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The Effect of Aloe Vera Clinical Trials on Prevention and Healing of Skin Wound: A Systematic Review.

Introduction

The process of wound healing is a complex biological process and promotion of tissue recovery is the main objective of medical interventions. Skin lesions are caused due to different reasons such as burns, arterial diseases, surgery, and trauma. (1) Wound healing is a dynamic process that takes place in three phases. The first phase is inflammation, congestion, and leukocyte infiltration. The second phase involves the removal of dead tissue and the third phase of proliferation includes epithelial regeneration and fibrous tissue formation. (2) Several studies on Aloe vera have been conducted and shown to be effective in the prevention and healing of skin wounds.

Aloe vera is a medicinal plant traditionally used since 1500 BC in many countries such as Greece, China, and Mexico. It also has been used for centuries as a traditional medicine for various diseases and skin lesions. (3) Aloe vera is an indigenous plant from tropical Madagascar, Saudi Arabia, and Iran. It belongs to the Liliaceae family; it is similar to Cactus and is an herbaceous and perennial plant with thick, fleshy and long leaves. The Egyptian queens Nefertiti and Cleopatra used Aloe vera as part of their regular beauty regime. (4) So far, 75 known compounds have been identified in Aloe vera, including 20 minerals, 20 amino acids, vitamins, and water. (5, 6) In vitro studies and studies conducted on living organisms have shown that Aloe vera can inhibit thromboxane (an inhibitor of wound healing), improve the wound healing process, and reduce inflammation. (3, 7) Magnesium lactate available in the gel can prevent the production of histamine that causes itching and irritation of the skin. (8, 9) It also enhances the immune system and the synthesis of cytokines. Aloe vera is effective in inhibiting inflammatory reactions by the inhibition of IL-6 and IL-8, the reduction of leukocyte adhesion, an increase of IL-10 levels, and decrease of TNF alpha levels. (10) Its regenerative properties are due to the compound glucomannan, which is rich with polysaccharides like mannose. Glucomannan affects fibroblast growth factor receptors and stimulates their activity and proliferation, which in turn increases the production of collagen. Aloe vera gel can not only increase the amount of collagen in wounds but also change the composition of collagen, increase collagen cross-linking and thereby promote wound healing. (11) Scientific studies have shown that the gel can increase the flexibility and reduce the fragility of the skin since 99% of the gel is water. (4) Additionally, mucopolysaccharides along with amino acids and zinc present in Aloe vera can lead to skin integrity, moisture retention, erythema reduction, and helps to prevent skin ulcers. (12) Several studies have shown the positive effects of Aloe vera to treat wounds such as psoriasis, mouth sores, ulcers, diabetes, herpes, bedsores, and burn wounds. (1, 4, 6, 13-15) Aloe vera is known for its anti-tumor, anti-inflammatory, skin protection, anti-diabetic, anti-bacterial, anti-viral, antiseptic, and wound healing properties. (6)

Considering the availability of several clinical trials on the effect of Aloe vera on the prevention and healing of skin wounds, as well as its popularity among people and widespread use in the cosmetic industry, the present study aimed to review research studies on this topic.

Materials and Methods

Search Strategy

The present study is a review of clinical trials on the effect of Aloe vera in preventing and healing of skin wounds. Articles published in both national and international journals were considered.Articles published online (1990-2016) were selected from the national databases (SID, IRANDOC) and international databases (Google Scholar, PubMed, MEDLINE, Scopus, Cochrane Library, and ScienceDirect). Moreover, the references of the identified articles were searched for additional sources of information. The used keywords were Aloe vera, wound healing, and prevention. All keywords were searched electronically, the titles and abstracts of all identified articles were screened, and duplicated articles were omitted. Each article was independently screened by four reviewers and possible disagreements were resolved in a joint review meeting. The language of the articles was either Persian or English.

Inclusion Criteria

All clinical trials using Aloe vera gel, cream, or derivatives that included a control group with placebo or comparison with other treatments were included in the study. The sample size of at least 30 cases was considered sufficient.

Exclusion Criteria

All studies using animal models, lack of access to full text, lack of transparency of statistical results, and sample size less than 30 cases were excluded.

Methodological Appraisal

The PRISMA checklist (2009) was used to conduct the review. Articles that were performed on animals, duplicated articles, non-transparent statistical results (without mean, standard deviation, confidence interval, test, P value, etc.), incomplete articles (duration of intervention, dosage, frequency, lost to follow-up, type of control groups, number of treatment sessions, and with no results based on its goals), and all articles with less than 30 sample size were removed. Eventually, 23 trials that met the inclusion criteria were studied (figure 1).

Data Extraction

Data such as the author's name, year of publication, study region, study design, sample size, age of participants, sex, type of wound, type of intervention, duration of treatment, intervention and control groups, and main results were extracted.

Results

In total, 57 articles were identified out of which 16 were conducted on animals, 2 lacked access to the full text, 10 lacked transparency of statistical results, and 6 had a sample size less than 30 cases. These articles were removed and eventually, 23 articles were evaluated.

Wound healing and preventive effects of Aloe vera have been reported in several studies. (16) Topical application of Aloe vera to prevent ulcers and enhance the healing process of dermal injuries (e.g., burns, frostbite, skin infections, surgical wounds, inflammation, herpes ulcers, diabetic foot ulcers, pressure sores, and chronic wounds) has been reported. (17) Aloe vera is highly suitable for wound dressings. (18) Most of the studies were conducted on burn wounds. Aloe vera is considered as the traditional therapy for burns. Five studies investigated burn wound healing. In these studies, Aloe vera was more effective than petroleum jelly gauze dressing, silver sulfadiazine 1% ointment, and framycetin cream. Moreover, it reduced the recovery time, prevented infection in the wound area, and prevented redness and itching. (4, 14, 19-21 In these studies, Aloe vera was more effective in first- and second-degree burn wounds than in the other degrees. As described in table 1, it is concluded that Aloe vera can reduce the healing time of first-and second-degree burns to 9 days (P=0.006). (15)

As described in table 2, Aloe vera was used on postoperative wounds such as episiotomy, cesarean section, skin biopsy, hemorrhoidectomy, gynecologic laparotomy surgery, and graft. (22-28) In these studies, the use of Aloe vera gel and cream reduced the pain and recovery time compared to other conventional treatments. Only one study group, Aloe vera dressing for skin shave biopsy, did not show any difference in terms of improvement compared to the combined dressing group. (27)

As described in table 3, Aloe vera was used for healing of cracked nipples in 2 studies and it reduced the pain and discharge in the area. (29, 30)

Aloe vera has been effective in chronic wounds such as pressure ulcers, diabetic ulcers, chronic anal fissure wounds, chronic wounds caused by accidents, psoriasis, and genital herpes. In this regard, 7 articles were studied and Aloe vera was more effective compared to saline gauze dressing, phenytoin, and current treatments. (31-37) Only in one study, no differences were found between the two groups which can be due to the small sample size compared to the other studies. (36) Aloe vera reduced the pain, bleeding, and recovery time in chronic wounds (table 4).

Aloe vera has also been effective in the prevention of ulcers. Mucopolysaccharides along with amino acids and zinc available in Aloe vera can lead to skin integrity, moisture retention, erythema reduction, and helps to prevent skin ulcers. As described in table 5, two studies were reviewed. (12, 38)

Discussion

Based on a detailed review of articles, the application of Aloe vera as a medicinal plant for skin wound healing is confirmed. (1-40) Aloe Vera is widely used for its antibacterial, anti-viral, anti-inflammatory effects and has been considered in medical sciences. (2, 3, 6) Dat and colleagues (2012) showed that Aloe vera is more effective in chronic than acute wounds. (1) Aloe vera is mainly used to treat first- and second-degree burn wounds resulting in reduced recovery time to 9 days. Aloe vera dressing for once or twice a day has been more effective than the current treatments, including petroleum jelly gauze dressing, silver sulfadiazine 1% ointment, and framycetin cream. It has resulted in reduced recovery time, the absence of wound infection, and the lack of redness and itching. (4, 14, 21) Aloe vera has long been used to treat burns and is commonly known as the burn tree and first aid plant. (39) Due to anti-inflammatory, increased immune activity, anti-bacterial and anti-viral effects, and decreased histamine activity properties of Aloe vera, it accelerates the healing process of burn wounds. The outcome of the present review study shows that Aloe vera is unanimously considered as the ideal dressing. Most studies have been performed on grade 1 and 2 ulcers and there are limited studies on grade 3 ulcers. The latter could be due to full thickness skin loss in grade 3 wounds and possible onset of wound infection.

Aloe vera gel or cream on postoperative wounds (three times a day for 5-10 days) could reduce pain and recovery time. (22-28) Only one study indicated that there was no difference between the experimental and placebo groups. (28) This could be due to inappropriate placebo or the optimal time point for improvement. Cracked nipples could also be treated using Aloe vera if applied 3 times a day or after each breastfeeding. It would reduce the pain due to cracked nipples. (29, 30) This finding was also confirmed in a study by Eshgizade and colleagues (2016). (40)

It is indicated that Aloe vera (as a gel or cream) can be effective to treat chronic wounds such as psoriasis lesions (twice a day for 4-8 weeks), (34, 37) pressure ulcers (1-3 months), venous, diabetic, (31, 32) and herpes ulcers and chronic anal fissure (2-3 weeks). (33-36) In these articles, in addition to the recovery time, the following factors were also checked: Lesion scores; (34) depth, size, edema around the wound area, the amount of exudate and necrotic tissue, (32) inflammation, (34, 37) pain and bleeding, (33) and infection. (19) It was shown that Aloe vera could have a positive effect on the above-mentioned factors and their reduction. Only Thomas and colleagues found no healing difference between saline and Aloe vera in the treatment of pressure ulcers. Perhaps the small sample size (30 cases) was the reason behind their findings. (35) As the secondary objective, many studies measured the length of hospitalization, cost of scar treatment, and redness and itching of the wound area. They indicated that Aloe vera is superior to other treatments. (14, 21, 31)

Several studies noted the traditional belief that a wound should not be covered, allowing it to become dry and detach itself from the wound area since it inhibits the migration of cells and growth factors leading to wound healing. Aloe vera as a wound cover would keep the wound area moist and allows optimal migration of fibroblasts and epidermal. Aloe vera (1 to 100 mg/kg) can improve wound healing. (41)

The main limitations of the present systematic review were the quality of available literature, lack of access to all articles, and unpublished reports. Moreover, only the literature in English and Persian were reviewed. These have considerably reduced our sample size regarding various data parameters and consequently hindered our ability to determine statistically significant results. Furthermore, not all articles were blind experiments, which is a challenge to determine the true effect of Aloe vera on wound healing. In total, 57 articles had to be excluded since they involved multiple procedures or multiple indications without providing specific outcomes data for the Aloe vera effect on wound healing. Since the present study was not a meta-analysis and had no major summary, data analysis to determine publication bias with the STATA software was not performed. However, qualitative analysis of both the survey responses and the focus group discussion identified possible ways of reducing publication bias. This was done through increased transparency, improvements in trial registries, search engines and databases, enhancing the role of the institutional review boards, and positive support from the scientists. The above-mentioned approaches minimized publication bias.

Conclusion

Due to the properties of Aloe vera and its compounds, it can be used to retain skin moisture and integrity. It also prevents skin ulcers as it contains mucopolysaccharides, amino acids, zinc, and water. In terms of quality and speed of wound healing, Aloe vera is much more effective and less costly compared to the currently available alternative treatments. Considering the tendency to promote traditional medicine as well as rare side effects of Aloe vera, the use of this medicinal plant to improve wound healing is recommended as the complementary treatment alongside other methods.

Conflict of Interest: None declared.

References

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Davood Hekmatpou (1), PhD;

Fatemeh Mehrabi (2),

Kobra Rahzani (1), PhD;

Atefeh Aminiyan (3), PhD

(1) Department of Nursing, Nursing and Midwifery Faculty, Arak University of Medical Sciences, Arak, Iran;

(2) Student of Nursing, Nursing and Midwifery Faculty, Arak University of Medical Sciences, Arak, Iran;

(3) Department of Clinical Pharmacology; Arak University of Medical Sciences, Arak, Iran

Correspondence:

Davood Hekmatpou, PhD;

Payambar-e-Azam Educational Complex, Basij Sq., Arak, Iran

Tel: +98 918 1616539

Fax: +98 86 34173528

Email: dr_hekmat@arakmu.ac.ir

Received: 30 April 2017

Revised: 28 May 2017

Accepted: 2 September 2017

Please cite this article as: Hekmatpou D, Mehrabi F, Rahzani K, Aminiyan A. The Effect of Aloe Vera Clinical Trials on Prevention and Healing of Skin Wound: A Systematic Review. Iran J Med Sci. 2019;44(1):1-9.

What's Known

* Aloe vera is a medicinal plant, traditionally used to improve skin integrity.

* Aloe vera is known for its antiinflammatory, skin protection, antibacterial, anti-viral, antiseptic, and wound healing properties.

What's New

* Aloe vera can be used to retain skin moisture and integrity, and to prevent ulcers. However, there are limited studies on this topic.

* The use of Aloe vera to improve wound healing is recommended as the main or complementary treatment alongside other methods.
Table 1: Analysis of studies using Aloe vera for first- and
second-degree burns

Authors          Year  Sample size

Malek Hosseini   2013  64 patients with
et al. (4)             second-degree burns
Khorasani        2009  30 patients with burns on
et al. (19)            two areas of the body
Moghbel          2007  30 patients with
et al.14               second-degree burn
                       wounds
Akhtar et al.20  1996  100 patients with burns
Tamlikikal       1991  38 patients with first- to
et al. (21)            third-degree burns in
                       which less than 30% of
                       their body surface area
                       was burned.

Authors          Methods

Malek Hosseini   32 patients were dressed with
et al. (4)       Aloe vera gel and 32 other
                 patients were dressed with silver
                 sulfadiazine 1% cream, daily.
                 Parameters of the wound on
                 the 1st, 7th, and 15th days were
                 studied using Bates-Jensen
                 wound assessment tool.
Khorasani        In each patient, one part of the
et al. (19)      body was randomly used to
                 apply Aloe vera cream 0.5% and
                 the other part with sulfadiazine
                 1%. In both groups, Aloe vera
                 and sulfadiazine were applied
                 twice a day. The healing time
                 was 19 days.
Moghbel          The patients applied Aloe vera
et al.14         dressing and silver sulfadiazine
                 1% ointment on each hand as
                 the experimental and control
                 groups, symmetrically.
Akhtar et al.20  100 patients were divided into
                 two groups. The AV group
                 applied Aloe vera dressing three
                 times a day and the control group
                 applied framycetin ointment.
Tamlikikal       The samples were assigned
et al. (21)      into two groups by random
                 allocation; in SSD group silver
                 sulfadiazine was applied twice
                 a day and in the AV group Aloe
                 vera was applied twice a day.

Authors          Results

Malek Hosseini   By comparing the average
et al. (4)       improvement in both groups at
                 baseline and on the 15th day,
                 a significant difference was
                 found between the two groups
                 (P<0.0001). Finally, it was
                 reported that wounds healed
                 faster using Aloe vera gel
                 dressing than silver sulfadiazine
Khorasani        80% of the SSD group and
et al. (19)      100% of the AV group were
                 cured after 19 days. The
                 mean days of recovery in the
                 AV and SSD groups were
                 15.9[+ or -]2 and 18.73[+ or -]2.56 days,
                 respectively. In addition, no
                 infection was observed in both
                 groups (P<0.0001).
Moghbel          They reported improvements
et al.14         within 10 days in 90.6% of the
                 experimental group and 28.7%
                 of the control group (P<0.001).
Akhtar et al.20  The average improvement
                 for the AV group was 18 days
                 versus 30.9 days.
Tamlikikal       55% (11/20) with mucilage AV
et al. (21)      and 39% (7/18) with SSD were
                 recovered.

Table 2: Analysis of studies using Aloe vera on postoperative wounds

Authors              Year  Sample size

Malazem et al. (22)  2015  90 women
                           undergoing cesarean
                           section
SabzAli Gol          2014  84 women
et al. (23)                undergoing
                           nulliparous
                           episiotomy
Eghdam Poor          2013  74 women
et al. (24)                undergoing
                           nulliparous
                           episiotomy
Jahdi et al. (25)    2011  74 women
                           undergoing
                           nulliparous
                           episiotomy
Khorasani            2011  45 skin graft donor
et al. (26)                sites
Eshghi et al. (27)   2010  49 patients after
                           hemorrhoidectomy
Philips              1995  49 patients
et al. (28)                undergoing skin
                           shave biopsy

Authors              Methods

Malazem et al. (22)  Aloe vera gel dressing was
                     used in the intervention group
                     and a simple dressing on
                     the wound immediately after
                     cesarean section was applied
                     in the other group. The pain
                     and improvement in the first
                     24 hours and the 8th day were
                     compared.
SabzAli Gol          In the intervention group, Aloe
et al. (23)          vera gel was used twice a day
                     for 10 days and betadine bath
                     was used for the control group
                     twice a day for 10 days.
Eghdam Poor          Aloe vera ointment every 8
et al. (24)          hours for 5 days was applied in
                     the intervention group and the
                     control group used betadine
                     bath every 4 hours for 5 days.
Jahdi et al. (25)    In the intervention group, Aloe
                     vera ointment (3 cc) was applied
                     every 8 hours for 5 days and
                     betadine bath used in the control
                     group every 4 hours for 5 days.
Khorasani            A group using Aloe vera cream
et al. (26)          (three times daily), a placebo
                     group (three times daily), and
                     the other group without any
                     topical agent were studied.
                     Dressing was applied daily in all
                     three groups.
Eshghi et al. (27)   Aloe vera gel 0.05% was
                     used in the intervention group
                     and placebo was used in the
                     control group 12 hours after
                     hemorrhoidectomy three times
                     a day for 28 days.
Philips              The intervention group used
et al. (28)          Aloe vera gel dressing and
                     the control group used the
                     combined dressing (hydrogel
                     parkside, antibiotic ointment,
                     and absorbent dressing) twice
                     a day.

Authors              Results

Malazem et al. (22)  In the Aloe vera group, wound
                     healing was faster than the
                     control group in the first 24
                     hours (P=0.003). However, no
                     difference was observed on the 8th
                     day (P=0.283). Finally, the positive
                     effect of Aloe vera treatment was
                     confirmed.
SabzAli Gol          In the Aloe vera group, 57.1% on
et al. (23)          the 7th day and 30% on the 10th day
                     had complete remission. The pain
                     intensity average was 2.3 on the 7th
                     day and 1.21 on the 10th day.
Eghdam Poor          The average improvement in the
et al. (24)          Aloe vera group was 1.62, which
                     was significantly high (P<0.0001).
Jahdi et al. (25)    Regarding pain intensity, the
                     average pain score was 1.86 in
                     the Aloe vera group, which was
                     significantly low (P<0.001).
Khorasani            It was concluded that the effect
et al. (26)          of Aloe vera gel on the donor
                     sites resulted in a significant
                     improvement in recovery time
                     between the control group (without
                     any topical agent: 17[+ or -]8.6), the
                     placebo group (without Aloe
                     vera cream: 8.8[+ or -]2.8), and the
                     experimental group (cream without
                     Aloe vera: 9.7[+ or -]2.9). However, there
                     was no difference in the placebo
                     and experimental group, which can
                     be due to the moisturizing effect of
                     both creams.
Eshghi et al. (27)   The complete time of remission
                     was considered as 14 days. 100%
                     of the intervention group and only
                     4% of the control group cured after
                     14 days.
Philips              After 14 days, no difference was
et al. (28)          observed between the two groups
                     in terms of the healing and 24/24
                     in the AV group and 23/23 in the
                     control group recovered.

Table 3: Analysis of studies using Aloe vera for healing of cracked
nipples

Authors               Year  Sample size

Alamolhoda            2013  110 nulliparous
et al.29                    lactating women
Tafazoli et al. (30)  2009  100 lactating
                            women with
                            breast fissure

Authors               Methods

Alamolhoda            In one group, after each
et al.29              breastfeeding, lactating
                      women applied 0.5 ml of Aloe
                      vera gel on their nipples and
                      around the areola. The control
                      group applied 4 drops of their
                      breast milk. Both groups were
                      evaluated at days 10 and 14
                      postpartum.
Tafazoli et al. (30)  Two groups were divided into
                      lanolin ointment or Aloe gel
                      groups (three times a day for
                      1 week).

Authors               Results

Alamolhoda            The pain and damage of the nipple
et al.29              and discharge in the Aloe vera group
                      were much less than the control
                      group and Aloe vera improved the
                      fissure (P<0.001).
Tafazoli et al. (30)  There was a statistically significant
                      difference between the two groups
                      on the 3rd day (P=0.048) and 7th
                      day (P=0.003). Aloe vera gel was
                      more effective than lanolin ointment in
                      healing cracked nipples.

Table 4: Analysis of studies using Aloe vera on chronic wounds

Authors                  Year  Sample size

Avijegan et al. (31)     2016  60 patients with chronic
                               wounds
Panahi et al. (32)       2015  60 patients with chronic
                               wounds (41 patients
                               with pressure ulcers,
                               13 patients with diabetic
                               ulcers, and 6 patients with
                               ulcer caused by venous
                               disorders)
Rahmani et al. (33)      2014  60 patients with a
                               confirmed diagnosis
                               of chronic anal fissures
Choonhakarn et al. (34)  2010  80 patients with a
                               diagnosis of psoriasis
                               vulgaris
Thomas et al. (35)       1998  30 patients with two-,
                               three- and four-degree
                               ulcer with a wound size
                               [greater than or equal to]1 [cm.sup.2]
Syed et al. (36)         1996  120 patients with a
                               diagnosis of genital
                               herpes
Syed et al. (37)         1996  60 patients with a
                               diagnosis of psoriasis
                               vulgaris

Authors                  Methods

Avijegan et al. (31)     In the intervention group,
                         30 patients used Aloe
                         vera gel twice a day in
                         combination with current
                         treatments and the
                         control group only used
                         conventional treatments.
                         Patients were evaluated
                         1 week and 3 months after
                         treatment.
Panahi et al. (32)       Aloe vera cream in
                         combination with olive
                         oil was used in the
                         intervention group and
                         the control group used
                         phenytoin cream for
                         30 days. The pain, depth,
                         size, edema around the
                         wound area, the amount
                         of exudate, and necrotic
                         tissue were examined using
                         Bence Jones and VAG
                         tools.
Rahmani et al. (33)      Aloe vera cream
                         0.5% (3 grams) was
                         used in the intervention
                         group three times a day
                         3 weeks and the control
                         group used the placebo.
Choonhakarn et al. (34)  Mucilage from Aloe
                         vera (70%) twice a day
                         without any treatment was
                         used in the intervention
                         group and triamcinolone
                         cream 0.1% was used
                         in the control group for
                         8 weeks.
Thomas et al. (35)       16 people used carrasyn
                         dressing derived from Aloe
                         vera gel (along with the
                         acemannan Aloe vera) and
                         14 of the patients used
                         saline gauze dressing,
                         daily. They were followed
                         up for 10 weeks.
Syed et al. (36)         0.05% cream or Aloe
                         vera gel was used
                         in the intervention
                         group three times a day
                         and the placebo was used
                         for 2 weeks in the control
                         group.
Syed et al. (37)         The intervention group
                         used 0.05% cream or
                         Aloe vera gel maximum
                         three times a day (or
                         15 times a week) and in the
                         control group, the placebo
                         was used for 4 weeks.

Authors                  Results

Avijegan et al. (31)     After 3 months follow-up,
                         wound healing occurred
                         in 28 (93.3%) of patients
                         in the Aloe vera group and
                         14 (46.7%) patients in the
                         control group (P<0.05). The
                         overall mean time of wound
                         healing was 31.25[+ or -]11.2
                         and 63.2[+ or -]20.4 in the Aloe
                         vera and control groups,
                         respectively (P<0.05). The
                         mean hospitalization time was
                         35.2[+ or -]6.4 and 67.4[+ or -]8.9 in the
                         Aloe vera and control groups,
                         respectively (P<0.05).
Panahi et al. (32)       The pain, depth, size,
                         edema around the wound
                         area, the amount of exudate,
                         and necrotic tissue in the
                         intervention group showed
                         a statistically significant
                         difference compared with
                         the control group (P<0.001).
                         Aloe vera gel in combination
                         with olive oil was much
                         more effective in reducing
                         pain and wound healing
                         compared with phenytoin.
Rahmani et al. (33)      A statistically significant
                         difference was observed
                         in the pain, bleeding, and
                         for  wound healing of chronic
                         anal fissure before and at
                         the end of the 1st week of
                         the study compared with
                         the control group (P<0.001)
                         and topical application of
                         Aloe vera was considered
                         effective in treating wounds.
Choonhakarn et al. (34)  Aloe vera cream was at
                         least as effective in reducing
                         psoriatic plaque in patients
                         as triamcinolone acetonide
                         cream with significantly more
                         reduction in psoriasis area
                         severity index and equal
                         reduction in dermatology life
                         quality index.
Thomas et al. (35)       63% of the Aloe vera group
                         and 64% of the saline gauze
                         dressing group recovered
                         after 10 weeks. The mean
                         time of improvement was
                         5.3[+ or -]2.3 for AV group and
                         5.2[+ or -]2.4 for saline gauze
                         dressing group and there
                         was no difference.
Syed et al. (36)         Both Aloe cream and gel
                         were effective in reducing
                         healing time compared to
                         placebo (4.8 vs. 7.0 vs.
                         14.0 days, respectively),
                         Aloe cream was more
                         efficacious in the number of
                         cured patients compared to
                         gel (70% vs. 45% vs. 7%,
                         respectively.
Syed et al. (37)         Aloe hydrophilic cream
                         cured 83.3% of patients
                         treated versus 6.6%
                         in the control group.
                         Psoriatic plaques were
                         significantly (P<0.001)
                         reduced and biopsies
                         presented with reduced
                         inflammation and
                         parakeratosis.

Table 5: Analysis of studies using Aloe vera to prevent ulcers

Authors               Year  Sample size

West et al. (12)      2003  30 adult females with
                            bilateral occupational
                            dry skin with or
                            without irritant contact
                            dermatitis
                            (with or without
                            erythema, fissures,
                            and excoriations)
Williams et al. (38)  1996  194 women receiving
                            radiation therapy for
                            breast cancer

Authors               Methods

West et al. (12)      The intervention group wore a
                      glove containing Aloe vera gel 8
                      hours a day for 30 days on one
                      hand and the control group (the
                      other hand) did not use any
                      material. The patients rested for
                      30 days and the intervention was
                      repeated for an additional 10 days.
Williams et al. (38)  Aloe vera gel was used in
                      the intervention group (98%)
                      in combination with common
                      treatments. The control group only
                      used common treatments.

Authors               Results

West et al. (12)      Average recovery of the dry
                      skin time was 3.5 days for
                      the intervention group and no
                      event occurred in the control
                      group. Aloe vera could help
                      in preventing the onset of
                      erythema, dryness and eczema,
                      and scarring (P<0.0001).
Williams et al. (38)  No difference was observed
                      between the two groups.
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Author:Hekmatpou, Davood; Mehrabi, Fatemeh; Rahzani, Kobra; Aminiyan, Atefeh
Publication:Iranian Journal of Medical Sciences
Article Type:Report
Date:Jan 1, 2019
Words:6042
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