A Fresh Look At Aloe. dermatology. dermatology

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1 A Fresh Look At Aloe ADOPTING A KEY TREATMENT TOOL FOR YOUR PRACTICE dermatology atnt By Ahmed Abdullah, M.D., F.A.C.S., F.I.C.S. For centuries, aloe vera has been a popular natural remedy for the treatment of a myriad of ailments from sinus infections to indigestion. Today, however, most individuals recognize aloe simply as a sunburn soother, ignoring its more substantial benefits of this plant, which Aristotle called the potted physician, requires a deeper understanding of aloe s abilities and the conditions under which they may be maximized. Aloe was first included in the United States Pharmacopoeia Featuring more than 200 active components, including vitamins, minerals, amino acids, enzymes, polysaccharides, and fatty acids, aloe s medicinal uses are still being uncovered today. benefits to the skin. Given aloe s proven ability to heal wounds, it can play an important role in both surgical and non-surgical applications. But reaping the in 1820 and, since then, countless scientists have studied its efficacy in a range of clinical applications. The first documented research dates back to 1935 when Collins and Collins found it to be beneficial in the treatment of radiation dermatitis. Since that time, countless studies have proven aloe s effectiveness in treating a wide range of conditions, including superficial periodontal disease, herpes, and even diabetes, making it one of the few natural substances scientifically proven to heal the body. Featuring more than 200 active components, including vitamins, minerals, amino acids, enzymes, polysaccharides, and fatty acids, aloe s medicinal uses are still being uncovered today. In fact, in the past few years alone, researchers have discovered aloe s ability to protect organs from blood loss, thus keeping trauma victims alive until they can receive september october

2 a blood transfusion (Macias et al, 2004); increase the efficacy of chemotherapy in terms of tumor regression and survival time (Lissoni et al, 2009); and even work better than toothpaste at fighting decay (Dilip et al, 2009). The reasons for aloe s impact on so many diseases and conditions can be isolated to several key abilities of the plant, including: Aloe penetrates tissue. Aloe can be absorbed deep into the skin s layers due to the presence of lignin, a substance similar to cellulose. Aloe acts as an anesthetic. This is because of its high magnesium content and aspirinlike compounds. Aloe has antimicrobial properties. Among its antimicrobial compounds are saponin, which acts as an antisepsis, and barbaloin, which is effective against Mycobacterium. A 1979 study by Heggers et al showed that aloe in concentrations greater than 60% is lethal against various organisms. Aloe is an anti-inflammatory and edema reliever. Aloe contains salicylic acid, a beta hydroxy acid that blocks the formation of detrimental products of the arachidonic acid cascade, including prostaglandin and thromboxane. Thus, it prevents dermal ischemia. It also contains sterols that, similar to cortisone, inhibit acute inflammation but without the risk of side effects. While aloe s characteristics make the plant an appropriate treatment in a broad array of medical specialties, they lend themselves particularly well to the fields of plastic surgery, dermatology and other aesthetic practices that focus on improving the skin. Aloe is proven to heal wounds. Scientific research has shown that aloe has an excellent ability to regenerate cells. This is due to the presence of gibberellin, a growth hormone-like substance that increases protein synthesis, and lectin, a protein that increases collagen activity and improves the collagen matrix. ALOE IN CLINICAL PRACTICE While aloe s characteristics make the plant an appropriate treatment in a broad array of medical specialties, they lend themselves particularly well to the fields of plastic surgery, dermatology, and other aesthetic practices that focus on improving the skin. Among the conditions and scenarios where aloe may prove beneficial are the following: Burns and Frostbite. Given aloe s ability to prevent dermal ischemia, it is a superior treatment for frostbite and burns. In fact, a 1963 study 2 september october

3 by McCauley et al showed a 60% increase in tissue survival in frostbite when treated with aloe. Surgical Flaps and Grafts. Dr. Martin Robson, past chair of the American Board of Plastic Surgery, and Dr. John Heggers are among the plastic surgeons who pioneered the act of applying pharmaceutical-grade aloe to skin flaps in surgery after SELECTING THE APPROPRIATE FORM OF ALOE Before using aloe in your practice or prescribing its use to a patient, it is important to note that not just any aloe will demonstrate the positive results shown in scientific studies. Fresh aloe, for example, will prove quite useless. After all, the household aloe plant is a different species than the Aloe The only aloe appropriate for use in clinical practice is pharmaceutical-grade aloe. their research demonstrated aloe s role in preventing dermal ischemia. This practice is slowly growing in popularity. Laser Skin Resurfacing, Dermabrasion, and Chemical Peels. Given aloe s proven ability to decrease edema and stimulate early epithelialization, along with its anesthetic capabilities, treating skin with aloe following outpatient procedures can produce a marked improvement in healing time while easing discomfort. Acne, Eczema, Rosacea, Psoriasis, etc. As a superior antiinflammatory, aloe can successfully be used in the treatment of inflammation-based conditions. Because most skin disorders stem from inflammation, the opportunities for aloe usage in clinical practice are limitless. Barbadensis used in clinical applications. Additionally, unprocessed aloe, as well as processed aloe of a low purity level, contains irritating substances, such as anthraquinones, which may cause contact irritation or allergic reactions in some individuals. Over-the-counter aloe gels should should also be avoided as these are most often water-based and feature aloe of an inadequate purity level. The only aloe appropriate for use in clinical practice is pharmaceutical-grade, the purest form available. Simply purchasing pharmaceutical-grade aloe, however, is no guarantee that the plant has been properly harvested and processed. Aloe s active ingredients begin to decompose and lose their effectiveness soon after harvesting. To avoid this, aloe must be processed within four to six hours to maintain its bioactivity. To ensure the product you select has been properly handled and processed, look for aloe that has been certified by the International Aloe Science Council (IASC), a non-profit trade organization that is dedicated to providing the world with the highest quality aloe. SKIN CARE PRODUCTS Beyond its use within the clinical environment, aloe is further beneficial to patients when participating in a skin care regimen with products that feature the ingredient. But don t be fooled. Results are rarely garnered from the countless skin care products that tout their inclusion of aloe. This is because most Thyroid cancer radiation patient before (left) and three months after (right) treatment with pharmaceutical-grade aloe vera. Photos courtesy of Dr. Abdullah. dermatology summer

4 ALOE FACTOIDS Records of aloe s restorative powers appear in Sumarian clay tablets dating back to 2100 BC. Cleopatra was said to have regarded the use of aloe as her beauty secret. In the United States, aloe is grown throughout Florida, southern California and the Rio Grande Valley of South Texas. Of the 300 species of aloe grown throughout the world, only two are grown commercially: Aloe Barbadensis Miller and Aloe Aborescense. 6. Heggers JP, Pineless GR, Robson MC. (1979) Dermaide Aloe/Aloe Vera Gel: Comparison of the Antimicrobial Effects. J Am Med Technology (41) Heggers JP, Robson MC, Manavalen K, Weingarten MD, Carethers JM, Boertman JA, Smith DJ Jr, Sachs RJ. (1987) Experimental and Clinical Observations on Frostbite. Annals of Emergency Med 16 (9) Lv RL, Wu BY, Chen XD, Jiang Q. (2006) The Effects of Aloe Extract on Nitric Oxide and Endothelin Levels in Deep- Partial Thickness Burn Wound Tissue in Rat. Zhonghua Shao Shang Za Zhi 22 (5) brands utilize aloe of inadequate quality or consistency. To ensure the effectiveness of a skin care product utilizing aloe, look at the ingredient list to ensure aloe is listed first, making it the base. Most often, you ll find a base of water, which only dilutes the active ingredients in a product. This makes any aloe the product does contain virtually worthless. Conversely, a base of aloe is beneficial because of the ingredient s ability to penetrate tissue, thus delivering healing benefits to the source of damaged skin while acting as an excellent carrier for other effective ingredients in the product. Finally, as mentioned earlier, ensure the aloe that is listed is described as pharmaceutical-grade. Aloe vera is a powerhouse whose value should not be underestimated by medical and skin care professionals. After all, it is easy to obtain, generally inexpensive, and comes without much risk of side effects. Simply try incorporating the use of pharmaceutical-grade aloe into your practice for a short period of time. The outcomes you ll experience will most certainly be all the proof you need that it is a worthwhile endeavor. References 1. Macias CA, Kameneva MV, Tenhunen JJ, Puyana JC, Fink, MP (2004) Survival in A Rat Model of Lethal Hemorrhagic Shock is Prolonged Following Resuscitation with a Small Volume of a Solution Containing a Drag- Reducing Polymer Derived from Aloe Vera. Shock 22 (2) Lissoni P, Rovelli F, Brivio F, Zago R, Colciago M, Messina G, Mora A, Porro G. (2009) A Randomized Study of Chemotherapy Versus Biochemotherapy with Chemotherapy Plus Aloe Arborescens in Patients with Metastatic Cancer. In Vivo 23 (1) Dilip G, Bhat S., Antony B. (2009) Comparative Evaluation of Antimicrobial Efficacy of Aloe Vera Tooth Gel and Two Popular Marketed Tooth Pastes An In Vitro Study. 4. General Dentistry 57 (3) Atherton, P. (1998) Aloe Vera: Magic or Medicine? Nursing Standard 12: Lewis WH, Elvin-Lewis MP. (1977) Medical Botany, Plants Affecting Man s Health: Skin. Ch McCauley RL, Hing DN, Robson MC, et al (1983) J Trauma 23: Chithra P, Sajithial GB, Chandrakasan G. (1998) Influence of Aloe Vera on Collagen Turnover in Healing of Dermal Wounds in Rats. Indian Journal of Exp Bio 36 (9) About the Author Dr. Ahmed Abdullah is a recognized expert on the restorative and medicinal effects of aloe vera. A board-certified plastic and cosmetic surgeon, he is also the founder and formulator of the Lexli line of aloe-based skin care. A member of the International Aloe Science Council (IASC), Dr. Abdullah has served on its board of directors. Visit the Lexli website for more information: 4 september october

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