Written by Ava Lorenc, Edzard Ernst and the CAM-Cancer Consortium.
Updated September 18, 2018

Aloe vera

Abstract and key points

  • Aloe vera is a cactus-like plant with a long history of medicinal use.
  • Evidence of Aloe vera gel/cream for radiation-induced skin problems is inconclusive.
  • Topical Aloe vera appears as effective as conventional treatment for some symptoms in chemotherapy-/radiation-induced oral mucositis/stomatitis but the evidence is not convincing.
  • Aloe vera gel may improve symptoms of oral submucosal fibrosis but evidence is poor quality.
  • Topical Aloe vera may improve some symptoms of radiotherapy-induced proctitis, compared to placebo.
  • Orally administered Aloe vera latex (juice) has been insufficiently tested as a cancer therapy.
  • Adverse events are generally mild and transient but oral use might cause abortion in pregnant women.

Aloe vera, Aloe barbadensisis a plant remedy used for a wide range of problems. In oncology, Aloe vera is applied topically for radiation-induced skin problems, oral submucosal fibrosis (a precancerous condition) and chemotherapy-/radiation-induced inflammation of the digestive tract.

One systematic review (n=7) and four additional randomized controlled trials (RCTs) of Aloe vera for radiation-induced skin problems have conflicting results and many limitations. Moderate evidence from four RCTs suggests that Aloe vera mouthwash is as beneficial as conventional mouthwash for radiation-induced oral mucositis in head and neck cancer and chemotherapy-induced stomatitis in leukaemia. Although topical Aloe vera has shown some positive results for oral submucosal fibrosis compared to other treatment, these findings are limited by the methodological limitations of the trials. Evidence from one randomized clinical trial suggests Aloe vera ointment improves some symptoms of radiotherapy-induced proctitis compared to placebo. Oral Aloe vera juice has been tested as anti-cancer treatment, but studies are too preliminary to tell whether it is effective.

Numerous adverse events are on record but they are generally mild and reversible. Oral use might cause abortion.

Read about the regulation, supervision and reimbursement of herbal medicine at NAFKAMs website CAM Regulation.

What is it?

Description

Aloe vera is a cactus-like plant with a long history of medicinal use.

Scientific name

Aloe vera, Aloe barbadensis.

Ingredients

Aloe vera gel is the mucilaginous tissue from the centre of the Aloe ver aleaf and contains polysaccharides. Aloe vera latex (taken orally), is made of the peripheral bundle sheath cells and contains aloin, anthraquinones, barbaloine and glycosides1.

Application and dosage

Gel is applied topically as needed. Latex is taken orally at doses between 50 and 200mg daily1.

History

Aloe vera has been used medicinally in many medical cultures. Today it is available as over-the-counter products and used by a range of healthcare professionals e.g. doctors, nurses, herbalists, naturopaths, nutritionists.

Claims of efficacy

Traditionally, Aloe vera has been used for a very wide range of conditions. In oncology, the main claim is that topical application of the gel prevents or treats radiation-induced skin reactions2.

The notion that oral Aloe vera might prevent lung cancer was supported by a Japanese case-control study3. A comparison of 44 pairs was analysed according to plant food intake. The results suggested that those study participants regularly consuming Aloe vera were associated with a reduced lung cancer-risk. Even though interesting, this small study cannot prove that the detected association is causal.

Mechanisms of action

A multitude of potential mechanisms of action has been identified by in vitro experiments2. Aloe perryiflowers inhibit the growth of seven cancer cell lines4 and Aloe vera extract inhibits the growth of breast, cervical cancer and neuroblastoma cells, and increases the therapeutic efficacy of conventional drugs5,6. Regarding the constituents of Aloe vera, aloin/barbaloin exhibits anti-cancer effects through anti-angiogenic and cytotoxic activities7-10, and aloe emodin inhibits the proliferation of cancer cells (including gastric, cervical, and lung cancers, glioma and melanoma)11-15, induces the expression of genes involved in apoptosis16, induces cell differentiation12, inhibits cancer metastasis17 and enhances the effect of radiation18 and tamoxifen19. Photodynamic therapy with aloe-emodin causes cell death, induces autophagy, and inhibits adhesion, migration and invasion of cancer cells14,20,21. Animal experiments have demonstrated detoxification of carcinogens22, reduced tumour angiogenesis23 and reduction of papilloma growth in mice24,25. and chemopreventive effects13,26,27 through modulating antioxidant and detoxification enzyme activity28.

Aloe vera latex is a powerful laxative. Aloe vera gel has antimicrobial, antioxidant, antiproliferative, chemo-preventive, anti-inflammatory, moisturising and antipuritic actions1,29,30. Anthraquinones of Aloe vera latex also have cytotoxic, radioprotective as well as anti angiogenic effects and inhibit angiogenic and metastatic regulatory processes31,32. In addition, aloin may enhance cisplatin antineoplastic activity in B16-F10 melanoma cells33. Whole leaf extract of Aloe vera has been shown in animal experiments to have carcinogenic potential8.

Aloin-loaded tablets may be a useful drug delivery system as a coadjuvant of conventional chemotherapy/radiation therapy34.

Alleged indications

In oncology, the main indication for Aloe vera is the application of the gel for radiation-induced skin irritation, as well as to prevent or treat cancer

Prevalence of use

Generally speaking, Aloe vera products are very popular, particularly for self-treatment and for cosmetic use. Most healthcare professionals caring for cancer patients are aware of the claim that Aloe vera gel reduces skin inflammation, and many recommend it to their patients.  In the general population, Aloe vera is used by between 7 and 10% of adults in Australia, Italy, and Jamaica. In the USA, dietary supplements containing Aloe vera were used by 0.1% of adults in the past 30 days, and Aloe vera is the 20th best-selling dietary supplement, with sales of US$72million in 201135.

Legal issues

Aloe vera products are sold as cosmetics or as herbal supplements.

Cost and expenditure

High quality products are widely available and usually inexpensive. A typical week’s supply of Aloe vera gel would cost less than €6.

Does it work?

Radiation-induced skin problems

Richardson et al’s 2005 systematic review29 included seven randomized controlled trials (RCTs) of topical Aloe vera gel to treat radiation-induced skin problems. The quality of the studies and of reporting was frequently poor. Overall, the results failed to show the superiority of topical Aloe vera gel over various control treatments. The authors conclude that “there is no evidence from clinical trials to suggest that topical Aloe vera is effective in preventing or minimising radiation-induced skin reactions in cancer patients”29.

Since the publication of this review, four further trials of topical Aloe vera on radiation-induced skin problems have become available (see Table 1)36-39. As highlighted by Richardson et al29, study quality and reporting are often poor. Topical Aloe vera may reduce the incidence of radiation-induced dermatitis in patients (n=60) with head and neck cancer36 although the study does have some limitations. One good quality (n=248) and one poor quality study (n=100) suggest no effect in breast cancer37,38. Haddad et al39 conclude that topical Aloe vera lotion reduces the intensity of radiation-induced dermatitis in various cancers (n=60), but their study is poor quality.

Oral mucositis

A 2011 Cochrane review of interventions to prevent mucositis in cancer patients included no further trials40. The authors did not draw a positive conclusion but felt that “there is a need for well-designed and conducted trials.”

Three subsequently published RCTs studied Aloe vera for radiation-induced oral mucositis in head and neck cancer (see Table 1)30,41,42, and one studied chemotherapy-induced stomatitis in patients with leukaemia43.  There is moderate quality evidence that oral Aloe vera reduces the incidence but not duration of mucositis compared to placebo (n=61)41, and may reduce onset, severity, intensity and pain better than or as well as conventional mouthwashes (n=26, n=64)42,43. However, Su et al (n=58)30 found no difference compared to placebo.

Oral Submucosal Fibrosis (OSMF)

Four trials tested Aloe vera for oral submucosal fibrosis (OSMF), three topical (gel) (n=20), (n=120), (n=40)44-46 and one oral and topical (n=74)47 (see Table 1). OSMF is a potentially malignant disorder of the oral mucosa, frequently associated with chewing gutka and betel quid44. There was some evidence that Aloe vera may improve symptoms (burning sensation, mouth opening, tongue protrusion and cheek flexibility) as well as conventional treatment, but all four trials have significant limitations in methodology and reporting.

Proctitis

Based on one small RCT (n=20), topical Aloe vera appears to improve some symptoms of radiotherapy-induced proctitis (diarrhoea, faecal urgency, clinical presentation and lifestyle), compared to placebo48.

Other outcomes

There is preliminary evidence from two RCTs (n=240) that Aloe vera in combination with chemotherapy (n=240)49 or melatonin (n=50)31 may improve stabilization of disease and survival in patients with advanced solid tumours, for whom no other standard effective therapy is available.

Is it safe?

Adverse effects

Numerous adverse effects are on record but, generally speaking, these are mild and reversible2. Topical use: allergic reactions, delayed healing of deep wounds.

Oral use: irritation of and damage to intestinal mucosa, intestinal pain, vomiting, diarrhoea, cathartic colon, fluid and electrolyte loss, kidney failure, phototoxicity and hypersensitive reactions50.

Contraindications

Oral: pregnancy (oral administration can cause abortion), intestinal obstruction or inflammation.

Interactions

Oral: increased effects of antiarrhythmics, cardiac glycosides, diuretics and steroids2.

Warning

Based on animal studies, there is a suspicion that oral use of Aloe vera might promote colonic cancer51,52 although a subsequent study using Aloe vera extract with the latex component removed (which removed some mutagenic components53) had no toxicological findings after 13 weeks54. There is also suspicion that topical use might enhance the induction of skin cancer by ultraviolet light55.

Evidence tables

Please view the PDF below for details of the systematic reviews and/or controlled clinical trials included in this summary:

Citation

Ava Lorenc, Edzard Ernst, CAM-Cancer Consortium. Aloe vera [online document]. http://cam-cancer.org/The-Summaries/Herbal-products/Aloe-vera. September 18, 2018.

Document history

Fully updated and revised in September 2018 by Ava Lorenc
Fully updated and revised in March 2013 by Edzard Ernst. 
Summary first published in July 2011, authored by Edzard Ernst.

References

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