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Aloe vera: A short review

Article in Indian Journal of Dermatology · February 2008

DOI: 10.4103/0019-5154.44785 · Source: PubMed

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7/20/2015 ALOE VERA: A SHORT REVIEW

Indian J Dermatol. 2008; 53(4): 163–166. PMCID: PMC2763764

doi: 10.4103/0019­5154.44785

ALOE VERA: A SHORT REVIEW

Amar Surjushe, Resham Vasani, and D G Saple
From the Department of Dermatology, Venereology and Leprosy, Grant Medical College and Sir J J Group of Hospitals, Mumbai ­ 400 008
Maharashtra, India
Address for correspondence: Dr. Amar Surjushe, Department of Dermatology, Venereology and Leprosy, Grant Medical College, Gokuldas
Tejpal Hospital, Mumbai ­ 400 008, Maharashtra, India. E­mail: [email protected]

Received 2007 Jul; Accepted 2008 Mar.

Copyright © Indian Journal of Dermatology

This is an open­access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Aloe vera is a natural product that is now a day frequently used in the field of cosmetology. Though there are
various indications for its use, controlled trials are needed to determine its real efficacy. The aloe vera plant,
its properties, mechanism of action and clinical uses are briefly reviewed in this article.

Keywords: Aloe vera, health and beauty, skin

Introduction

The Aloe vera plant has been known and used for centuries for its health, beauty, medicinal and skin care
properties. The name Aloe vera derives from the Arabic word “Alloeh” meaning “shining bitter substance,”
while “vera” in Latin means “true.” 2000 years ago, the Greek scientists regarded Aloe vera as the universal
panacea. The Egyptians called Aloe “the plant of immortality.” Today, the Aloe vera plant has been used for
various purposes in dermatology.

History

Aloe vera has been used for medicinal purposes in several cultures for millennia: Greece, Egypt, India,
Mexico, Japan and China.1 Egyptian queens Nefertiti and Cleopatra used it as part of their regular beauty
regimes. Alexander the Great, and Christopher Columbus used it to treat soldiers’ wounds. The first
reference to Aloe vera in English was a translation by John Goodyew in A.D. 1655 of Dioscorides’ Medical
treatise De Materia Medica.2 By the early 1800s, Aloe vera was in use as a laxative in the United States, but
in the mid­1930s, a turning point occurred when it was successfully used to treat chronic and severe radiation
dermatitis.2

Plant

The botanical name of Aloe vera is Aloe barbadensis miller. It belongs to Asphodelaceae (Liliaceae) family,
and is a shrubby or arborescent, perennial, xerophytic, succulent, pea­ green color plant. It grows mainly in
the dry regions of Africa, Asia, Europe and America. In India, it is found in Rajasthan, Andhra Pradesh,
Gujarat, Maharashtra and Tamil Nadu.

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Anatomy

The plant has triangular, fleshy leaves with serrated edges, yellow tubular flowers and fruits that contain
numerous seeds. Each leaf is composed of three layers: 1) An inner clear gel that contains 99% water and
rest is made of glucomannans, amino acids, lipids, sterols and vitamins. 2) The middle layer of latex which is
the bitter yellow sap and contains anthraquinones and glycosides. 3) The outer thick layer of 15–20 cells
called as rind which has protective function and synthesizes carbohydrates and proteins. Inside the rind are
vascular bundles responsible for transportation of substances such as water (xylem) and starch (phloem).3

Active components with its properties: Aloe vera contains 75 potentially active constituents: vitamins,
enzymes, minerals, sugars, lignin, saponins, salicylic acids and amino acids.4–6

1. Vitamins: It contains vitamins A (beta­carotene), C and E, which are antioxidants. It also contains
vitamin B12, folic acid, and choline. Antioxidant neutralizes free radicals.
2. Enzymes: It contains 8 enzymes: aliiase, alkaline phosphatase, amylase, bradykinase,
carboxypeptidase, catalase, cellulase, lipase, and peroxidase. Bradykinase helps to reduce excessive
inflammation when applied to the skin topically, while others help in the breakdown of sugars and
fats.
3. Minerals: It provides calcium, chromium, copper, selenium, magnesium, manganese, potassium,
sodium and zinc. They are essential for the proper functioning of various enzyme systems in
different metabolic pathways and few are antioxidants.
4. Sugars: It provides monosaccharides (glucose and fructose) and polysaccharides:
(glucomannans/polymannose). These are derived from the mucilage layer of the plant and are
known as mucopolysaccharides. The most prominent monosaccharide is mannose­6­phosphate, and
the most common polysaccharides are called glucomannans [beta­(1,4)­acetylated mannan].
Acemannan, a prominent glucomannan has also been found. Recently, a glycoprotein with
antiallergic properties, called alprogen and novel anti­inflammatory compound, C­glucosyl
chromone, has been isolated from Aloe vera gel.7,8
5. Anthraquinones: It provides 12 anthraquinones, which are phenolic compounds traditionally
known as laxatives. Aloin and emodin act as analgesics, antibacterials and antivirals.
6. Fatty acids: It provides 4 plant steroids; cholesterol, campesterol, β­sisosterol and lupeol. All these
have anti­inflammatory action and lupeol also possesses antiseptic and analgesic properties.
7. Hormones: Auxins and gibberellins that help in wound healing and have anti­inflammatory action.
8. Others: It provides 20 of the 22 human required amino acids and 7 of the 8 essential amino acids. It
also contains salicylic acid that possesses anti­inflammatory and antibacterial properties. Lignin, an
inert substance, when included in topical preparations, enhances penetrative effect of the other
ingredients into the skin. Saponins that are the soapy substances form about 3% of the gel and have
cleansing and antiseptic properties.

Mechanism of actions

1. Healing properties: Glucomannan, a mannose­rich polysaccharide, and gibberellin, a growth

hormone, interacts with growth factor receptors on the fibroblast, thereby stimulating its activity and
proliferation, which in turn significantly increases collagen synthesis after topical and oral Aloe
vera.9 Aloe gel not only increased collagen content of the wound but also changed collagen
composition (more type III) and increased the degree of collagen cross linking. Due to this, it
accelerated wound contraction and increased the breaking strength of resulting scar tissue.10 An
increased synthesis of hyaluronic acid and dermatan sulfate in the granulation tissue of a healing
wound following oral or topical treatment has been reported.11
2. Effects on skin exposure to UV and gamma radiation: Aloe vera gel has been reported to have a
12,13
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protective effect against radiation damage to the skin.12,13 Exact role is not known, but following
the administration of aloe vera gel, an antioxidant protein, metallothionein, is generated in the skin,
which scavenges hydroxyl radicals and prevents suppression of superoxide dismutase and
glutathione peroxidase in the skin. It reduces the production and release of skin keratinocyte­derived
immunosuppressive cytokines such as interleukin­10 (IL­10) and hence prevents UV­induced
suppression of delayed type hypersensitivity.14
3. Anti­inflammatory action: Aloe vera inhibits the cyclooxygenase pathway and reduces
prostaglandin E2 production from arachidonic acid. Recently, the novel anti­inflammatory
compound called C­glucosyl chromone was isolated from gel extracts.8
4. Effects on the immune system: Alprogen inhibit calcium influx into mast cells, thereby inhibiting
the antigen­antibody­mediated release of histamine and leukotriene from mast cells.7 In a study on
mice that had previously been implanted with murine sarcoma cells, acemannan stimulates the
synthesis and release of interleukin­1 (IL­1) and tumor necrosis factor from macrophages in mice,
which in turn initiated an immune attack that resulted in necrosis and regression of the cancerous
cells.15 Several low­molecular­weight compounds are also capable of inhibiting the release of
reactive oxygen free radicals from activated human neutrophils.16
5. Laxative effects: Anthraquinones present in latex are a potent laxative. It increases intestinal water
content, stimulates mucus secretion and increases intestinal peristalsis.17
6. Antiviral and antitumor activity: These actions may be due to indirect or direct effects. Indirect
effect is due to stimulation of the immune system and direct effect is due to anthraquinones. The
anthraquinone aloin inactivates various enveloped viruses such as herpes simplex, varicella zoster
and influenza.18 In recent studies, a polysaccharide fraction has shown to inhibit the binding of
benzopyrene to primary rat hepatocytes, thereby preventing the formation of potentially cancer­
initiating benzopyrene­DNA adducts. An induction of glutathione S­transferase and an inhibition of
the tumor­promoting effects of phorbol myristic acetate has also been reported which suggest a
possible benefit of using aloe gel in cancer chemoprevention.19,20
7. Moisturizing and anti­aging effect: Mucopolysaccharides help in binding moisture into the skin.
Aloe stimulates fibroblast which produces the collagen and elastin fibers making the skin more
elastic and less wrinkled. It also has cohesive effects on the superficial flaking epidermal cells by
sticking them together, which softens the skin. The amino acids also soften hardened skin cells and
zinc acts as an astringent to tighten pores. Its moisturizing effects has also been studied in treatment
of dry skin associated with occupational exposure where aloe vera gel gloves improved the skin
integrity, decreases appearance of fine wrinkle and decreases erythema.21 It also has anti­acne
effect.
8. Antiseptic effect: Aloe vera contains 6 antiseptic agents: Lupeol, salicylic acid, urea nitrogen,
cinnamonic acid, phenols and sulfur. They all have inhibitory action on fungi, bacteria and viruses.

Clinical uses: The clinical use of aloe vera is supported mostly by anecdotal data. Though most of these uses
are interesting, controlled trials are essential to determine its effectiveness in all the following diseases.22,23

A. Uses based on scientific evidence: These uses have been tested in humans or animals. Safety and
effectiveness have not always been proven.

Conditions: Seborrheic dermatitis,24 psoriasis vulgaris,25,26 genital herpes,27,28 skin burns,5,29 diabetes
(type 2),30 HIV infection,31 cancer prevention,32,33 ulcerative colitis34 wound healing (results of aloe on
wound healing are mixed with some studies reporting positive results35 and others showing no benefit36 or
potential worsening37,38 ), pressure ulcers,36 mucositis,39 radiation dermatitis,40 acne vulgaris,41 lichen
planus,42 frostbite,43 aphthous stomatitis,44 and constipation.17

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B. 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.

Conditions: Alopecia, bacterial and fungal skin infections, chronic leg wounds, parasitic infections, systemic
lupus erythematosus, arthritis and tic douloureux.

Side effects

Topical: It may cause redness, burning, stinging sensation and rarely generalized dermatitis in sensitive
individuals. Allergic reactions are mostly due to anthraquinones, such as aloin and barbaloin. It is best to
apply it to a small area first to test for possible allergic reaction.

Oral: Abdominal cramps, diarrhea, red urine, hepatitis, dependency or worsening of constipation. Prolonged
use has been reported to increase the risk of colorectal cancer. Laxative effect may cause electrolyte
imbalances (low potassium levels).

Contraindication: Contraindicated in cases of known allergy to plants in the Liliaceae family.

Pregnancy and breastfeeding: Oral aloe is not recommended during pregnancy due to theoretical
stimulation of uterine contractions, and in breastfeeding mothers, it may sometime causes gastrointestinal
distress in the nursing infant.

Interactions: Application of aloe to skin may increase the absorption of steroid creams such as
hydrocortisone. It reduces the effectiveness and may increases the adverse effects of digoxin and digitoxin,
due to its potassium lowering effect. Combined use of Aloe vera and furosemide may increase the risk of
potassium depletion. It decreases the blood sugar levels and thus may interact with oral hypoglycemic drugs
and insulin.

Thus, though Aloe vera has wide spectrum of the properties and uses, some of them could be myths and
some of them could be real magic. In future, controlled studies are required to prove the effectiveness of
Aloe vera under various conditions.

Footnotes
Source of Support: Nil

Conflict of Interest: Nil.

References

1. Marshall JM. Aloe vera gel: What is the evidence? Pharma Jr. 1990;24:360–2.

2. Davis RH. Aloe vera: A scientific approach. New York: Vantage Press;

3. Tyler V. The honest herbal: A sensible guide to the use of herbs and related remedies. 3rd ed.
Binghamton, New York: Pharmaceutical Products Press; 1993.

4. Atherton P. Aloe vera revisited. Br J Phytother. 1998;4:76–83.

5. Shelton M. Aloe vera, its chemical and therapeutic properties. Int J Dermatol. 1991;30:679–83.
[PubMed: 1823544]

6. Atherton P. The essential Aloe vera: The actions and the evidence. 2nd ed 1997.

7. Ro JY, Lee B, Kim JY, Chung Y, Chung MH, Lee SK, et al. Inhibitory mechanism of aloe single
component (Alprogen) on mediator release in guinea pig lung mast cells activated with specific antigen­
antibody reactions. J Pharmacol Exp Ther. 2000;292:114–21. [PubMed: 10604937]

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2763764/?report=printable 4/7
7/20/2015 ALOE VERA: A SHORT REVIEW

8. Hutter JA, Salmon M, Stavinoha WB, Satsangi N, Williams RF, Streeper RT, et al. Anti­inflammatory C­
glucosyl chromone from Aloe barbadensis. J Nat Prod. 1996;59:541–3. [PubMed: 8778246]

9. Chithra R Sajithlal GB, Chandrakasan G. Influence of aloe vera on collagen characteristics in healing
dermal wounds in rats. Mol Cell Biochem. 1998;181:71–6. [PubMed: 9562243]

10. Heggers J, Kucukcelebi A, Listengarten D, Stabenau J, Ko F, Broemeling LD, et al. Beneficial effect of
aloe on wound healing in an excisional wound model. J Altern Complement Med. 1996;2:271–7.
[PubMed: 9395659]

11. Chithra P, Sajithlal G, Chandrakasan G. Influence of aloe vera on the glycosaminoglycans in the matrix
of healing dermal wounds in rats. J Ethnopharmacol. 1998;59:179–86. [PubMed: 9507902]

12. Roberts DB, Travis EL. Acemannan­containing wound dressing gel reduces radiation­induced skin
reactions in C3H mice. Int J Radiat Oncol Biol Phys. 1995;32:1047–52. [PubMed: 7607925]

13. Sato Y, Ohta S, Shinoda M. Studies on chemical protectors against radiation XXXI: Protective effects of
Aloe arborescens on skin injury induced by x­irradiation. Yakugaku Zasshi. 1990;110:876–84.
[PubMed: 2082014]

14. Byeon S, Pelley R, Ullrich SE, Waller TA, Bucana CD, Strickland FM. Aloe barbadensis extracts
reduce the production of interleukin­10 after exposure to ultraviolet radiation. J Invest Dermtol.
1988;110:811–7.

15. Peng SY, Norman J, Curtin G, Corrier D, McDaniel HR, Busbee D. Decreased mortality of Norman
murine sarcoma in mice treated with the immunomodulator, acemannon. Mol Biother. 1991;3:79–87.
[PubMed: 1910624]

16. Hart LA, Nibbering PH, van den Barselaar MT, van Dijk H, van den Burg AJ, Labadie RP. Effects of
low molecular constituents from aloe vera gel on oxidative metabolism and cytotoxic and bactericidal
activities of human neutrophils. Int J Immunopharmacol. 1990;12:427–34. [PubMed: 2167880]

17. Ishii Y, Tanizawa H, Takino Y. Studies of aloe. V: Mechanism of cathartic effect. Biol Pharm Bull.
1994;17:651–3. [PubMed: 7920425]

18. Sydiskis RJ, Owen DG, Lohr JL, Rosler KH, Blomster RN. Inactivation of enveloped viruses by
anthraquinones extracted from plants. Antimicrob Agents Chemother. 1991;35:2463–6.
[PMCID: PMC245413] [PubMed: 1810179]

19. Kim HS, Lee BM. Inhibition of benzo [a] pyrene­DNA adduct formation by aloe barbadensis Miller.
Carcinogenesis. 1997;18:771–6. [PubMed: 9111213]

20. Kim HS, Kacew S, Lee BM. In vitro chemopreventive effects of plant polysaccharides (Aloe
barbadensis Miller, Lentinus edodes, Ganoderma lucidum, and Coriolus vesicolor) Carcinogenesis.
1999;20:1637–40. [PubMed: 10426820]

21. West DP, Zhu YF. Evaluation of aloe vera gel gloves in the treatment of dry skin associated with
occupational exposure. Am J Infect Control. 2003;31:40–2. [PubMed: 12548256]

22. Zawahry ME, Hegazy MR, Helal M. Use of aloe in treating leg ulcers and dermatoses. Int J Dermatol.
1973;12:68–73. [PubMed: 4266516]

23. Ernst E, Fugh­Berman A. Methodological considerations in testing the efficacy of

complementary/alternative treatments (CATs) Int J Alt Comp Med. 1998;16:8–10.

24. Vardy AD, Cohen AD, Tchetov T. A double­blind, placebo­controlled trial of Aloe vera (A.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2763764/?report=printable 5/7
7/20/2015 ALOE VERA: A SHORT REVIEW

barbadensis) emulsion in the treatment of seborrheic dermatitis. J Derm Treatment. 1999;10:7–11.

25. Paulsen E, Korsholm L, Brandrup F. A double­blind, placebo­controlled study of a commercial Aloe

vera gel in the treatment of slight to moderate psoriasis vulgaris. J Eur Acad Dermatol Venereol.
2005;19:326–31. [PubMed: 15857459]

26. Syed TA, Ahmad SA, Holt AH, Ahmad SH, Afzal M. Management of psoriasis with Aloe vera extract
in a hydrophilic cream: A placebo­controlled, double­blind study. Trop Med Int Health. 1996;1:505–9.
[PubMed: 8765459]

27. Syed TA, Afzal M, Ashfaq AS. Management of genital herpes in men with 0.5% Aloe vera extract in a
hydrophilic cream A placebo­controlled double­blind study. J Derm Treatment. 1997;8:99–102.

28. Syed TA, Cheema KM, Ahmad SA, Ashfaq A. Aloe vera extract 0.5% in hydrophilic cream versus aloe
vera gel for the measurement of genital herpes in males: A placebo­controlled, double­blind, comparative
study. J Eur Acad Derm Venereol. 1996;7:294–5.

29. Visuthikosol V, Chowchuen B, Sukwanarat Y, Sriurairatana S, Boonpucknavig V. Effect of aloe vera

gel to healing of burn wound a clinical and historic study. J Med Assoc Thai. 1995;78:403–9.
[PubMed: 7561562]

30. Yeh GY, Eisenberg DM, Kaptchuk TJ, Phillips RS. Systematic review of herbs and dietary supplements
for glycemic control in diabetes. Diabetes Care. 2003;26:1277–94. [PubMed: 12663610]

31. Montaner JS, Gill J, Singer J. Double­blind placebo­controlled pilot trial of acemannan in advanced
human immunodeficiency virus disease. J Acquir Immune Defic Syn Hum Retrovirol. 1996;12:153–7.

32. Furukawa F, Nishikawa A, Chihara T, Shimpo K, Beppu H, Kuzuya H, et al. Chemopreventive effects
of Aloe arborescens on N­nitrosobis (2­oxopropyl) amine­induced pancreatic carcinogenesis in hamsters.
Cancer Lett. 2002;178:117–22. [PubMed: 11867195]

33. Fenig E, Nordenberg J, Beery E, Sulkes J, Wasserman L. Combined effect of aloe­emodin and
chemotherapeutic agents on the proliferation of an adherent variant cell line of Merkel cell carcinoma. Oncol
Rep. 2004;11:213–7. [PubMed: 14654928]

34. Langmead L, Feakins M, Goldthorpe S, Holt H, Tsironi E, De Silva A, et al. Randomized, double­blind,
placebo­controlled trial of oral aloe vera gel for active ulcerative colitis. Aliment Pharmacol Ther.
2004;19:739–47. [PubMed: 15043514]

35. Fulton J. The stimulation of postdermabrasion wound healing with stabilized aloe vera gel­polyethylene
oxide dressing. J Dermatol Surg Oncol. 1990;16:460–7. [PubMed: 2341661]

36. Thomas DR, Goode PS, LaMaster K, Tennyson T. Acemannan hydrogel dressing for pressure ulcers: A
randomized, controlled trial. Adv Wound Care. 1998;11:273–6. [PubMed: 10326343]

37. Hunter D, Frumkin A. Adverse reactions to Vit E and aloe vera preparations after dermabrasion and
chemical peel. Cutis. 1991;47:193–6. [PubMed: 2022130]

38. Schmidt JM, Greenspoon JS. Aloe vera dermal wound gel is associated with a delay in wound healing.
Obstet Gynecol. 1991;78:115–7. [PubMed: 2047051]

39. Su K, Mehta V, Ravikumar L, Shah R, Pinto H, Halpern J, et al. Phase II double­blind randomized
study comparing oral aloe vera versus placebo to prevent radiation­related mucositis in patients with head­
and­neck neoplasms. Int J Radiat Oncol Biol Phys. 2004;60:71–7. [PubMed: 15337553]

40. Bosley C, Smith J, Baratti P. A phase III trial comparing an anionic phospholipid­based (APP) cream
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2763764/?report=printable 6/7
 View publication stats

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and aloe vera­based gel in the prevention and treatment of radiation dermatitis. Int J Radiat Oncol Biol Phys.
2003;57:S4–38.

41. Bassett IB, Pannowitz DL, Barnetson RS. A comparative study of tea­tree oil versus benzoylperoxide in
the treatment of acne. Med J Aust. 1990;153:455–8. [PubMed: 2145499]

42. Hayes SM. Lichen planus: A report of successful treatment with aloe. Gen Dent. 1999;47:268–72.
[PubMed: 10687438]

43. McCauley RL, Heggers JP, Robson MC. Frostbite: Methods to minimize tissue loss. Postgrad Med.
1990;88:67–8. 73–7. [PubMed: 2243830]

44. Garnick JJ, Singh B, Winkley G. Effectiveness of a medicament containing silicon dioxide, aloe, and
allantoin on aphthous stomatitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;86:550–6.
[PubMed: 9830646]

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