Sains Malaysiana 52(6)(2023): 1785-1794

http://doi.org/10.17576/jsm-2023-5206-14

A Systematic Review of the Clinical Effectiveness of Aloe vera for the Prevention and Treatment of Chronic Wounds

(Suatu Ulasan Sistematik Keberkesanan Klinikal Aloe vera untuk Pencegahan dan Rawatan Luka Kronik)

AHMAD NUR AFIEQ IDRUS¹, KHURRAM REHMAN² & MOHD HANIF ZULFAKAR^1,3,*

¹Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia

²Department of Pharmacy, Forman Christian College, Ferozpur Road, 54600, Lahore, Pakistan

³Centre for Drug Delivery Technology, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia

Received: 25 February 2023/Accepted: 12 June 2023

Abstract

Aloe vera is an herbaceous and perennial plant that belongs to Liliaceae family and used for many medicinal purposes. Aloe vera have been associated with the treatment of skin burns and postoperative wound healing but not many clinical studies have been conducted to evaluate its effectiveness against chronic wounds such as pressure injury. The present study aimed to systematically review clinical trials investigating the effect of Aloe vera on the prevention and healing of chronic wounds. To identify all related published studies, Science Direct, Google Scholar, PubMed, and Ovid MEDLINE databases were searched in English language from the year 2015-2022. 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 according to the PRISMA selection process. In total, 11 trials that met the inclusion criteria were reviewed. The results of the studies showed successful use of Aloe vera in the prevention and treatment of chronic wounds including pressure injuries, chronic wound ulcers, diabetic foot ulcers, chronic anal fissures, and traumatic oral ulceration due to orthodontic appliances. Based on its safety and efficacy profile, this review concluded that Aloe verahas potential benefits to be used as a complementary or alternative treatment in chronic wounds along with conventional methods. Its ability to retain skin moisture and preservation of skin integrity supports its use in the prevention of ulcers.

Keywords: Aloe vera; chronic wound; clinical trial; wound prevention; wound treatment

Abstrak

Aloe vera adalah tumbuhan herba dan saka yang tergolong dalam famili Liliaceae dan banyak digunakan untuk tujuan perubatan. Aloe vera telah dikaitkan dengan rawatan kulit melecur dan penyembuhan luka selepas pembedahan tetapi tidak banyak kajian klinikal yang dijalankan untuk menilai keberkesanannya terhadap luka kronik seperti kecederaan tekanan. Kajian ini bertujuan untuk menilai secara sistematik ujian klinikal yang mengkaji kesan Aloe vera terhadap pencegahan dan penyembuhan luka kronik. Untuk mengenal pasti semua kajian berkaitan yang telah diterbitkan, artikel dalam bahasa Inggeris dari tahun 2015-2022 telah dicari di pangkalan data Science Direct, Google Scholar, PubMed dan Ovid MEDLINE. Semua ujian klinikal menggunakan gel Aloe vera, krim atau derivatif yang turut melibatkan kumpulan kawalan dengan plasebo atau perbandingan dengan rawatan lain dimasukkan ke dalam kajian mengikut proses pemilihan PRISMA. Eja ujian yang memenuhi kriteria kemasukan telah disemak. Hasil kajian menunjukkan keberkesanan penggunaan Aloe vera dalam pencegahan dan rawatan luka kronik termasuk kecederaan tekanan, ulser luka kronik, ulser kaki diabetik, fisur dubur kronik dan ulser mulut traumatik akibat peralatan ortodontik. Kajian ini menyimpulkan bahawa Aloe vera mempunyai potensi untuk digunakan sebagai pelengkap atau rawatan alternatif dalam luka kronik bersama-sama dengan kaedah konvensional. Keupayaannya untuk mengekalkan kelembapan kulit dan pemeliharaan integriti kulit menyokong penggunaannya dalam pencegahan ulser.

Kata kunci: Aloe vera; luka kronik; pencegahan luka; rawatan luka; ujian klinikal

REFERENCES

Anuradha, A., Patil, B. & Asha, V.R. 2017. Evaluation of efficacy of aloe vera in the treatment of oral submucous fibrosis - A clinical study. J. Oral Pathol. Med. 46(1): 50-55.

Aqsa, T., Shafique, M.S., Qureshi, U., Changeez, M., Farooqi, S.A. & Khan, J.S. 2019. Efficacy of aloe vera cream for healing diabetic foot ulcers. Journal of Rawalpindi Medical College 23(2): 113-115.

Athavale, V.S., Khandalkar, S.N., Mahawar, M., Shetty, I. & Lad, A. 2017. A comparative study between aloe vera gel dressing and conventional dressing in chronic wounds. International Surgery Journal 4(10): 3427-3432.

Avijgan, M., Kamran, A. & Abedini, A. 2016. Effectiveness of aloe vera gel in chronic ulcers in comparison with conventional treatments. Iran J. Med. Sci. 41(3 Suppl): S30.

Baghdadi, M., Rafiei, H., Rashvand, F. & Oveisi, S. 2020. Effect of Aloe vera gel, Calendula officinalis ointment and simple prophylactic sacral dressings for pressure injury development. Chronic Would Care Management and Research 7: 19-26. 

Burusapat, C., Supawan, M., Pruksapong, C., Pitiseree, A. & Suwantemee, C. 2018. 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. 142(1): 217-226.

Dat, A.D., Poon, F., Pham, K.B. & Doust, J. 2012. Aloe vera for treating acute and chronic wounds. Cochrane Database Syst. Rev. 2: CD008762.

Eshghi, F., Hosseinimehr, S.J., Rahmani, N., Khademloo, M., Norozi, M.S. & Hojati, O. 2010. Effects of aloe vera cream on posthemorrhoidectomy pain and wound healing: Results of a randomized, blind, placebo-control study. J. Altern. Complement. Med. 16(6): 647-650.

Finberg, M.J., Muntingh, G.L. & van Rensburg, C.E. 2015. A comparison of the leaf gel extracts of aloe ferox and aloe vera in the topical treatment of atopic dermatitis in Balb/C mice. Inflammopharmacology 23(6): 337-341.

Garcia-Orue, I., Gainza, G., Garcia-Garcia, P., Gutierrez, F.B., Aguirre, J.J., Hernandez, R.M., Delgado, A. & Igartua, M. 2019. Composite nanofibrous membranes of PLGA/aloe vera containing lipid nanoparticles for wound dressing applications. Int. J. Pharm. 556: 320-329.

Garcia-Orue, I., Gainza, G., Gutierrez, F.B., Aguirre, J.J., Evora, C., Pedraz, J.L., Hernandez, R.M., Delgado, A. & Igartua, M. 2017. Novel nanofibrous dressings containing rhEGF and aloe vera for wound healing applications. Int. J. Pharm. 523(2): 556-566.

Hamman, J.H. 2008. Composition and applications of aloe vera leaf gel. Molecules 13(8): 1599-1616.

Han, G. & Ceilley, R. 2017. Chronic wound healing: A review of current management and treatments. Adv. Ther. 34(3): 599-610.

Hashemi, S.A., Madani, S.A. & Abediankenari, S. 2015. The review on properties of aloe vera in healing of cutaneous wounds. BioMed. Research International 2015: Article ID 714216.

Hekmatpou, D., Mehrabi, F., Rahzani, K. & Aminiyan, A. 2018. 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. 18(1): 264.

Kanliöz, M., Ekici, U., Tatli, F. & Karatas, T. 2020. Symptomatic efficacy of aloe vera 2% cream in the treatment of chronic anal fissure. Turk. J. Colorectal 30: 99-103.

Leiva-Cala, C., Lorenzo-Pouso, A.I., Centenera-Centenera, B., López-Palafox, J., Gándara-Vila, P., García-García, A. & Pérez-Sayáns, M. 2020. 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 108(3): 470-478.

Maenthaisong, R., Chaiyakunapruk, N., Niruntraporn, S. & Kongkaew, C. 2007. The efficacy of aloe vera used for burn wound healing: A systematic review. Burns 33(6): 713-718.

Molazem, Z., Mohseni, F., Younesi, M. & Keshavarzi, S. 2014. Aloe vera gel and cesarean wound healing; A randomized controlled clinical trial. Glob. J. Health Sci. 7(1): 203-209.

Muangman, P., Praditsuktavorn, B., Chinaroonchai, K. & Chuntrasakul, C. 2016. Clinical efficacy test of polyester containing herbal extract dressings in burn wound healing. Int. J. Low Extrem. Wounds 15(3): 203-212.

Najafian, Y., Khorasani, Z.M., Najafi, M.N., Hamedi, S.S., Mahjour, M. & Feyzabadi, Z. 2019. Efficacy of Alore vera/Plantago major gel in diabetic foot ulcer: A randomized double-blind clinical trial. Current Drug Discovery Technologies 16(2): 223-231.

Oliveira, S.H., Soares, M.J. & Rocha Pde, S. 2010. Use of collagen and aloe vera in ischemic wound treatment: Study case. Rev. Esc. Enferm USP 44(2): 346-351.

Oryan, A., Mohammadalipour, A., Moshiri, A. & Tabandeh, M.R. 2016. Topical application of aloe vera accelerated wound healing, modeling, and remodeling: An experimental study. Ann. Plast Surg. 77(1): 37-46.

Panahi, Y., Izadi, M., Sayyadi, N., Rezaee, R., Jonaidi-jafari, N., Beiraghdar, F., Zamani, A. & Sahebkar, A. 2015. Comparative trial of aloe vera/olive oil combination cream versus phenytoin cream in the treatment of chronic wounds. J. Wound Care 24(10): 459-460.

Pinheiro, J.D., Ribeiro, J.A., Rocha, K.D.O.S., & do Nascimento. G.N.L. 2020. Simple blind clinical study of scaring action in aloe vera as coverage in pressure injuries in hospitalized patients. International Journal of Development Research 10(03): 34766-34770.

Shahzad, M.N. & Ahmed, N. 2013. Effectiveness of aloe vera gel compared with 1% silver sulphadiazine cream as burn wound dressing in second degree burns. J. Pak. Med. Assoc. 63(2): 225-230.

Shao, M., Hussain, Z., Thu, H.E., Khan, S., de Matas, M., Silkstone, V., Qin, H.L. & Bukhari, S.N.A. 2017. Emerging trends in therapeutic algorithm of chronic wound healers: Recent advances in drug delivery systems, concepts-to-clinical application and future prospects. Crit. Rev. Ther. Drug Carrier Syst. 34(5): 387-452.

Singh, S., Gupta, A. & Gupta, B. 2018. Scar free healing mediated by the release of aloe vera and manuka honey from dextran bionanocomposite wound dressings. Int. J. Biol. Macromol. 120(Pt B): 1581-1590.

Zanaty, M.M., Sultan, M.A., Shebl, A.M., Soliman, O.A. & Abdelrahman, H.A. 2017. The effect of aloe vera on the healing of second degree pressure ulcers among critically ill patients. Journal of Nursing and Health Science 6(6): 23-34.

*Corresponding author; email: hanifzulfakar@ukm.edu.my