Effectiveness of Aloe Vera for Acute and Chronic Wounds: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

1. Medical College, Northwest University for Nationalities, Lanzhou 730030, China;2. Science & Research Department, The First Affiliated Hospital of Lanzhou University, Lanzhou 730000, China;3. Nursing Department, PLA General Hospital of Lanzhou Military Region, Lanzhou 730050, China; 4. The Research Institute of Evidence-Based Medicine, Lanzhou University, Lanzhou 730000, China;

Corresponding author：

Keywords：

Aloe vera; Wound and injury; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20130080

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Objective 　To systematically evaluate the effectiveness of aloe vera and its products (e.g. dressing for external use, and gel) for both acute (e.g. laceration, surgical incision, and burn) and chronic (e.g. infectious wound, and artery and venous ulceration) wounds.
Methods 　With “aloe” and “wound” as the index words, such databases as Cochrane Library, PubMed, EMbase, CBM, CNKI and VIP were searched from the inception to April, 2012 to collect the randomized controlled trials (RCTs) about aloe vera or its products for treating acute and chronic wounds. Two authors independently screened literature, extracted data and assessed the risks of bias. Then meta-analysis was conducted using RevMan 5.0 software.
Results 　A total of 15 RCTs involving 773 participants were included, and all studies were of low quality. There were 8 RCTs which evaluated aloe vera for treating acute wounds (burn, haemorrhoidectomy, and skin biopsy), and no RCT reported the incidence of infection. Compared with silver sulfadiazine, aloe vera products could increase the proportion of healing wounds for patients with burn (RR=1.28, 95%CI 1.03 to 1.60, P=0.03 ); compared with antibiotic cream, aloe vera products could reduce the average healing time for patients with burn (MD= ?12.90, 95%CI ?13.29 to ?12.51, P lt;0.000 01); compared with conventional therapy, aloe vera gel could increase the proportion of healed patients with acute surgical wounds (RR=16.33, 95%CI 3.46 to 77.15, P=0.000 4), and could increase the proportion of healed patients with pressure sores (RR=1.73, 95%CI 1.21 to 2.49, P=0.003).
Conclusion 　The application of aloe vera topical agents and dressings is positively significant to both acute and chronic wounds. But this conclusion still needs to be supported by high quality trials.

Citation： WANG Xintian,TENG Yongjun,GE Xiujie,MA Hui,YANG Xiuling,CHEN Wangsheng,KANG Juzhen,YANG Kehu. Effectiveness of Aloe Vera for Acute and Chronic Wounds: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2013, 13(4): 468-473. doi: 10.7507/1672-2531.20130080 Copy

1.	Mendonça F, Passarini Jr J, Esquisatto M, et al. Effects of the application of Aloe vera (L.) and microcurrent on the healing of wounds surgically induced in Wistar rats. Acta Cir Bras, 2009, 24(2): 150-155.
2.	Lazarus G, Cooper D, Knighton D, et al. Definitions and guidelines for assessment of wounds and evaluation of healing. Arch Dermatol, 1994, 130(4): 489-493.
3.	Vogler B, Ernst E. Aloe Vera: a systematic review of its clinical effectiveness. Br J Gen Pract, 1999, 49(447): 823-828.
4.	Chithra P, Sajithal G, Chandrakasan G. Influence of aloe vera on the healing of dermal wounds in diabetic rats. J Ethnopharmacol, 1998, 59(3): 195-201.
5.	Takzare N, Hosseini M, Hasanzadeh G, et al. Influence of aloe vera gel on dermal wound healing process in rat. Toxicol Mech Methods, 2009, 19(1): 73-77.
6.	Steenkamp V, Stewart M. Medicinal applications and toxicological activities of aloe products. Pharm Biol, 2007, 45(5): 411-420.
7.	Davis R, Di Donato J, Hartman G, et al. Antiinflammatory and wound healing activity of a growth substance in Aloe vera. J Am Podiatr Med Assoc, 1994, 84(2): 77-81.
8.	Boudreau M, Beland F. An evaluation of the biological and toxicological properties of Aloe Barbadensis (Miller), Aloe Vera. J Environ Sci Health B, 2006, Part C 24(1): 103-154.
9.	Lefebvre C, Eisinga A, McDonald S, et al. Enhancing access to reports of clinical trials published world-wide - the contribution of EMBASE records to the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library. Emerg Themes Epidemiol, 2008, sep 30; 5: 13, doi:10.1186/1742-7622-5-13.
10.	Akhtar M, Hatwar S. Efficacy of Aloe vera extract cream in management of burn wound. J Clin Epidemiol, 1996, 49(Suppl 1): 24.
11.	Eshghi F, Hosseinimehr S, Hahmani N, et al. Effects of Aloe vera cream on posthemorrhoidectomy pain and wound healing: results of a randomised, blind, placebo-control study. J Altern Complement Med, 2010, 16(6): 647-650.
12.	Khorasani G, Hosseinmehr S, Azadbakht M, et al. Aloe versus silver sulfadiazaine creams for second-degree burns: a randomised controlled study. Surg Today, 2009, 39(7): 587-591.
13.	Phillips T, Ongenae K, Kanj L, et al. A randomised study of an Aloe vera derivative gel dressing versus conventional treatment after shave biopsy excisions. Wounds, 1995, 7(5): 200-202.
14.	Schmidt J, Greenspoon J. Aloe vera dermal wound gel is associated with a delay in wound healing. Obstet Gynecol, 1991, 78(1): 115-117.
15.	Thamlikitkul V, Bunyapraphatsara N, Riewpaiboon W, et al. Clinical trial of Aloe vera linn. for treatment of minor burns. Siriraj Hosp Gaz, 991, 43(5): 31-36.
16.	Thomas DR, Goode PS, LaMaster K, et al. Acemannan hydrogel dressing versus saline dressing for pressure ulcers: a randomized controlled trial. Adv Wound Care, 1998, 11(6): 273-276.
17.	陈飞艳, 陈远, 何永姬. 完美芦荟胶治疗压疮的疗效观察及护理. 护理实践与研究(上半月版), 2009, 6(1): 87-88.
18.	陈叶香, 易萍. 芦荟粉治疗Ⅱ期以上压疮的效果分析. 齐鲁护理杂志, 2005, 11(11): 1575-1576.
19.	李利, 王莉, 李咏, 等. 芦荟胶对皮肤激光术后局部炎症反应的影响. 临床皮肤科杂志, 2003, 32(12): 739-740.
20.	李晓霞, 唐勇, 罗小红, 等. 鲜芦荟治疗肿瘤患者微波热疗烧伤疗效观察. 护理学杂志, 2007, 22(21): 33-34.
21.	罗琼, 周海翠. 芦荟凝胶配合烤灯治疗压疮的方法与效果. 临床肺科杂志, 2010, 15(4): 583.
22.	莫佩妙, 张春兰, 黄年娇. 鲜芦荟治疗褥疮临床观察. 右江民族医学院学报, 2007, 29(6): 967-968.
23.	王惠玲. 运用芦荟治疗压疮的实践. 中国当代医药, 2010, 17(29): 49-50.
24.	杨金霞. 云南白药加芦荟汁用于压疮的临床观察. 中外医疗, 2011, 30(8): 96-98.
25.	Choi SW, Son BW, Son YS, et al. The wound-healing effect of a glycoprotein fraction isolated from Aloe vera. Br J Dermatol, 2001, 145(4): 535-545.
26.	Lee JK, Lee MK, Yun YP, et al. Acemannan puri-fied from Aloe verainduces phenotypic and functional maturation of immature dendritic cells. Int Immunopharmacol, 2001, 1(7): 1275-1284.
27.	Begg C, Cho M, Eastwood S, et al. Improving the quality of reporting of randomized controlled trials: the CONSORT statement. JAMA, 1996, 276(8): 637-639.

1. Mendonça F, Passarini Jr J, Esquisatto M, et al. Effects of the application of Aloe vera (L.) and microcurrent on the healing of wounds surgically induced in Wistar rats. Acta Cir Bras, 2009, 24(2): 150-155.
2. Lazarus G, Cooper D, Knighton D, et al. Definitions and guidelines for assessment of wounds and evaluation of healing. Arch Dermatol, 1994, 130(4): 489-493.
3. Vogler B, Ernst E. Aloe Vera: a systematic review of its clinical effectiveness. Br J Gen Pract, 1999, 49(447): 823-828.
4. Chithra P, Sajithal G, Chandrakasan G. Influence of aloe vera on the healing of dermal wounds in diabetic rats. J Ethnopharmacol, 1998, 59(3): 195-201.
5. Takzare N, Hosseini M, Hasanzadeh G, et al. Influence of aloe vera gel on dermal wound healing process in rat. Toxicol Mech Methods, 2009, 19(1): 73-77.
6. Steenkamp V, Stewart M. Medicinal applications and toxicological activities of aloe products. Pharm Biol, 2007, 45(5): 411-420.
7. Davis R, Di Donato J, Hartman G, et al. Antiinflammatory and wound healing activity of a growth substance in Aloe vera. J Am Podiatr Med Assoc, 1994, 84(2): 77-81.
8. Boudreau M, Beland F. An evaluation of the biological and toxicological properties of Aloe Barbadensis (Miller), Aloe Vera. J Environ Sci Health B, 2006, Part C 24(1): 103-154.
9. Lefebvre C, Eisinga A, McDonald S, et al. Enhancing access to reports of clinical trials published world-wide - the contribution of EMBASE records to the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library. Emerg Themes Epidemiol, 2008, sep 30; 5: 13, doi:10.1186/1742-7622-5-13.
10. Akhtar M, Hatwar S. Efficacy of Aloe vera extract cream in management of burn wound. J Clin Epidemiol, 1996, 49(Suppl 1): 24.
11. Eshghi F, Hosseinimehr S, Hahmani N, et al. Effects of Aloe vera cream on posthemorrhoidectomy pain and wound healing: results of a randomised, blind, placebo-control study. J Altern Complement Med, 2010, 16(6): 647-650.
12. Khorasani G, Hosseinmehr S, Azadbakht M, et al. Aloe versus silver sulfadiazaine creams for second-degree burns: a randomised controlled study. Surg Today, 2009, 39(7): 587-591.
13. Phillips T, Ongenae K, Kanj L, et al. A randomised study of an Aloe vera derivative gel dressing versus conventional treatment after shave biopsy excisions. Wounds, 1995, 7(5): 200-202.
14. Schmidt J, Greenspoon J. Aloe vera dermal wound gel is associated with a delay in wound healing. Obstet Gynecol, 1991, 78(1): 115-117.
15. Thamlikitkul V, Bunyapraphatsara N, Riewpaiboon W, et al. Clinical trial of Aloe vera linn. for treatment of minor burns. Siriraj Hosp Gaz, 991, 43(5): 31-36.
16. Thomas DR, Goode PS, LaMaster K, et al. Acemannan hydrogel dressing versus saline dressing for pressure ulcers: a randomized controlled trial. Adv Wound Care, 1998, 11(6): 273-276.
17. 陈飞艳, 陈远, 何永姬. 完美芦荟胶治疗压疮的疗效观察及护理. 护理实践与研究(上半月版), 2009, 6(1): 87-88.
18. 陈叶香, 易萍. 芦荟粉治疗Ⅱ期以上压疮的效果分析. 齐鲁护理杂志, 2005, 11(11): 1575-1576.
19. 李利, 王莉, 李咏, 等. 芦荟胶对皮肤激光术后局部炎症反应的影响. 临床皮肤科杂志, 2003, 32(12): 739-740.
20. 李晓霞, 唐勇, 罗小红, 等. 鲜芦荟治疗肿瘤患者微波热疗烧伤疗效观察. 护理学杂志, 2007, 22(21): 33-34.
21. 罗琼, 周海翠. 芦荟凝胶配合烤灯治疗压疮的方法与效果. 临床肺科杂志, 2010, 15(4): 583.
22. 莫佩妙, 张春兰, 黄年娇. 鲜芦荟治疗褥疮临床观察. 右江民族医学院学报, 2007, 29(6): 967-968.
23. 王惠玲. 运用芦荟治疗压疮的实践. 中国当代医药, 2010, 17(29): 49-50.
24. 杨金霞. 云南白药加芦荟汁用于压疮的临床观察. 中外医疗, 2011, 30(8): 96-98.
25. Choi SW, Son BW, Son YS, et al. The wound-healing effect of a glycoprotein fraction isolated from Aloe vera. Br J Dermatol, 2001, 145(4): 535-545.
26. Lee JK, Lee MK, Yun YP, et al. Acemannan puri-fied from Aloe verainduces phenotypic and functional maturation of immature dendritic cells. Int Immunopharmacol, 2001, 1(7): 1275-1284.
27. Begg C, Cho M, Eastwood S, et al. Improving the quality of reporting of randomized controlled trials: the CONSORT statement. JAMA, 1996, 276(8): 637-639.

Chinese Journal of Evidence-Based Medicine

Effectiveness of Aloe Vera for Acute and Chronic Wounds: A Systematic Review

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