Aloe Vera (Aloe barbadensis Miller)
1. Identity: Botanical Classification, Nomenclature, and Forms
1.1 Scientific and Common Names
The accepted scientific names for the common aloe plant include Aloe barbadensis Miller, Aloe vera L., and Aloe vera Tournefort ex Linné; the synonym Aloe vulgaris Lamarck (also known as Curacao or Barbados aloe) is also encountered in the literature. Other recognized species used commercially include Aloe ferox Miller (Cape aloe) and Aloe perryi Baker (Zanzibar or Socotrine aloe). Common names in English include "aloe vera," "burn plant," and "lily of the desert." In various languages and traditions it has been called Ghee-Kunwar, Hsiang-Dan, Kanya, and Kumari.
1.2 Botanical Description and Natural Source
Aloe vera is one of approximately 420 plant species of the genus Aloe; it is a stemless or very short-stemmed perennial succulent (xerophyte). The whole leaf of Aloe vera is composed of two primary components: the inner gel and the outer leaf latex. The main feature of the whole leaf is its high water content, ranging from 99.0% to 99.5%. However, the remaining 0.5%–1.0% of the plant leaf contains over 75 potentially bioactive ingredients, such as aloin, aloe-emodin, aloe rhein, and aloe polysaccharides.
This herbaceous plant belongs to the Asphodelaceae family, previously classified as Liliaceae. Although Aloe vera originated in the warm, dry climates of Africa, the plant is readily adaptable and grows worldwide. Aloe vera has since spread to many parts of the world through trade and human migration, and is now cultivated in many tropical and subtropical regions including India, Mexico, China, South America, Spain, and Italy.
1.3 Plant Anatomy: Gel vs. Latex
Aloe products can be made from various parts of the aloe leaf, including the gel (from the inner leaf), latex (from the leaf's outer layer), and whole crushed leaf (containing both the gel and latex). These two fractions—gel and latex—have fundamentally different chemical compositions and safety profiles. The inner colorless gel is the basis for most topical and many oral preparations; the yellow-green latex (also called "aloe juice" or "dried aloe" in older texts) is located in the cells just beneath the outer green rind and contains the anthraquinone glycosides responsible for cathartic activity.
1.4 Common Preparations and Dosage Forms
Commercial topical forms include topical cream, topical gel, topical liquid, topical lotion, topical soap, topical spray, and mucous membrane preparations for oral wound rinse. Oral preparations include raw gel, juice, capsules, tablets, and powdered extracts. Use of Aloe vera gel extracts in health foods and beverages and moisturizing cosmetics began during the 1970s, starting in the USA and parts of Europe. In Western society, Aloe vera is one of the few herbal medicines in common usage, and it has found widespread use in the cosmetic, pharmaceutical, and food industries.
2. Traditional and Historical Use
2.1 Earliest Documented Records
The first record of human use of Aloe vera is in Sumerian hieroglyphics engraved on clay tablets during the Mesopotamia civilization circa 2200 BC, in which it is described as a laxative. Use of aloe in ancient times is also documented in Egypt, Greece, and China.
Aloe vera, known as the "plant of immortality" in early Egypt, has been used as a traditional medicine in Arab, Chinese, Egyptian, Greek, Indian, Japanese, Korean, and Roman cultures for more than 2000 years to empirically treat a broad list of disorders and ailments, such as skin problems (wounds, X-ray and radium burns, and psoriasis), constipation, external and internal ulcers, hyperlipidemia, diabetes, and lupus erythematosus.
2.2 Ancient Egypt and the Mediterranean World
Aloe vera has been used for medicinal purposes in several cultures for millennia — Greece, Egypt, India, Mexico, Japan, and China. 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. Aloe vera was also used in ancient times to embalm the dead, as well as to protect embalmers from pathogens. Other early civilizations used it for skin care, to relieve insect stings and bites, to treat scratches and ulcerated skin, to promote wound healing, to prevent hair loss, and as a purgative.
Greek botanist Dioscorides, in his De Materia Medica (circa 40–90 CE), recorded its use for burns, stomach issues, and more, highlighting the wide range of applications of aloe vera in traditional medicine.
2.3 Traditional Indian Medicine (Ayurveda)
It is used in traditional Indian medicine for constipation, colic, skin diseases, worm infestation, and infections. In India, Ayurvedic healers called it "kumari" (meaning "princess" for its renewing qualities) and used it for skin issues, menstrual problems, and digestion. In Ayurveda, Aloe vera is revered as the "wand of heaven" or "heaven's blessing" and precisely the "silent healer."
2.4 Traditional Chinese Medicine
In Traditional Chinese Medicine (TCM), Aloe vera is acknowledged for its abundant bioactive substances that have considerable therapeutic value. In ancient China, aloe vera — called "lu hui" — was used for skin conditions and constipation. In Chinese medicine, it is often recommended in the treatment of fungal diseases.
2.5 Other Cultures and Traditions
It is also used in Trinidad and Tobago for hypertension and among Mexican Americans for the treatment of type 2 diabetes mellitus. It was the traditional medicine of many cultures as an anthelmintic, cathartic, and stomachic, and was used for leprosy, burns, and allergic conditions.
2.6 Introduction to the Caribbean and North America
Aloe vera was cultivated on the islands of Barbados and Curaçao in the Caribbean by Spain and the Netherlands, and was sold in various parts of Europe during the 17th century. Commercial cultivation of Aloe vera in the USA began in the 1920s in Florida. Aloe vera first gained popularity in the USA in the 1930s with reports of successful use of freshly cut leaves in treating X-ray burns.
3. Key Constituents and Active Compounds
Aloe vera contains several bioactive compounds, including polysaccharides, vitamins, minerals, enzymes, and amino acids, each contributing to its therapeutic effects. The most investigated active compounds are aloe-emodin, aloin, aloesin, emodin, and acemannan.
3.1 Polysaccharides (Including Acemannan)
The mucopolysaccharides are derived from the mucilage layer of the plant. The most prominent monosaccharide is mannose-6-phosphate, and the most common polysaccharides are called glucomannans [beta-(1,4)-acetylated mannan]. Acemannan, a prominent glucomannan, has also been identified.
Acemannan (AC) is considered to be a natural polysaccharide with good biodegradability and biocompatibility extracted from Aloe vera; it has a wide range of applications in the biomedical field due to excellent immunomodulatory, antiviral, antitumor, and tissue regeneration effects. Acemannan, considered one of the main bioactive polysaccharides of Aloe vera, possesses immunoregulation, anti-cancer, anti-oxidation, wound healing and bone proliferation promotion, neuroprotection, and intestinal health promotion activities, among others.
Acemannan is a strong plant-based immunomodulator that controls various immunological reactions and has various pharmacological roles in combination with other bioactive compounds. Acemannan acts as a modulator of the immune system by increasing macrophage cytokine production, expression of surface markers, and nitric oxide release. Many of the health benefits associated with Aloe vera have been attributed to the polysaccharides contained in the gel of the leaves. These biological activities include promotion of wound healing, antifungal activity, hypoglycemic or antidiabetic effects, anti-inflammatory properties, anticancer effects, immunomodulatory properties, and gastroprotective properties.
3.2 Anthraquinones
Aloe vera provides 12 anthraquinones, which are phenolic compounds traditionally known as laxatives. Aloin and emodin act as analgesics, antibacterials, and antivirals. Aloin is converted by gut bacteria to aloe-emodin, which stimulates colonic motility and fluid secretion, producing the laxative effect. The well-established cathartic properties of anthraquinone glycosides provide strong evidence in support of the laxative properties of Aloe vera.
3.3 Phytosterols (Fatty Acids)
Aloe vera provides 4 plant steroids: cholesterol, campesterol, β-sitosterol, and lupeol. All of these have anti-inflammatory action; lupeol also possesses antiseptic and analgesic properties.
3.4 Hormones
Auxins and gibberellins present in Aloe vera help in wound healing and exert anti-inflammatory action.
3.5 Glycoproteins and Other Phenolic Compounds
A glycoprotein with antiallergic properties, called alprogen, and a novel anti-inflammatory compound, C-glucosyl chromone, have been isolated from Aloe vera gel. Aloe vera also contains salicylic acid, which possesses anti-inflammatory and antibacterial properties. Lignin, an inert substance, when included in topical preparations, enhances the penetrative effect of the other ingredients into the skin. Saponins, the soapy substances, form about 3% of the gel and have cleansing and antiseptic properties.
While the polysaccharides present in the inner gel — particularly acemannan — have been credited for many of the therapeutic effects of Aloe vera, other constituents such as lectins, alkaloids, anthraquinones, anthrones, chromones, coumarins, and polyphenols also contribute to its diverse and numerous benefits.
3.6 Amino Acids and Nutrients
Aloe vera gel provides 20 of the 22 human-required amino acids and 7 of the 8 essential amino acids.
4. Scientific Evidence by Area of Use
Aloe vera has been traditionally used to treat skin injuries (burns, cuts, insect bites, and eczemas) and digestive problems because of its anti-inflammatory, antimicrobial, and wound healing properties. Research on this medicinal plant has been aimed at validating traditional uses and deepening the mechanism of action, identifying the compounds responsible for these activities. Most recent works are in vitro and in vivo. Clinical trials have been conducted only with Aloe vera whole preparations, and not with isolated compounds; therefore, it would be interesting to study the clinical effect of relevant metabolites in different human conditions and pathologies.
4.1 Skin: Burns and Wound Healing
Clinical evidence: Aloe vera has been traditionally used for burn healing, but clinical evidence has remained unclear. A systematic review was conducted to determine the efficacy of topical aloe vera for the treatment of burn wounds. Four studies with a total of 371 patients were included in this review. Based on a meta-analysis using duration of wound healing as an outcome measure, the summary weighted mean difference in healing time in the aloe vera group was 8.79 days shorter than those in the control group (P = 0.006).
Due to the differences in products and outcome measures, there is paucity of evidence sufficient to draw a specific conclusion regarding the effect of aloe vera on burn wound healing. However, cumulative evidence tends to support that aloe vera might be an effective intervention in burn wound healing for first- to second-degree burns. Further, well-designed trials with sufficient detail on the contents of aloe vera products should be carried out to determine its effectiveness.
In a systematic review of 23 clinical trials meeting inclusion criteria, the results showed that Aloe vera has been used to prevent skin ulcers and to treat burn wounds, postoperative wounds, cracked nipples, genital herpes, psoriasis, and chronic wounds including pressure ulcers.
Five studies specifically investigated burn wound healing. In these studies, Aloe vera was more effective than petroleum jelly gauze dressing, silver sulfadiazine 1% ointment, and framycetin cream.
Evidence limitations: Collectively, there is little high-level evidence to support the use of Aloe vera topical agents or aloe-derived dressings in the treatment of acute and chronic wounds. There is currently insufficient clinical trial evidence available regarding the effects of Aloe vera topical agents or dressings as treatments for acute and chronic wounds. This is primarily due to the lack of high-quality trials with adequate methodology. The measurement of outcomes was subjective, and clinicians were, in general, not blinded to intervention category, thereby introducing the possibility of measurement bias.
Overall, clinical research suggests topical application of aloe gel may speed burn healing and reduce burn-related pain. Whether it promotes wound healing more broadly is unclear.
4.2 Skin: Psoriasis, Lichen Planus, and Other Dermatological Conditions
A small amount of research suggests topical use of aloe also may help people with genital herpes, lichen planus, psoriasis, oral submucous fibrosis, skin damage from radiation therapy, or sores in the mouth from dental appliances.
Aloe gel has been studied as a topical treatment for oral lichen planus, with some studies demonstrating reduced pain, burning sensation, and clinical improvement compared to placebo. While the evidence is more consistent here than for some other indications, the studies remain small and additional research is needed. One systematic review and meta-analysis examining the effect of topical aloe vera in clinical improvement in those with symptomatic oral lichen planus found weak evidence that aloe vera is more efficient than placebo in the treatment of oral lichen planus but results were described as promising, especially since it has no adverse effects.
Topical aloe vera's application to radiation-induced skin injury has been studied: Topical application of aloe vera is not an effective preventive for radiation-induced injuries.
Topical aloe appears to inhibit infection and promote healing of minor burns and wounds, frostbite, striae gravidum, and skin affected by diseases such as psoriasis and seborrheic dermatitis, although studies have had conflicting results.
4.3 Gastrointestinal System: Constipation and Laxative Use
The World Health Organization (WHO) lists the short-term treatment of occasional constipation as a use for Aloe vera latex that is supported by clinical data. In 2002, the US Food and Drug Administration (FDA) issued a final rule stating that use of Aloe as a nonprescription laxative drug is no longer generally recognized as safe and effective. In 2002, the U.S. Food and Drug Administration issued a ruling that required manufacturers to remove aloe latex from over-the-counter laxative products because of a lack of safety data.
4.4 Gastrointestinal System: Gastroesophageal Reflux Disease (GERD)
A review by Mahboubi (2021) summarizes studies regarding the effectiveness of Aloe vera gel in the management of GERD. It comprises five clinical studies in patients suffering from GERD treated with 10 mL of Aloe vera gel syrup twice daily, in comparison to omeprazole, ranitidine, pantoprazole, or aluminum–magnesium hydroxide. It was found that Aloe vera gel syrup significantly eliminated GERD symptoms without any adverse effects, when compared with omeprazole or ranitidine. This preparation was found to be safe and well tolerated, reducing the frequencies of all assessed GERD symptoms, with no side events requiring withdrawal.
4.5 Gastrointestinal System: Irritable Bowel Syndrome (IBS) and Ulcerative Colitis
In a 3-month randomized controlled trial of 58 patients with irritable bowel syndrome, no evidence was found to suggest that Aloe vera has any beneficial effect.
A randomized controlled trial of 44 subjects with mild to moderately active ulcerative colitis produced encouraging, although not conclusive, results. The oral administration twice daily of 100 mL of Aloe vera gel to 30 subjects for 4 weeks generated clinical remission and improvement.
There is interest in using aloe for many other conditions, but there isn't enough reliable information to say whether it might be helpful for those conditions, which include eczema, diabetic foot ulcers, irritable bowel syndrome, and ulcerative colitis.
4.6 Metabolic Health: Diabetes and Blood Glucose
Clinical evidence: A systematic search of PubMed, Embase, and Cochrane Central Register of Controlled Trials identified a total of five randomized controlled trials (RCTs) involving 415 participants. Compared with controls, aloe vera supplementation significantly reduced the concentrations of fasting blood glucose (FBG) (p = 0.02; weighted mean difference [WMD]: −30.05 mg/dL; 95% CI: −54.87 to −5.23 mg/dL), glycosylated hemoglobin A1c (HbA1c) (p < 0.00001; WMD: −0.41%; 95% CI: −0.55% to −0.27%), triglyceride, total cholesterol (TC), and low-density lipoprotein-cholesterol (LDL-C). Aloe vera was superior to placebo in increasing serum high-density lipoprotein-cholesterol (HDL-C) levels (p = 0.04).
Evidence presented in multiple supported clinical trials proved a mean reduction in HbA1c of −0.99% (95% CI: −1.75, −0.23) with Aloe vera leaf gel, placing it at the top of the most efficient natural remedies for long-term glycemic regulation in type 2 diabetes mellitus.
One double-blind RCT in pre-diabetic subjects used capsules twice daily in three groups: Aloe vera 300 mg (AL300), 500 mg (AL500), and placebo (PL). Fasting blood glucose (FBS), HbA1c, and lipid profile were evaluated at baseline, 4 weeks, and 8 weeks.
Evidence limitations: The results of systematic reviews are controversial. Two systematic reviews supported the use of oral aloe vera for significantly reducing fasting blood glucose, and the other two showed limited evidence for the effectiveness of oral and topical aloe vera. The effects are not sufficiently defined, and the inconsistent results of previous systematic reviews indicate that the results must be interpreted with caution. The available meta-analyses suggest that Aloe vera has a therapeutic and consistent effect on glycemic control, but short-term FBG was markedly influenced by the variations of prevention protocols. Therefore, prolonged HbA1c reduction is consistently promising, emphasizing the need for further clinical trials to implement standardized preparations, stable and steady doses, and surveillance periods longer than 8 weeks.
A small amount of research suggests that aloe taken orally may reduce blood sugar and HbA1c in people with diabetes. A small study showed that a specific aloe gel product taken orally for 8 weeks modestly reduced weight and fat mass in adults with obesity or overweight who had diabetes or prediabetes.
4.7 Oral Health: Oral Submucous Fibrosis and Dental Applications
Aloe vera extract (50%) increased cell viability of dental pulp stem cells, which may be useful for avulsed broken teeth. This effect is attributed to polysaccharides, mainly acemannan, by inducing osteogenic-specific gene expressions, DNA synthesis, growth factor, and JAK-STAT pathway activation.
Topical aloe vera gel was applied to the oral mucosa 3 times daily for 3 months in a study of oral submucous fibrosis. Burning sensation (P = 0.001), mouth opening (P = 0.004), and tongue protrusion (P = 0.001) were improved significantly in the topical aloe group compared to the oral antioxidant comparator.
4.8 Immune Modulation and Anticancer Research
New pharmacological data research has shown that most studies refer to anti-cancer action, skin and digestive protective activity, and antimicrobial properties. The two fractions from aloe claimed to have anti-cancer effects include glycoproteins (lectins) and polysaccharides. The anti-tumour activity of polysaccharides isolated from Aloe vera and specifically acemannan has been investigated in many in vitro models as well as in different animal species. Different studies have indicated anti-tumour activity for Aloe vera gel in terms of reduced tumour burden, tumour shrinkage, tumour necrosis, and prolonged survival rates.
The promising results of these studies in basic research encourage a greater number of clinical trials to test the clinical application of Aloe vera and its main compounds, particularly on bone protection, cancer, and diabetes. It is important to note that anticancer evidence for Aloe vera in humans is, as of the most recent reviews, predominantly limited to in vitro and animal models; robust human clinical trial data are lacking.
4.9 Acne
Two small studies suggest that topical application of aloe gel, in combination with other forms of treatment, may improve acne.
5. Body Systems and Health Areas Associated with Aloe Vera
- Integumentary system (skin): Burns, wound healing, psoriasis, seborrheic dermatitis, lichen planus, genital herpes, acne, radiation dermatitis, oral submucous fibrosis, frostbite.
- Gastrointestinal system: Constipation (latex/anthraquinone action), GERD, irritable bowel syndrome, ulcerative colitis, peptic ulcer.
- Endocrine/metabolic system: Blood glucose regulation, lipid profile improvement in pre-diabetes and type 2 diabetes.
- Immune system: Immunomodulation (primarily via acemannan), potential antiviral and antimicrobial effects.
- Oral/dental: Gingivitis, lichen planus of the mouth, oral mucositis, dental pulp cell viability.
Conditions for which some scientific evidence exists include seborrheic dermatitis, psoriasis vulgaris, genital herpes, skin burns, diabetes (type 2), HIV infection, cancer prevention, ulcerative colitis, wound healing (with mixed results), pressure ulcers, mucositis, radiation dermatitis, acne vulgaris, lichen planus, frostbite, aphthous stomatitis, and constipation.
6. Dosage Forms and Dosages Reported in Clinical Studies
There is no established standard dose for aloe vera, as the appropriate amount depends on the form, preparation method, and intended use.
- Oral aloe vera gel for GERD: Ten mL of Aloe vera gel syrup twice daily, studied in five clinical trials against standard pharmacological comparators.
- Oral aloe vera gel for ulcerative colitis: 100 mL of Aloe vera gel administered orally twice daily for 4 weeks in 30 subjects in one RCT.
- Oral capsules for metabolic syndrome/blood sugar: 500 mg twice daily for 8 weeks has been reported as a dosage studied in metabolic syndrome trials.
- Oral capsules for pre-diabetes: Aloe vera 300 mg and 500 mg capsules twice daily were studied in a double-blind RCT of 72 subjects with pre-diabetic symptoms.
- Topical gel for oral submucous fibrosis: Topical aloe vera gel was applied to the oral mucosa 3 times daily for 3 months.
- Topical preparations for burns: Various clinical trials have employed aloe vera gel, cream, or derivatives that included a control group with placebo or comparison with other treatments. Specific concentrations and formulations varied across trials.
- Oral safety data: Research studies suggest that short-term use of oral aloe gel up to 42 days is safe.
7. Safety Considerations and Drug Interactions
7.1 Gel vs. Latex: Distinct Safety Profiles
The inner leaf gel and outer leaf latex have distinct properties and very different safety profiles. While aloe gel is generally safe and shows preliminary benefits for GERD, blood sugar, and topical skin conditions, aloe latex carries significant risks including potential carcinogenicity. Understanding the difference between gel and latex is critical for safe use.
7.2 Adverse Effects of Oral Aloe Preparations
Ingestion of Aloe preparations is associated with diarrhea, hypokalemia, pseudomelanosis coli, kidney failure, as well as phototoxicity and hypersensitive reactions. Oral use of aloe latex can cause abdominal pain, cramps, and diarrhea. Oral consumption of aloe leaf extracts (for as little as 3 weeks and as long as 5 years) has been related to cases of acute hepatitis.
Taking 1 g a day of aloe latex for several days can cause kidney damage and might be fatal. There have been a few case reports of acute hepatitis from this product when taken orally, although evidence is not definitive.
7.3 Carcinogenicity Classification
Aloe vera whole leaf extract showed clear evidence of carcinogenic activity in rats and was classified by the International Agency for Research on Cancer as a possible human carcinogen (Group 2B). This review presents updated information on the toxicological effects, including the cytotoxicity, genotoxicity, carcinogenicity, and adverse clinical effects of Aloe vera whole leaf extract, gel, and latex.
The International Agency for Research on Cancer has classified whole leaf extract of Aloe vera as a possible human carcinogen. This form, called non-decolorized, has not undergone activated carbon treatment to remove toxic anthraquinone components. Some animal studies have noted an association between a non-decolorized extract of aloe vera leaf taken orally and gastrointestinal cancer in rats and mice; most toxicity and safety studies in animals have tested non-decolorized whole leaf extract of aloe vera, which is not commonly used by consumers.
Due to its widespread human exposure and concerns that some components may cause cancer, in 1998 the National Cancer Institute nominated Aloe vera as a high-priority candidate for a carcinogenicity study under the National Toxicology Program (NTP).
7.4 Topical Safety
Topical use of aloe gel is generally well tolerated; however, there have been occasional reports of burning, itching, rash, and eczema. Topical aloe preparations are not recommended for treating deep vertical wounds: Aloe vera gel has been shown to delay wound healing in cases of surgical wounds such as those produced during laparotomy or cesarean delivery.
7.5 Populations Requiring Particular Caution
The oral use of aloe latex and whole-leaf extracts is possibly unsafe for children, as it may cause abdominal pain, cramps, and diarrhea in children under 12 years of age. During pregnancy, oral use of aloe is considered possibly unsafe due to the presence of irritant, cathartic, and potential mutagenic effects of anthraquinones found in aloe latex and whole-leaf extracts. Anecdotal reports and animal research suggest that these substances may induce abortion and stimulate menstruation. For lactating individuals, the oral use of aloe preparations is possibly unsafe. Cathartic and mutagenic anthraquinones present in aloe latex and whole-leaf extracts might pass into breast milk.
Due to the irritating effect of its anthranoid aloins, aloe dried juice/latex should not be used by individuals with intestinal obstruction, Crohn's disease, ulcerative colitis, appendicitis, peptic ulcers, abdominal pain of unknown origin, nausea, vomiting, hemorrhoids, or kidney disease.
7.6 Drug Interactions
Due to the hypoglycemic effects of internally consumed Aloe vera gel, persons using glyburide drugs to control blood sugar (e.g., Diabeta, Micronase, Glynase) should monitor blood glucose levels closely. Orally administered aloe dried juice/latex causes a shorter gastrointestinal transit time and may reduce the absorption of some drugs.
When taken orally for prolonged periods with diuretics or digoxin, aloe can lead to low blood levels of potassium (hypokalemia) due to diarrhea. When combined with sevoflurane, an inhaled general anesthetic used in surgery, aloe vera may cause excessive bleeding due to its anti-platelet effect. It increases the effects of the blood thinner warfarin and can cause excessive bleeding.
Potential for adverse effects exists when aloe dried juice/latex is used excessively along with herbs containing cardiac glycosides (e.g., black hellebore, Canadian hemp roots, digitalis leaf, pheasant's eye plant, pleurisy root, squill bulb leaf scales, and strophanthus seeds) or with other cardiac medications.
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