Aloe Vera

Purported Benefits, Side Effects & More
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Aloe Vera

Purported Benefits, Side Effects & More
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Aloe Vera

Common Names

  • Aloe gel
  • aloe leaf

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For Patients & Caregivers

Tell your healthcare providers about any dietary supplements you’re taking, such as herbs, vitamins, minerals, and natural or home remedies. This will help them manage your care and keep you safe.

What is it?

Aloe vera is a succulent plant that’s used in traditional medicine. The clear gel from its leaves can be put on the skin as a moisturizer and to treat burns. Some people drink aloe vera juice as a laxative (something that helps you poop). Aloe latex (yellow substance that comes from just under the plant’s skin) is also used as a laxative.

You can inject aloe vera into your body as an alternative cancer therapy, but this can cause severe side effects including death.

What are the potential uses and benefits?

Aloe vera gel (put on the skin) is used:

  • To treat burns
  • To reduce swelling, itchiness, or redness
  • To reduce redness, rashes, and itchy skin caused by radiation therapy. It’s also used to decrease redness and swelling of mouth caused by chemotherapy.
  • To improve blood sugar level in patients with diabetes (when taken by mouth)

Aloe vera has other uses that haven’t been studied by doctors to see if they work.

It’s generally safe to use aloe vera as a gel on your skin. But taking supplements or giving yourself an aloe vera injection (shot) can cause serious side effects.

Herbal supplements can also interact with some medications and affect how they work. For more information, read the “What else do I need to know?” section below.

What are the side effects?

Side effects of taking aloe vera supplements by mouth may include:

  • Stomach pain
  • Nausea (feeling like you’re going to throw up)
  • Vomiting (throwing up)
  • Seizure (uncontrollable shaking or stiffening of your body)
  • Low blood potassium levels
  • Abnormal liver function
What else do I need to know?
  • Let your healthcare provider know if you are taking sevoflurane (Ultane®). This is an anesthetic (medication to make you sleep during surgery). Aloe vera may cause excessive bleeding during surgery.
  • Aloe vera isn’t an effective cancer treatment, and it should not be taken as a supplement or injection because it can cause serious side effects.
  • Pregnant women should not take aloe vera as its safety is not known.
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For Healthcare Professionals

Scientific Name
Aloe vera, Aloe barbadensis, Aloe capensis
Clinical Summary

Aloe vera is a perennial, succulent plant that resembles a cactus and is used in traditional medicine throughout the world. The clear thick gel obtained from aloe leaves is used for wound healing, to treat burns, psoriasis, frostbite, ulcerative colitis, diabetes and to relieve constipation. Aloe demonstrated antioxidant and anti-inflammatory properties in vitro (9).

In clinical studies, topical aloe was superior to silver sulfadiazine creams for second-degree burns (21), equally effective as an estrogen cream against vaginal atrophy in menopausal women (48), useful for skin graft donor-site healing (38) and improving symptoms of acute radiation proctitis in patients receiving radiotherapy (39) as well as postoperative pain and discomfort following pilonidal sinus excision (45).  Additionally, an aloe vera dressing was found superior to conventional dressing for reducing pressure ulcer pain (60). 

In a study of patients with systolic heart failure, adjunctive use of oral aloe vera improved QOL (61).

Aloe vera mouthwash reduced plaque and gingivitis with the effects comparable to chlorhexidine (46) (53). Systematic reviews also determined benefits of aloe vera against oral ulcers (54), oral submucous fibrosis (41) (55) and oral lichen planus (37). In addition, aloe gel complex reduced body weight and insulin resistance in obese individuals with pre-diabetes or early untreated diabetes mellitus (29), prevented pressure ulcers in hospitalized orthopedic patients at risk of developing such ulcers (42) and traumatic oral ulceration in patients with fixed orthodontic appliances (47), along with accelerating split-thickness skin graft donor-site healing (43). Adjuvant use of aloe may improve quality of life in patients with systolic heart failure (56).

Constituents of aloe, such as acemannan, emodin, aloeride,and di(2-ethylhexyl)phthalate (DEHP) also have immunomodulating and anticancer effects  (4) (5) (7) (8) (34) (35). Preliminary findings suggest benefits of aloe in preventing chemo-induced oral mucositis in adults (23) (51). Studies in pediatric patients reported similar benefit (52) and case reports show reduction in chemo-induced hyperpigmentation (62). It may also help improve tumor regression rate and survival in those with metastatic cancers (20). However, studies of aloe for radiation-induced skin damage produced mixed results (1) (2) (3) (32) (36) (44) (49) (57) (58) (59) (63).

Purported Uses and Benefits
  • Burns
  • Inflammation
  • Cancer treatment side effects
  • Diabetes
Mechanism of Action

Several studies have been conducted to explore the mechanisms of action of aloe.
Oligosaccharides isolated from aloe extracts were found to prevent ultraviolet radiation-induced suppression of delayed type hypersensitivity by reducing keratinocyte-derived immunosuppressive cytokines (25). Proposed mechanism underlying anti-psoriatic effect includes inhibition of tumor necrosis factor (TNF)‑alpha‑induced proliferation of keratinocytes and overactivation of the nuclear factor (NF‑kappa B signaling pathway, by an aloe polysaccharide (40). And a polymer fraction of aloe was shown to protect the gastric mucosa against ethanol-induced gastric damage by decreasing mRNA expression levels of inducible nitric oxide synthase (iNOS), neuronal nitric oxide synthase (nNOS), and matrix metalloproteinase (MMP-9). The three enzymes are critical biomarkers in gastric ulceration (26). Other findings suggest that the radio-protective effects of aloe polysaccharides are most likely due to inhibition of apoptosis (27).

Emodin, an extract of Aloe vera, was shown to inhibit cell proliferation and induce apoptosis in human liver cancer cell lines through p53- and p21-dependent pathways (4). Acemannan, a carbohydrate fraction derived from Aloe vera leaf, was found to stimulate cytokine production in mouse macrophage cell line (5). It also exhibited immunomodulating activity by inducing maturation of dendritic cells (6). And aloeride, a polysaccharide obtained from aloe vera juice, was reported to be a potent immunostimulator that acts by enhancing NF-kappa B activities (7). In addition, di(2-ethylhexyl)phthalate (DEHP), isolated from Aloe vera, inhibited leukemic cells, in vitro (8).

Warnings
  • Aloe gel should not be confused with aloe juice or aloe latex, both of which contain anthraquinone, a cathartic laxative.
  • Internal use of aloe should be discouraged due to possible adverse effects and inconclusive clinical data.
  • Aloe injections for cancer patients have resulted in several deaths.
  • The FDA has ruled that aloe is not safe as a stimulant laxative (14).
Contraindications

Pregnant women should avoid consumption of aloe vera (50).

Adverse Reactions
  • Thyroid dysfunction  (10), liver injury  (33) and acute hepatitis  (11): Associated with inappropriate use of aloe supplements.
  • Hypokalemia: Following use of aloe vera during chemotherapy (19). Hypokalemia resolved after stopping aloe.
  • Toxic hepatitis: In three adults, after using aloe preparations for several months. Their liver enzymes normalized after discontinuing aloe (22).
Herb-Drug Interactions
  • Cytochrome P450 substrates: Aloe juice inhibited CYP3A4 and CYP2D6 and may affect the intracellular concentration of drugs metabolized by these enzymes (24). Clinical relevance is not known.
  • Sevoflurane: Excessive intraoperative bleeding was reported in a patient after oral consumption of aloe vera tablets (12).
Dosage (OneMSK Only)
References
  1. Heggie S, Bryant GP, Tripcony L, Keller J, Rose P, Glendenning M, et al. A Phase III study on the efficacy of topical aloe vera gel on irradiated breast tissue. Cancer Nurs. 2002 Dec;25(6):442-51.
  2. Olsen DL, Raub W, Jr., Bradley C, Johnson M, Macias JL, Love V, et al. The effect of aloe vera gel/mild soap versus mild soap alone in preventing skin reactions in patients undergoing radiation therapy. Oncol Nurs Forum. 2001 Apr;28(3):543-7.
  3. Williams MS, Burk M, Loprinzi CL, Hill M, Schomberg PJ, Nearhood K, et al. Phase III double-blind evaluation of an aloe vera gel as a prophylactic agent for radiation-induced skin toxicity. Int J Radiat Oncol Biol Phys. 1996 Sep 1;36(2):345-9.
  4. Kuo PL, Lin TC, Lin CC. The antiproliferative activity of aloe-emodin is through p53-dependent and p21-dependent apoptotic pathway in human hepatoma cell lines. Life Sci. 2002 Sep 6;71(16):1879-92
  5. Zhang L, Tizard IR. Activation of a mouse macrophage cell line by acemannan: the major carbohydrate fraction from Aloe vera gel. Immunopharmacology. 1996 Nov;35(2):119-28.
  6. Lee JK, Lee MK, Yun YP, Kim Y, Kim JS, Kim YS, et al. Acemannan purified from Aloe vera induces phenotypic and functional maturation of immature dendritic cells. Int Immunopharmacol. 2001 Jul;1(7):1275-84.
  7. Pugh N, Ross SA, ElSohly MA, Pasco DS. Characterization of Aloeride, a new high-molecular-weight polysaccharide from Aloe vera with potent immunostimulatory activity. J Agric Food Chem. 2001 Feb;49(2):1030-4.
  8. Lee KH, Kim JH, Lim DS, Kim CH. Anti-leukaemic and anti-mutagenic effects of di(2-ethylhexyl)phthalate isolated from Aloe vera Linne. J Pharm Pharmacol. 2000 May;52(5):593-8.
  9. Yagi A, Kabash A, Okamura N, Haraguchi H, Moustafa SM, Khalifa TI. Antioxidant, free radical scavenging and anti-inflammatory effects of aloesin derivatives in Aloe vera. Planta medica. 2002 Nov;68(11):957-60.
  10. Pigatto PD, Guzzi G. Aloe linked to thyroid dysfunction. Archives of medical research. 2005 Sep-Oct;36(5):608.
  11. Rabe C, Musch A, Schirmacher P, Kruis W, Hoffmann R. Acute hepatitis induced by an Aloe vera preparation: a case report. World J Gastroenterol. 2005 Jan 14;11(2):303-4.
  12. Lee A, Chui PT, Aun CS, Gin T, Lau AS. Possible interaction between sevoflurane and Aloe vera. Ann Pharmacother. 2004 Oct;38(10):1651-4.
  13. Anon. License revoked for aloe vera use. Nat Med Law 1998;1:1-2.
  14. Food and Drug Administration, HHS. Status of Certain Additional Over-the-Counter Drug Category II and III Active Ingredients. Fed Regist 2002 May 9;67(90):31125-7.
  15. Brinker F. Herb Contraindications and Drug Interactions, 3rd ed. Sandy (OR): Eclectic Med; 2001.
  16. Robbers JE, et al. Pharmacognosy and pharmacobiotechnology. Baltimore: Williams & Wilkins; 1996.
  17. Foster S, et al. Tyler’s Honest Herbal: A Sensible Guide to the Use of Herbs and Related Remedies. New York: Haworth Herbal Press; 1999.
  18. Tyler, V. Herbs of Choice, the Therapeutical Use of Phytomedicinals. Binghamton, New York: Pharmaceutical Press; 1994.
  19. Baretta Z, Ghiotto C, Marino D, Jirillo A. Aloe-induced hypokalemia in a patient with breast cancer during chemotherapy. Ann Oncol 2009 Aug;20(8):1445-6.
  20. Lissoni P, Rovelli F, Brivio F, et al. A randomized study of chemotherapy versus biochemotherapy with chemotherapy plus Aloe arborescens in patients with metastatic cancer. In Vivo. 2009 Jan-Feb;23(1):171-5.
  21. Khorasani G, Hosseinimehr SJ, Azadbakht M, Zamani A, Mahdavi MR. Aloe versus silver sulfadiazine creams for second-degree burns: a randomized controlled study. Surg Today. 2009;39(7):587-91.
  22. Yang HN, Kim DJ, Kim YM, et al. Aloe-induced toxic hepatitis. J Korean Med Sci. 2010 Mar;25(3):492-5.
  23. Worthington HV, Clarkson JE, Bryan G, et al. Interventions for preventing oral mucositis for patients with cancer receiving treatment. Cochrane Database Syst Rev. 2011 Apr 13;(4):CD000978.
  24. Djuv A, Nilsen OG. Aloe Vera Juice: IC(50) and Dual Mechanistic Inhibition of CYP3A4 and CYP2D6. Phytother Res. 2011 Aug 15. doi: 10.1002/ptr.3564.
  25. Byeon SW, Pelley RP, Ullrich SE, et al. Aloe barbadensis extracts reduce the production of interleukin-10 after exposure to ultraviolet radiation. J Invest Dermatol. 1998 May;110(5):811-7.
  26. Park CH, Nam DY, Son HU, et al. Polymer fraction of Aloe vera exhibits a protective activity on ethanol-induced gastric lesions. Int J Mol Med. 2011 Apr;27(4):511-8.
  27. Wang ZW, Zhou JM, Huang ZS, et al. Aloe polysaccharides mediated radioprotective effect through the inhibition of apoptosis. J Radiat Res. 2004 Sep;45(3):447-54.
  28. Boudreau MD, Beland FA, Nichols JA, Pogribna M. Toxicology and Carcinogenesis Studies of a Nondecolorized Whole Leaf Extract of Aloe Barbadensis Miller (Aloe Vera) in F344/N Rats and B6C3F1 Mice  Natl Toxicol Program Tech Rep Ser. 2013 Aug;(577):1-266.
  29. Choi HC, Kim SJ, Son KY, Oh BJ, Cho BL. Metabolic effects of aloe vera gel complex in obese prediabetes and early non-treated diabetic patients: randomized controlled trial. Nutrition. 2013 Sep;29(9):1110-4.
  30. Luo J, Yuan Y, Chang P, et al. Combination of aloe-emodin with radiation enhances radiation effects and improves differentiation in human cervical cancer cells. Mol Med Rep. 2014 Aug;10(2):731-6.
  31. Hamman JH. Composition and applications of Aloe vera leaf gel. Molecules. 2008 Aug 8;13(8):1599-616. Review.
  32. Hoopfer D, Holloway C, Gabos Z, et al. Three-Arm Randomized Phase III Trial: Quality Aloe and Placebo Cream Versus Powder as Skin Treatment During Breast Cancer Radiation Therapy. Clin Breast Cancer. 2014 Dec 24. pii: S1526-8209(14)00287-0.
  33. Teschke R, Genthner A, Wolff A, Frenzel C, Schulze J, Eickhoff A. Herbal hepatotoxicity: analysis of cases with initially reported positive re-exposure tests. Dig Liver Dis. 2014 Mar;46(3):264-9.
  34. Im SA, Kim JW, Kim HS, et al. Prevention of azoxymethane/dextran sodium sulfate-induced mouse colon carcinogenesis by processed Aloe vera gel. Int Immunopharmacol. 2016 Nov;40:428-435.
  35. Chang X, Zhao J, Tian F, et al. Aloe-emodin suppresses esophageal cancer cell TE1 proliferation by inhibiting AKT and ERK phosphorylation. Oncol Lett. 2016 Sep;12(3):2232-2238.
  36. Ferreira EB, Vasques CI, Gadia R, et al. Topical interventions to prevent acute radiation dermatitis in head and neck cancer patients: a systematic review. Support Care Cancer. 2016 Dec 12. [Epub ahead of print] Review.
  37. Ali S, Wahbi W. The efficacy of aloe vera in management of oral lichen planus: a systematic review and meta-analysis. Oral Dis. 2016 Dec 28.
  38. Burusapat C, Supawan M, Pruksapong C, Pitiseree A, Suwantemee C. Topical Aloe Vera Gel for Accelerated Wound Healing of Split-Thickness Skin Graft Donor Sites: A Double-Blind, Randomized, Controlled Trial and Systematic Review. Plast Reconstr Surg. 2018 Jul;142(1):217-226.
  39. Sahebnasagh A, Ghasemi A, Akbari J, et al. Successful Treatment of Acute Radiation Proctitis with Aloe Vera: A Preliminary Randomized Controlled Clinical Trial. J Altern Complement Med. 2017 Nov;23(11):858-865.
  40. Leng H, Pu L, Xu L, Shi X, Ji J, Chen K. Effects of aloe polysaccharide, a polysaccharide extracted from Aloe vera, on TNF‑α‑induced HaCaT cell proliferation and the underlying mechanism in psoriasis. Mol Med Rep. 2018 Sep;18(3):3537-3543.
  41. Al-Maweri SA, Ashraf S, Lingam AS, et al. Aloe vera in treatment of oral submucous fibrosis: A systematic review and meta-analysis. J Oral Pathol Med. 2019 Feb;48(2):99-107.
  42. Hekmatpou D, Mehrabi F, Rahzani K, Aminiyan A. The effect of Aloe Vera gel on prevention of pressure ulcers in patients hospitalized in the orthopedic wards: a randomized triple-blind clinical trial. BMC Complement Altern Med. 2018 Sep 29;18(1):264.
  43. Burusapat C, Supawan M, Pruksapong C, Pitiseree A, Suwantemee C. Topical Aloe Vera Gel for Accelerated Wound Healing of Split-Thickness Skin Graft Donor Sites: A Double-Blind, Randomized, Controlled Trial and Systematic Review. Plast Reconstr Surg. 2018 Jul;142(1):217-226.
  44. Farrugia CE, Burke ES, Haley ME, Bedi KT, Gandhi MA. The use of aloe vera in cancer radiation: An updated comprehensive review. Complement Ther Clin Pract. 2019 May;35:126-130.
  45. SICCR PILONIDALIS STUDY GROUP, Giannini I, Andreoli R, Bianchi FP, et al. Effectiveness of topical use of Lietofix® in wound healing after pilonidalis sinus excision: a multicenter study by the Italian Society of Colorectal Surgery (SICCR). Tech Coloproctol. 2019 Apr;23(4):373-378.
  46. Kamath NP, Tandon S, Nayak R, Naidu S, Anand PS, Kamath YS. The effect of aloe vera and tea tree oil mouthwashes on the oral health of school children. Eur Arch Paediatr Dent. 2020 Feb;21(1):61-66.
  47. Leiva-Cala C, Lorenzo-Pouso AI, Centenera-Centenera B, et al. Clinical efficacy of an Aloe Vera gel versus a 0.12% chlorhexidine gel in preventing traumatic ulcers in patients with fixed orthodontic appliances: a double-blind randomized clinical trial. Odontology. 2019 Oct 29.
  48. Poordast T, Ghaedian L, Ghaedian L, et al. Aloe Vera; A new treatment for atrophic vaginitis, A randomized double-blinded controlled trial. J Ethnopharmacol. 2021 Apr 24;270:113760.
  49. Sahebnasagh A, Ghasemi A, Akbari J, et al. Prevention of acute radiation-induced Proctitis by Aloe vera: a prospective randomized, double-blind, placebo controlled clinical trial in Pelvic Cancer patients. BMC Complement Med Ther. 2020 May 13;20(1):146.
  50. Bernstein N, Akram M, Yaniv-Bachrach Z, Daniyal M. Is it safe to consume traditional medicinal plants during pregnancy? Phytother Res. 2021 Apr;35(4):1908-1924.
  51. Karbasizade S, Ghorbani F, Ghasemi Darestani N, et al. Comparison of therapeutic effects of statins and aloe vera mouthwash on chemotherapy induced oral mucositis. Int J Physiol Pathophysiol Pharmacol. 2021 Aug 15;13(4):110-116.
  52. Alkhouli M, Laflouf M, Alhaddad M. Efficacy of Aloe-Vera Use for Prevention of Chemotherapy-Induced Oral Mucositis in Children with Acute Lymphoblastic Leukemia: A Randomized Controlled Clinical Trial. Compr Child Adolesc Nurs. 2021 Mar;44(1):49-62.
  53. Kamath DG, Nadimpalli H, Nayak SU, et al. Comparison of antiplaque and anti-gingivitis effects of aloe vera mouthwash with chlorhexidine in fixed orthodontic patients-A randomized controlled trial. Int J Dent Hyg. 2023 Feb;21(1):211-218.
  54. Zou H, Liu Z, Wang Z, Fang J. Effects of Aloe Vera in the Treatment of Oral Ulcers: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Oral Health Prev Dent. 2022 Dec 12;20(1):509-516.
  55. Rai A, Shrivastava PK, Kumar A, et al. Comparative effectiveness of medicinal interventions for oral submucous fibrosis: A network meta-analysis. J Stomatol Oral Maxillofac Surg. 2023 Feb 11;124(3):101423.
  56. Sabbaghzadegan S, Soltani MH, Kamalinejad M, et al. The effect of a standardized capsule of Aloe vera gel on the quality of life in patients with systolic heart failure: A randomized double-blind placebo-controlled clinical trial. Phytother Res. 2023 Feb 20.
  57. Robijns J, Becherini C, Caini S, et al. Natural and miscellaneous agents for the prevention of acute radiation dermatitis: a systematic review and meta-analysis. Support Care Cancer. 2023 Mar 2;31(3):195.
  58. Baharara H, Rahsepar S, Emami SA, et al. The efficacy of medicinal plant preparations in the alleviation of radiodermatitis in patients with breast cancer: A systematic review of clinical trials. Phytother Res. 2023 May 21.
  59. Wang T, Liao J, Zheng L, et al. Aloe vera for prevention of radiation-induced dermatitis: A systematic review and cumulative analysis of randomized controlled trials. Front Pharmacol. 2022 Sep 29;13:976698.
  60. Malek Hosseini A, Rostam Khani M, Abdi S, Abdi S, Sharifi N. Comparison of aloe vera gel dressing with conventional dressing on pressure ulcer pain reduction: a clinical trial.  BMC Res Notes. 2024 Jan 16;17(1):25.
  61. Sabbaghzadegan S, Soltani MH, Kamalinejad M, Bahrami M, Kabir A, Dadmehr M. The effect of a standardized capsule of Aloe vera gel on the quality of life in patients with systolic heart failure: A randomized double-blind placebo-controlled clinical trial.  Phytother Res. 2023 Jul;37(7):2800-2810.  
  62. Chiu CC, Hsiao YW, Wen YC, Chang TY, Chen SH, Jaing TH. Aloe vera gel for prevention of chemotherapy-induced hyperpigmentation: Four case reports. Medicine (Baltimore). 2023 Jun 23;102(25):e34037.
  63. Baharara H, Rahsepar S, Emami SA, Elyasi S, Mohammadpour AH, Ghavami V, Rajendram R, Sahebkar A, Arasteh O. The efficacy of medicinal plant preparations in the alleviation of radiodermatitis in patients with breast cancer: A systematic review of clinical trials.  Phytother Res. 2023 Aug;37(8):3275-3295.
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