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.

Citation

Ava Lorenc, Edzard Ernst, CAM-Cancer Consortium. Aloe vera [online document]. http://www.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

  1. Ernst E, Pittler M, Wider B, Boddy K. The Desktop Guide to Complementary and Alternative Medicine. 2nd edition ed. Edinburgh: Elsevier Mosby; 2006.
  2. Ulbricht C, Armstrong J, Basch E, Basch S, Bent S, Dacey C, et al. An evidence-based systematic review of Aloe vera by the natural standard research collaboration. Journal of herbal pharmacotherapy. 2007;7(3-4):279-323.
  3. Sakai R. Epidemiologic survey on lung cancer with respect to cigarette smoking and plant diet. Japanese journal of cancer research : Gann. 1989;80(6):513-20.
  4. Al-Oqail MM, El-Shaibany A, Al-Jassas E, Al-Sheddi ES, Al-Massarani SM, Farshori NN. In vitro anti-proliferative activities of Aloe perryi flowers extract on human liver, colon, breast, lung, prostate and epithelial cancer cell lines. Pakistan journal of pharmaceutical sciences. 2016;29(2 Suppl):723-9.
  5. Hussain A, Sharma C, Khan S, Shah K, Haque S. Aloe vera inhibits proliferation of human breast and cervical cancer cells and acts synergistically with cisplatin. Asian Pacific journal of cancer prevention : APJCP. 2015;16(7):2939-46.
  6. Yonehara A, Tanaka Y, Kulkeaw K, Era T, Nakanishi Y, Sugiyama D. Aloe vera Extract Suppresses Proliferation of Neuroblastoma Cells In Vitro. Anticancer research. 2015;35(8):4479-85.
  7. Cardenas C, Quesada AR, Medina MA. Evaluation of the anti-angiogenic effect of aloe-emodin. Cellular and molecular life sciences : CMLS. 2006;63(24):3083-9.
  8. Xiao B, Guo J, Liu D, Zhang S. Aloe-emodin induces in vitro G2/M arrest and alkaline phosphatase activation in human oral cancer KB cells. Oral oncology. 2007;43(9):905-10.
  9. Esmat AY, Tomasetto C, Rio MC. Cytotoxicity of a natural anthraquinone (Aloin) against human breast cancer cell lines with and without ErbB-2: topoisomerase IIalpha coamplification. Cancer biology & therapy. 2006;5(1):97-103.
  10. Wang YR, Yang SY, Chen GX, Wei P. Barbaloin loaded polydopamine-polylactide-TPGS (PLA-TPGS) nanoparticles against gastric cancer as a targeted drug delivery system: Studies in vitro and in vivo. Biochemical and biophysical research communications. 2018;499(1):8-16.
  11. Wu YY, Zhang JH, Gao JH, Li YS. Aloe-emodin (AE) nanoparticles suppresses proliferation and induces apoptosis in human lung squamous carcinoma via ROS generation in vitro and in vivo. Biochemical and biophysical research communications. 2017;490(3):601-7.
  12. Tabolacci C, Cordella M, Turcano L, Rossi S, Lentini A, Mariotti S, et al. Aloe-emodin exerts a potent anticancer and immunomodulatory activity on BRAF-mutated human melanoma cells. European journal of pharmacology. 2015;762:283-92.
  13. Chihara T, Shimpo K, Beppu H, Yamamoto N, Kaneko T, Wakamatsu K, et al. Effects of Aloe-emodin and Emodin on Proliferation of the MKN45 Human Gastric Cancer Cell Line. Asian Pacific journal of cancer prevention : APJCP. 2015;16(9):3887-91.
  14. Ismail S, Haris K, Abdul Ghani AR, Abdullah JM, Johan MF, Mohamed Yusoff AA. Enhanced induction of cell cycle arrest and apoptosis via the mitochondrial membrane potential disruption in human U87 malignant glioma cells by aloe emodin. Journal of Asian natural products research. 2013;15(9):1003-12.
  15. Trybus W, Krol T, Trybus E, Stachurska A, Kopacz-Bednarska A, Krol G. Induction of Mitotic Catastrophe in Human Cervical Cancer Cells After Administration of Aloe-emodin. Anticancer research. 2018;38(4):2037-44.
  16. Haris K, Ismail S, Idris Z, Abdullah JM, Yusoff AA. Expression profile of genes modulated by Aloe emodin in human U87 glioblastoma cells. Asian Pacific journal of cancer prevention : APJCP. 2014;15(11):4499-505.
  17. Ma JW, Hung CM, Lin YC, Ho CT, Kao JY, Way TD. Aloe-emodin inhibits HER-2 expression through the downregulation of Y-box binding protein-1 in HER-2-overexpressing human breast cancer cells. Oncotarget. 2016;7(37):58915-30.
  18. Luo J, Yuan Y, Chang P, Li D, Liu Z, Qu Y. Combination of aloe-emodin with radiation enhances radiation effects and improves differentiation in human cervical cancer cells. Molecular medicine reports. 2014;10(2):731-6.
  19. Tseng HS, Wang YF, Tzeng YM, Chen DR, Liao YF, Chiu HY, et al. Aloe-Emodin Enhances Tamoxifen Cytotoxicity by Suppressing Ras/ERK and PI3K/mTOR in Breast Cancer Cells. The American journal of Chinese medicine. 2017;45(2):337-50.
  20. Li KT, Chen Q, Wang DW, Duan QQ, Tian S, He JW, et al. Mitochondrial pathway and endoplasmic reticulum stress participate in the photosensitizing effectiveness of AE-PDT in MG63 cells. Cancer medicine. 2016;5(11):3186-93.
  21. Tu P, Huang Q, Ou Y, Du X, Li K, Tao Y, et al. Aloe-emodin-mediated photodynamic therapy induces autophagy and apoptosis in human osteosarcoma cell line MG63 through the ROS/JNK signaling pathway. Oncology reports. 2016;35(6):3209-15.
  22. Singh RP, Dhanalakshmi S, Rao AR. Chemomodulatory action of Aloe vera on the profiles of enzymes associated with carcinogen metabolism and antioxidant status regulation in mice. Phytomedicine : international journal of phytotherapy and phytopharmacology. 2000;7(3):209-19.
  23. Kocik J, Balan BJ, Zdanowski R, Jung L, Skopinska-Rozewska E, Skopinski P. Feeding mice with Aloe vera gel diminishes L-1 sarcoma-induced early neovascular response and tumor growth. Central-European journal of immunology. 2014;39(1):14-8.
  24. Chaudhary G, Saini MR, Goyal PK. Chemopreventive potential of Aloe vera against 7,12-dimethylbenz(a)anthracene induced skin papillomagenesis in mice. Integrative cancer therapies. 2007;6(4):405-12.
  25. Saini M, Goyal PK, Chaudhary G. Anti-tumor activity of Aloe vera against DMBA/croton oil-induced skin papillomagenesis in Swiss albino mice. Journal of environmental pathology, toxicology and oncology : official organ of the International Society for Environmental Toxicology and Cancer. 2010;29(2):127-35.
  26. Im SA, Kim JW, Kim HS, Park CS, Shin E, Do SG, et al. Prevention of azoxymethane/dextran sodium sulfate-induced mouse colon carcinogenesis by processed Aloe vera gel. International immunopharmacology. 2016;40:428-35.
  27. Shimpo K, Chihara T, Kaneko T, Beppu H, Wakamatsu K, Shinzato M, et al. Inhibitory effects of low-dose aloe-emodin on the development of colorectal tumors in min mice. Asian Pacific journal of cancer prevention : APJCP. 2014;15(14):5587-92.
  28. El-Shemy HA, Aboul-Soud MA, Nassr-Allah AA, Aboul-Enein KM, Kabash A, Yagi A. Antitumor properties and modulation of antioxidant enzymes' activity by Aloe vera leaf active principles isolated via supercritical carbon dioxide extraction. Current medicinal chemistry. 2010;17(2):129-38.
  29. Richardson J, Smith JE, McIntyre M, Thomas R, Pilkington K. Aloe Vera for Preventing Radiation-induced Skin Reactions: A Systematic Literature Review. Clinical Oncology. 2005;17(6):478-84.
  30. Su CK, Mehta V, Ravikumar L, Shah R, Pinto H, Halpern J, et al. Phase II double-blind randomized study comparing oral aloe vera versus placebo to prevent radiation-related mucositis in patients with head-and-neck neoplasms. International Journal of Radiation Oncology • Biology • Physics. 2004;60(1):171-7.
  31. Lissoni P, Giani L, Zerbini S, Trabattoni P, Rovelli F. Biotherapy with the pineal immunomodulating hormone melatonin versus melatonin plus aloe vera in untreatable advanced solid neoplasms. Natural immunity. 1998;16(1):27-33.
  32. Suboj P, Babykutty S, Valiyaparambil Gopi DR, Nair RS, Srinivas P, Gopala S. Aloe emodin inhibits colon cancer cell migration/angiogenesis by downregulating MMP-2/9, RhoB and VEGF via reduced DNA binding activity of NF-kappaB. European journal of pharmaceutical sciences : official journal of the European Federation for Pharmaceutical Sciences. 2012;45(5):581-91.
  33. Tabolacci C, Rossi S, Lentini A, Provenzano B, Turcano L, Facchiano F, et al. Aloin enhances cisplatin antineoplastic activity in B16-F10 melanoma cells by transglutaminase-induced differentiation. Amino acids. 2013;44(1):293-300.
  34. De Caro V, Scaturro AL, Di Prima G, Avellone G, Sutera FM, Di Fede O, et al. Aloin delivery on buccal mucosa: ex vivo studies and design of a new locoregional dosing system. Drug development and industrial pharmacy. 2014;41(9):1541-7.
  35. International Agency for Research on Cancer. SOME DRUGS AND HERBAL PRODUCTS VOLUME 108: IARC MONOGRAPHS ON THE EVALUATION OF CARCINOGENIC RISKS TO HUMANS. Switzerland: WHO; 2016.
  36. Rao S, Hegde SK, Baliga-Rao MP, Palatty PL, George T, Baliga MS. An Aloe Vera-Based Cosmeceutical Cream Delays and Mitigates Ionizing Radiation-Induced Dermatitis in Head and Neck Cancer Patients Undergoing Curative Radiotherapy: A Clinical Study. Medicines (Basel, Switzerland). 2017;4(3).
  37. Ahmadloo N, Kadkhodaei B, Omidvari S, Mosalaei A, Ansari M, Nasrollahi H, et al. Lack of Prophylactic Effects of Aloe Vera Gel on Radiation Induced Dermatitis in Breast Cancer Patients. Asian Pacific journal of cancer prevention : APJCP. 2017;18(4):1139-43.
  38. Hoopfer D, Holloway C, Gabos Z, Alidrisi M, Chafe S, Krause B, et al. Three-Arm Randomized Phase III Trial: Quality Aloe and Placebo Cream Versus Powder as Skin Treatment During Breast Cancer Radiation Therapy. Clinical breast cancer. 2015;15(3):181-90.e1-4.
  39. Haddad P, Amouzgar-Hashemi F, Samsami S, Chinichian S, Oghabian MA. Aloe vera for prevention of radiation-induced dermatitis: a self-controlled clinical trial. Current oncology (Toronto, Ont). 2013;20(4):e345-8.
  40. Worthington HV, Clarkson JE, Bryan G, Furness S, Glenny AM, Littlewood A, et al. Interventions for preventing oral mucositis for patients with cancer receiving treatment. The Cochrane database of systematic reviews. 2011(4):Cd000978.
  41. Puataweepong P, Dhanachai M, Dangprasert S, Sithatani C, Sawangsilp T, Narkwong L, et al. The efficacy of oral Aloe vera juice for radiation induced mucositis in head and neck cancer patients: a double-blind placebo-controlled study. Asian Biomedicine. 2009;3(4):375-82.
  42. Sahebjamee M, Mansourian A, Hajimirzamohammad M, Mohammad H, Zadeh M, Bekhradi R, et al. Comparative Efficacy of Aloe vera and Benzydamine Mouthwashes on Radiation-induced Oral Mucositis: a Triple-blind, Randomised, Controlled Clinical Trial. Oral health & preventive dentistry [Internet]. 2015; 13(4):[309-15 pp.].
  43. Mansouri P, Haghighi M, Beheshtipour N, Ramzi M. The Effect of Aloe Vera Solution on Chemotherapy-Induced Stomatitis in Clients with Lymphoma and Leukemia: A Randomized Controlled Clinical Trial. International journal of community based nursing and midwifery. 2016;4(2):119-26.
  44. Sudarshan R, Annigeri RG, Sree Vijayabala G. Aloe vera in the treatment for oral submucous fibrosis - a preliminary study. Journal of oral pathology & medicine : official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology. 2012;41(10):755-61.
  45. Patil S, Halgatti V, Maheshwari S, Santosh BS. Comparative study of the efficacy of herbal antioxdants oxitard and aloe vera in the treatment of oral submucous fibrosis. Journal of clinical and experimental dentistry. 2014;6(3):e265-70.
  46. Singh N, Hebbale M, Mhapuskar A, Ul NS, Thopte S, Singh S. Effectiveness of aloe vera and antioxidant along with physiotherapy in the management of oral submucous fibrosis. Journal of contemporary dental practice [Internet]. 2016; 17(1):[78-84 pp.].
  47. Anuradha A, Patil B, Asha VR. Evaluation of efficacy of aloe vera in the treatment of oral submucous fibrosis - a clinical study. Journal of oral pathology & medicine : official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology. 2016;46(1):50-5.
  48. Sahebnasagh A, Ghasemi A, Akbari J, Alipour A, Lashkardoost H, Ala S, et al. Successful Treatment of Acute Radiation Proctitis with Aloe Vera: A Preliminary Randomized Controlled Clinical Trial. Journal of alternative and complementary medicine (New York, NY). 2017;23(11):858-65.
  49. Lissoni P, Rovelli F, Brivio F, Zago R, Colciago M, Messina G, et al. A randomized study of chemotherapy versus biochemotherapy with chemotherapy plus Aloe arborescens in patients with metastatic cancer. In vivo (Athens, Greece). 2009;23(1):171-5.
  50. Guo X, Mei N. Aloe vera: A review of toxicity and adverse clinical effects. Journal of environmental science and health Part C, Environmental carcinogenesis & ecotoxicology reviews. 2016;34(2):77-96.
  51. Yokohira M, Matsuda Y, Suzuki S, Hosokawa K, Yamakawa K, Hashimoto N, et al. Equivocal colonic carcinogenicity of Aloe arborescens Miller var. natalensis berger at high-dose level in a Wistar Hannover rat 2-y study. Journal of food science. 2009;74(2):T24-30.
  52. Boudreau MD, Beland FA, Nichols JA, Pogribna M. Toxicology and carcinogenesis studies of a nondecolorized [corrected] whole leaf extract of Aloe barbadensis Miller (Aloe vera) in F344/N rats and B6C3F1 mice (drinking water study). National Toxicology Program technical report series. 2013(577):1-266.
  53. Guo X, Zhang S, Dial SL, Boudreau MD, Xia Q, Fu PP, et al. In vitro investigation of the mutagenic potential of Aloe vera extracts. Toxicology Research. 2014;3(6):487-96.
  54. Sehgal I, Winters WD, Scott M, David A, Gillis G, Stoufflet T, et al. Toxicologic assessment of a commercial decolorized whole leaf aloe vera juice, lily of the desert filtered whole leaf juice with aloesorb. Journal of toxicology. 2013;2013:802453.
  55. Photocarcinogenesis study of aloe vera [CAS NO. 481-72-1(Aloe-emodin)] in SKH-1 mice (simulated solar light and topical application study). National Toxicology Program technical report series. 2010(553):7-33, 5-97, 9-103 passim.