe mucilage (sticky substance from aloe) has been applied twice daily until either the burns were healed or the patient left the hospital.

For wound healing, a wound gel with aloe or a skin gel with aloe has been applied to the skin up to three times daily until the wound healed. A cream (3 grams) containing 0.5% aloe gel powder has been applied to the skin immediately after surgery and 12 hours after surgery. Aloe treatments have included topical creams, mucilage (sticky substance from aloe), gel dressings, and gels. Aloe products have been applied from three times daily to every third day for 2-19 weeks or until the wounds were healed.

The suggested dosage for injectable acemannan is lacking because safety has not been sufficiently evaluated. Four cases of death have been associated with aloe injections under unclear circumstances.

Children (younger than 18 years)

Use of aloe gel applied to the skin in children is common and appears to be well tolerated. Aloe taken by mouth or injected into the blood has not been studied in children.

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.

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)

Grading rationale

Evidence gradeCondition to which grade level applies
B

Constipation

Anthraquinone glycosides, a component of aloe, have well established laxative effects. However, case reports have associated hepatitis with aloe taken by mouth. Further research is needed on the efficacy and safety of aloe as a laxative.
B

Genital herpes

Research suggests that aloe may be an effective treatment for genital herpes. Additional research is needed in this area.
B

Psoriasis (skin disease)

Evidence suggests that aloe cream is an effective treatment for psoriasis. Additional research is warranted in this area.
B

Seborrheic dermatitis (seborrhea, dandruff)

Early evidence supports aloe for treating seborrheic dermatitis, flaky skin found at oily areas. Further research is needed before a firm conclusion can be made.
C

Cancer prevention

There is preliminary evidence that aloe consumption may reduce the risk of lung cancer or tumor growth. Further research is needed in this area.
C

Canker sores

Evidence that aloe gel reduces canker sore pain and prolongs ulcer-free intervals is unclear. Further research is needed.
C

Chemotherapy adjuvant

Early evidence suggests that aloe, in addition to chemotherapy, may improve chemotherapy effects on tumor growth and survival. Further evidence is needed in this area.
C

Chemotherapy side effects

There is early evidence that aloe applied to the skin may improve hand-foot syndrome due to chemotherapy. Further high-quality trials are needed in this area.
C

Common cold / upper respiratory tract infection

A combination treatment containing aloe may benefit lung cells. Further research on aloe alone is needed before conclusions may be drawn.
C

Dental conditions

Aloe may benefit inflammation of a bone in the mouth. Further research is needed in this area.
C

Dental plaque

Aloe lacked benefit in reducing plaque and gingivitis. Further research is needed before conclusions can be drawn.
C

Diabetes

The effect of aloe gel taken by mouth on lowering blood sugar is unclear. More studies are needed to explore the efficacy and safety of aloe in diabetics.
C

Dry mouth

Limited research using a combination aloe product has benefitted dry mouth. Further research using aloe alone is needed before firm conclusions may be drawn.
C

Dry skin

Aloe has been traditionally used to accelerate wound healing and as a moisturizer. Early research reports that aloe may reduce skin dryness. Higher-quality studies are needed in this area.
C

Gum disease

A toothpaste containing aloe may benefit gum disease. Further research is needed on this topic.
C

High cholesterol

Aloe has been reported to safely control cholesterol levels in diabetic patients. Further research is needed before firm conclusions may be drawn.
C

Inflammatory bowel disease (ulcerative colitis)

Aloe gel may be beneficial in people with ulcerative colitis. Further research is needed to confirm these results.
C

Itching

A cream with aloe has been used to treat skin lesions and has shown some evidence of benefit. Further studies are needed using aloe alone.
C

Lichen planus

Lichen planus causes an itchy rash of small purplish bumps, often on the arms, legs, back, or inside the mouth. Research has found that aloe may benefit lichen planus on the mouth or genitals. Additional research is needed.
C

Mucositis (mouth ulcers)

Cancer treatment is often associated with side effects, such as mouth ulcers. Early evidence suggests that aloe use lacks improvement in mucositis symptoms. Further research is needed on this topic.
C

Scabies (itchy skin condition)

Aloe has been studied for use in scabies treatment, with little evidence of benefit. Additional research is needed before firm conclusions may be drawn.
C

Skin burns

Preliminary evidence suggests that aloe may be effective in promoting healing of skin burns. Further research is needed in this area.
C

Skin damage caused by the sun

A study has evaluated an aloe combination treatment for sun damaged skin, with some evidence of benefit. Further research using aloe alone is needed in this area.
C

Skin inflammation (tungiasis)

A combination aloe product for control of tungiasis showed some evidence of benefit. Further research using aloe alone is needed before firm conclusions can be made.
C

Skin ulcers

A dressing containing aloe and Mimosa tenuiflora had positive results on skin ulcers. Further research using aloe alone is needed before firm conclusions may be drawn.
D

Colorectal cancer

Aloe use may not reduce the risk of developing colorectal cancer. Further studies are needed before firm conclusions can be made.
D

Diaper rash

Early research suggests that aloe cream may not benefit diaper rash. Further research is needed before a firm conclusion may be drawn.
D

Heart disease

The evidence for aloe in treating heart disease is unclear. Further research is needed before firm conclusions may be drawn.
D

HIV infection

Acemannan, a component in aloe gel, has been shown to stimulate the immune system and fight the HIV virus. Early results from human trials are mixed. Further research is needed.
D

Liver disease

Early research suggests that aloe lacks benefit in people with liver disease. Additional research is needed in this area.
D

Pressure ulcers

Wound cleansing using an aloe solution has shown a lack of benefit. Further research is needed on this topic.
D

Radiation dermatitis (skin damage from radiation exposure)

Preliminary research suggests that aloe applied to the skin may lack improvement for pain or skin peeling related to radiotherapy. Additional well-designed studies are needed in this area.
D

Wound healing

Aloe may alter immune function and reduce inflammation. However, evidence is lacking for aloe use in wound healing. Further research is needed in this area.

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, antibiotic, antifungal, anti-inflammatory, antioxidant, antiseptic, antiviral, arthritis (osteoarthritis, rheumatoid arthritis), asthma, bacterial skin infections, chronic fatigue syndrome, corneal abrasions/ulcers, frostbite, functional bowel disorders, gastric acid reduction, hair loss, hemorrhoids, human papilloma virus (HPV), immunomodulator, lupus, parasites, Parkinson's disease, peptic ulcer, periodontal surgical rinse, tic douloureux (nerve disorder), urolithiasis (bladder stones), uterine stimulant, vaginal contraceptive, yeast infections of the skin.

Interactions

Interactions with Drugs

Aloe may lower blood sugar levels. Caution is advised when using medications that may also lower blood sugar. People taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.

Because aloe contains estrogen like chemicals, the effects of other agents believed to have estrogen-like properties may be altered.

Aloe may also interact with agents for cancer; agents for the brain, heart, intestines, liver, skin, or stomach; agents that increase potassium excretion (loop diuretics, thiazide diuretics); agents that increase urination; agents that protect against radiation; agents toxic to the liver; anesthetics; antifungals; anti-inflammatories; antiretrovirals; antivirals; cardiac glycosides; cholesterol lowering agents; contraceptives; hormonal agents; insulin preparations; laxatives; oral corticosteroids; oral hydrocortisone; sevoflurane; steroids; sunscreen; thyroid hormones; topical hydrocortisone; water-soluble agents; wound healing agents; or zidovudine (AZT).

Interactions with Herbs and Dietary Supplements

Aloe may alter blood sugar levels. Caution is advised when using herbs or supplements that may also alter blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.

Because aloe contains estrogen like chemicals, the effects of other agents believed to have estrogen-like properties may be altered.

Aloe may also interact with anesthetics; antifungals; anti-inflammatories; cholesterol lowering herbs and supplements; herbs and supplements for cancer; herbs and supplements for the brain, heart, intestines, liver, skin, or stomach; antioxidants; antivirals; contraceptives; herbs and supplements toxic to the liver; hormonal herbs and supplements; laxatives; licorice root (Glycyrrhiza glabra); herbs and supplements that increase urination; herbs and supplements that protect against radiation; steroids; sunscreen; thyroid herbs and supplements; vitamin B12, C, and E; water-soluble herbs and supplements; wound-healing herbs and supplements

Methodology

This information is based on a systematic review of scientific literature, and was peer-reviewed and edited by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Monograph methodology

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®, Curaçao aloe, elephant's gall, first-aid plant, ghai kunwar (India), ghikumar (India), hirukattali, hsiang-dan (Chinese), jelly leek, kumari, lahoi, laloi, lily of the desert, Lu-Hui, medicine plant, maloyl glucan compounds, 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.

Combination product examples: Mepentol Leche (an emulsion based on hyperoxygenated fatty acids, Aloe barbadensis, and Mimosa tenuiflora).

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 sensitivity to Aloe vera, its parts, or plants of the Liliaceae family, such as garlic, onions, and tulips.

After prolonged use of an aloe gel applied to the skin, hives, allergic skin reactions, redness on the eyelids, and widespread skin inflammation have been reported.

Side Effects and Warnings

Aloe is likely safe when applied to the skin to reduce pain or inflammation. Aloe is likely safe for burns, frostbite, human papilloma virus-1 (HPV) infections (cold sores), psoriasis, and wound healing in people who are not allergic or sensitive to aloe. Medical attention should be sought for severe burns, wounds, or frostbite.

Aloe may lower blood sugar levels. Caution is advised in people with diabetes or hypoglycemia, 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, and medication adjustments may be necessary.

Aloe may increase the risk of bleeding. Caution is advised in people with bleeding disorders or taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary.

Use cautiously in people with heart disease or electrolyte abnormalities. Use cautiously when taken by mouth or used as a laxative.

Use cautiously in people taking agents for the heart, agents for the stomach or intestines, agents that increase potassium excretion, cardiac glycosides, oral corticosteroids, oral hydrocortisone, sevoflurane, thyroid hormones, topical hydrocortisone, or zidovudine (AZT).

Avoid in people with abdominal pain that is sudden and severe, appendicitis, bowel obstruction, fecal impaction, kidney disease, liver disease, or in people taking agents toxic to the liver. Avoid use as an injection, during postoperative incision healing, during pregnancy or lactation, or for prolonged periods as a laxative.

Avoid with known allergy or sensitivity to Aloe vera, its parts, or plants of the Liliaceae family, such as garlic, onions, and tulips.

Aloe may also cause abdominal cramping, allergic skin reaction, constipation, dehydration, dependency if used as a laxative, delayed wound healing, diarrhea, electrolyte imbalance, excess bleeding, hardening of the skin, Henoch-Schönlein purpura (purple spots on the skin), hepatitis, hives, increased risk of colorectal cancer, increased risk of irregular heartbeat, kidney failure, liver toxicity, low potassium in the blood, muscle weakness, redness of the skin and eyelids, skin dryness, skin inflammation from sun exposure, soreness, splitting of the skin, stinging, stomach discomfort, thyroid dysfunction, urinary stone, uterine contractions, and widespread inflammation of the skin.

Note: As a part of the Food and Drug Administration (FDA) over-the-counter (OTC) drug product review, a final rule was issued suggesting that the stimulant laxative ingredient of aloe (including aloe extract and aloe flower extract) in OTC products generally lack safety and effectiveness or may be misbranded.

Pregnancy and Breastfeeding

Although topical application is unlikely to be harmful during pregnancy or lactation, internal use is not suggested, due to theoretical stimulation of uterine contractions. It is not known if components of aloe may be excreted with breast milk. Consumption of the dried juice from aloe leaves is contraindicated during lactation.

Selected references

  1. Cheng, S., Kirtschig, G., Cooper, S., Thornhill, M., Leonardi-Bee, J., and Murphy, R. Interventions for erosive lichen planus affecting mucosal sites. Cochrane.Database.Syst.Rev. 2012;2:CD008092.
  2. Dat, A. D., Poon, F., Pham, K. B., and Doust, J. Aloe vera for treating acute and chronic wounds. Cochrane.Database.Syst.Rev. 2012;2:CD008762.
  3. Eshghi, F., Hosseinimehr, S. J., Rahmani, N., Khademloo, M., Norozi, M. S., and Hojati, O. Effects of Aloe vera cream on posthemorrhoidectomy pain and wound healing: results of a randomized, blind, placebo-control study. J.Altern.Complement Med. 2010;16(6):647-650.
  4. Huseini, H. F., Kianbakht, S., Hajiaghaee, R., and Dabaghian, F. H. Anti-hyperglycemic and anti-hypercholesterolemic effects of Aloe vera leaf gel in hyperlipidemic type 2 diabetic patients: a randomized double-blind placebo-controlled clinical trial. Planta Med. 2012;78(4):311-316.
  5. Lodi, G., Carrozzo, M., Furness, S., and Thongprasom, K. Interventions for treating oral lichen planus: a systematic review. Br.J.Dermatol. 2012;166(5):938-947.
  6. Mansourian, A., Momen-Heravi, F., Saheb-Jamee, M., Esfehani, M., Khalilzadeh, O., and Momen-Beitollahi, J. Comparison of aloe vera mouthwash with triamcinolone acetonide 0.1% on oral lichen planus: a randomized double-blinded clinical trial. Am.J.Med.Sci. 2011;342(6):447-451.
  7. Morales-Bozo, I., Rojas, G., Ortega-Pinto, A., Espinoza, I., Soto, L., Plaza, A., Lozano, C., and Urzua, B. Evaluation of the efficacy of two mouthrinses formulated for the relief of xerostomia of diverse origin in adult subjects. Gerodontology. 2012;29(2):e1103-e1112.
  8. Olatunya, O. S., Olatunya, A. M., Anyabolu, H. C., Adejuyigbe, E. A., and Oyelami, O. A. Preliminary trial of aloe vera gruel on HIV infection. J.Altern.Complement Med. 2012;18(9):850-853.
  9. Panahi, Y., Davoudi, S. M., Sahebkar, A., Beiraghdar, F., Dadjo, Y., Feizi, I., Amirchoopani, G., and Zamani, A. Efficacy of Aloe vera/olive oil cream versus betamethasone cream for chronic skin lesions following sulfur mustard exposure: a randomized double-blind clinical trial. Cutan.Ocul.Toxicol. 2012;31(2):95-103.
  10. Pradeep, A. R., Agarwal, E., and Naik, S. B. Clinical and microbiologic effects of commercially available dentifrice containing aloe vera: a randomized controlled clinical trial. J.Periodontol. 2012;83(6):797-804.
  11. Salazar-Sanchez, N., Lopez-Jornet, P., Camacho-Alonso, F., and Sanchez-Siles, M. Efficacy of topical Aloe vera in patients with oral lichen planus: a randomized double-blind study. J.Oral Pathol.Med. 2010;39(10):735-740.
  12. Shah, S. A., DiTullio, P., Azadi, M., Shapiro, R. J., Eid, T. J., and Snyder, J. A. Effects of oral Aloe vera on electrocardiographic and blood pressure measurements. Am.J.Health Syst.Pharm. 11-15-2010;67(22):1942-1946.
  13. Williamson, G., Coppens, P., Serra-Majem, L., and Dew, T. Review of the efficacy of green tea, isoflavones and aloe vera supplements based on randomised controlled trials. Food Funct. 2011;2(12):753-759.
  14. Worthington, H. V., Clarkson, J. E., Bryan, G., Furness, S., Glenny, A. M., Littlewood, A., McCabe, M. G., Meyer, S., and Khalid, T. Interventions for preventing oral mucositis for patients with cancer receiving treatment. Cochrane.Database.Syst.Rev. 2011;(4):CD000978.
  15. Yun, J. M., Singh, S., Jialal, R., Rockwood, J., Jialal, I., and Devaraj, S. A randomized placebo-controlled crossover trial of aloe vera on bioavailability of vitamins C and B(12), blood glucose, and lipid profile in healthy human subjects. J.Diet.Suppl 2010;7(2):145-153.

This evidence-based monograph was prepared by The Natural Standard Research Collaboration

www.naturalstandard.com