Treatment of Skin Disorders with Aloe Materials

Hanna       Svitina; Roan       Swanepoel; Jacques       Rossouw; Happiness       Netshimbupfe; Chrisna       Gouws; Josias       Hamman
Abstract

The skin is the largest organ and functions as a barrier to protect the underlying tissues against the elements and pathogens, while also fulfilling many physiological roles and biochemical functions such as preventing excessive water loss. Skin disorders vary greatly in terms of origin, severity, symptoms and affect persons of all ages. Many plants have been used for medicinal purposes since ancient times including the treatment of skin disorders and diseases. Aloe represents one of the earliest medicinal plant species mentioned in antique scriptures and even in rock art dating back thousands of years. Different Aloe species and materials have been used in the prevention and treatment of skin related disorders. Aloe vera is the most commonly used Aloe species for medicinal purposes. Some of the most prominent skin related applications and disorders that Aloe materials have been investigated for are discussed in this paper, which include cosmetic, radiation, cancer, wound and antimicrobial applications. Both in vitro and in vivo studies are included in the discussions of this paper and comprehensive summaries of all these studies are given in tables in each section. Although some contradictory results were obtained among studies, certain Aloe materials have shown excellent efficacy and exhibited potential for the treatment of skin related disorders and cosmetic applications.
Keywords: Aloe gel, Aloe whole leaf, xanthorrhoeaceae, Aloe vera, cosmeceutics, skin disorders, skin diseases, topical treatment, traditional medicine.
[1] 
Reynolds GW. The Aaloes of South Africa, Trustees of The Aloes
of South Africa Book Fund: Johannesburg 1950.
[2] 
Grace OM. Klopper, RR;, Figueiredo, E; etc, Smith GF The
Aloe Names Book, Strelitzia 28 Pretoria Kew: South African National
Biodiversity Institute: Pretoria; Royal Botanic Gardens: Kew,South African National Biodiversity Institute, Royal Botanic
Gardens 2011.
[3] 
Carter S, Lavranos JJ, Newton LE, Walker CC. Aloes-The definitive
guide London: Kew Publishing in association with the British
Cactus and Succulent Society 2011.
[4] 
Newton LE. AloeIllustrated Handbook of Succulent Plants: Monocotyledons.  Berlin, Heidelberg, New York: Springer Verlag 2001; pp. 103-86.
[5] 
Gutterman Y, Chauser-Volfson E. Secondary phenol metabolites (SPhMs), distribution and content of some Aloe species, originated from arid zones of South Africa: A review. Am J Food Technol  2007; 2(7): 555-69.
[http://dx.doi.org/10.3923/ajft.2007.555.569] 
[6] 
Klopper RR, Smith GF. The genus ALOE (Asphodelaceae: Alooideae)
in Namaqualand, South Africa. Haseltonia 2007; 13: 38-51.
[http://dx.doi.org/10.2985/1070-0048(2007)13[38:TGAAAI]2.0.CO;2]] 
[7] 
Grace OM, Klopper RR, Smith GF, et al. A revised generic classification
for Aloe (Xanthorrhoeaceae subfam. Asphodeloideae).
Phytotaxa 2013; 76(1): 7-14.
[http://dx.doi.org/10.11646/phytotaxa.76.1.2] 
[8] 
Boudreau MD, Beland FA. An evaluation of the biological and toxicological properties of Aloe barbadensis (miller), Aloe vera. J Environ Sci Health C Environ Carcinog Ecotoxicol Rev  2006; 24(1): 103-54.
[http://dx.doi.org/10.1080/10590500600614303] [PMID: 16690538] 
[9] 
Ahlawat KS, Khatkar BS. Processing, food applications and safety of aloe vera products: a review. J Food Sci Technol  2011; 48(5): 525-33.
[http://dx.doi.org/10.1007/s13197-011-0229-z] [PMID: 23572784] 
[10] 
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). Natl Toxicol Program Tech Rep Ser  2013; (577): 1-266.
[PMID:  24042237] 
[11] 
Pal S, Sahrawat A, Prakash D. Aloe vera composition, processing and medicinal properties. Curr Disc  2013; 2: 106-22.
[12] 
Grace OM, Simmonds MS, Smith GF, Wyk AE. Documented utility and biocultural value of Aloe L. (Asphodelaceae): A review. Econ Bot  2009; 63: 167-78.
[http://dx.doi.org/10.1007/s12231-009-9082-7] 
[13] 
Amoo SO, Aremu AO, Van Staden J. Unraveling the medicinal potential of South African Aloe species. J Ethnopharmacol  2014; 153(1): 19-41.
[http://dx.doi.org/10.1016/j.jep.2014.01.036] [PMID: 24509153] 
[14] 
Cristiano G, Murillo-Amador B, De Lucia B. Propagation techniques and agronomic requirements for the cultivation of Barbados aloe (Aloe vera (L.) Burm. F.) – a review. Front Plant Sci  2016; 7: 1410.
[http://dx.doi.org/10.3389/fpls.2016.01410] [PMID: 27721816] 
[15] 
Grindlay D, Reynolds T. The Aloe vera phenomenon: a review of the properties and modern uses of the leaf parenchyma gel. J Ethnopharmacol  1986; 16(2-3): 117-51.
[http://dx.doi.org/10.1016/0378-8741(86)90085-1] [PMID: 3528673] 
[16] 
Foster M, Hunter D, Samman S. Evaluation of the nutritional and metabolic effects of Aloe veraHerbal Medicine: Biomolecular and Clinical Aspects.  2nd ed. Boca Raton, FL: CRC Press/Taylor & Francis 2011; p. 473.
[http://dx.doi.org/10.1201/b10787-4] 
[17] 
Hamman JH. Composition and applications of Aloe vera leaf gel. Molecules  2008; 13(8): 1599-616.
[http://dx.doi.org/10.3390/molecules13081599] [PMID: 18794775] 
[18] 
Chandu AN, Kumar SC, Bhattacharjee C, Debnath S. Cytotoxicity study of plant Aloe vera (Linn). Chronicles of Young Scientists  2012; 3(3): 233-5.
[http://dx.doi.org/10.4103/2229-5186.99595] 
[19] 
Jackson TC, Verrier JD, Kochanek PM. Anthraquinone-2-sulfonic acid (AQ2S) is a novel neurotherapeutic agent. Cell Death Dis  2013; 4e451
[http://dx.doi.org/10.1038/cddis.2012.87] [PMID: 23303125] 
[20] 
Raju YP, Haritha K, Satyanarayana RP, et al. Formulation and characterization of aceclofenac -aloe vera transemulgel. Curr Drug Deliv  2015; 12(6): 703-8.
[http://dx.doi.org/10.2174/156720181206151228113209] [PMID: 25751659] 
[21] 
Radha MH, Laxmipriya NP. Evaluation of biological properties and clinical effectiveness of Aloe vera: A systematic review. J Tradit Complement Med  2014; 5(1): 21-6.
[http://dx.doi.org/10.1016/j.jtcme.2014.10.006] [PMID: 26151005] 
[22] 
Gerber W, Steyn JD, Kotzé AF, Hamman JH. Beneficial pharmacokinetic drug interactions: a tool to improve the bioavailability of poorly permeable drugs. Pharmaceutics  2018; 10(3)E106
[http://dx.doi.org/10.3390/pharmaceutics10030106] [PMID:  30049988] 
[23] 
Popadic D, Savic E, Ramic Z, et al. Aloe-emodin inhibits proliferation of adult human keratinocytes in vitro. J Cosmet Sci  2012; 63(5): 297-302.
[PMID:  23089351] 
[24] 
Radovic J, Maksimovic-Ivanic D, Timotijevic G, et al. Cell-type dependent response of melanoma cells to aloe emodin. Food Chem Toxicol  2012; 50(9): 3181-9.
[http://dx.doi.org/10.1016/j.fct.2012.05.047] [PMID:  22683487] 
[25] 
Frei B, Baltisberger M, Sticher O, Heinrich M. Medical ethnobotany of the Zapotecs of the Isthmus-Sierra (Oaxaca, Mexico): Documentation and assessment of indigenous uses. J Ethnopharmacol  1998; 62(2): 149-65.
[http://dx.doi.org/10.1016/S0378-8741(98)00051-8] [PMID:  9741887] 
[26] 
Sushen U, Unnithan C, Rajan S, et al. Aloe vera: A potential herb used as traditional medicine by tribal people of kondagatu and purudu of karimnagar district, Telangana state, India. And their preparative methods. Eur J Pharm Med Res  2017; 4: 820-31.
[27] 
Bassett IB, Pannowitz DL, Barnetson RS. A comparative study of tea-tree oil versus benzoylperoxide in the treatment of acne. Med J Aust  1990; 153(8): 455-8.
[PMID:  2145499] 
[28] 
McCauley RL, Heggers JP, Robson MC. Frostbite. Methods to minimize tissue loss. Postgrad Med  1990; 88(8): 67-68, 73-77.
[http://dx.doi.org/10.1080/00325481.1990.11704769] [PMID:  2243830] 
[29] 
Somboonwong J, Thanamittramanee S, Jariyapongskul A, Patumraj S. Therapeutic effects of Aloe vera on cutaneous microcirculation and wound healing in second degree burn model in rats. J Med Assoc Thai  2000; 83(4): 417-25.
[PMID:  10808702] 
[30] 
Paulsen E, Korsholm L, Brandrup F. A double-blind, placebo-controlled study of a commercial Aloe vera gel in the treatment of slight to moderate psoriasis vulgaris. J Eur Acad Dermatol Venereol  2005; 19(3): 326-31.
[http://dx.doi.org/10.1111/j.1468-3083.2004.01186.x] [PMID:  15857459] 
[31] 
Syed TA, Ahmad SA, Holt AH, Ahmad SA, Ahmad SH, Afzal M. Management of psoriasis with Aloe vera extract in a hydrophilic cream: a placebo-controlled, double-blind study. Trop Med Int Health  1996; 1(4): 505-9.
[http://dx.doi.org/10.1046/j.1365-3156.1996.d01-91.x] [PMID:  8765459] 
[32] 
Vardy AD, Cohen AD, Tchetov T. A double-blind, placebo-controlled trial of Aloe vera (A. barbadensis) emulsion in the treatment of seborrheic dermatitis. J Dermatolog Treat  1999; 10(1): 7-11.
[http://dx.doi.org/10.3109/09546639909055904] 
[33] 
Bosely C, Smith J, Baratti P. A phase III trial comparing an anionic phospholipids-based (APP) cream and Aloe vera gel in the prevention and treatment of radiation dermatitis. Int J Radiat Oncol Biol Phys  2003; 57: S438.
[http://dx.doi.org/10.1016/S0360-3016(03)01404-4] 
[34] 
Shahzad MN, Ahmed N. Effectiveness of Aloe vera gel compared with 1% silver sulphadiazine cream as burn wound dressing in second degree burns. J Pak Med Assoc  2013; 63(2): 225-30.
[PMID:  23894900] 
[35] 
Visuthikosol V, Chowchuen B, Sukwanarat Y, Sriurairatana S, Boonpucknavig V. Effect of aloe vera gel to healing of burn wound a clinical and histologic study. J Med Assoc Thai  1995; 78(8): 403-9.
[PMID:  7561562] 
[36] 
Grundmann O. Aloe vera gel research review: An overview of its clinical uses and proposed mechanisms of action. Nat Med J  2012; 4: 9.
[37] 
Thamlikitkul V, Bunyapraphatsara N, Riewpaiboon W, et al. Clinical trial of Aloe vera Linn. for treatment of minor burns. Siriraj Med J  1991; 43(5): 313-6.
[38] 
Fulton JE Jr. The stimulation of postdermabrasion wound healing with stabilized aloe vera gel-polyethylene oxide dressing. J Dermatol Surg Oncol  1990; 16(5): 460-7.
[http://dx.doi.org/10.1111/j.1524-4725.1990.tb00065.x] [PMID:  2341661] 
[39] 
Jia Y, Zhao G, Jia J. Preliminary evaluation: the effects of Aloe ferox Miller and Aloe arborescens Miller on wound healing. J Ethnopharmacol  2008; 120(2): 181-9.
[http://dx.doi.org/10.1016/j.jep.2008.08.008] [PMID:  18773950] 
[40] 
Lakhanpal G, Bhalerao S, Sharma S, Patil H. To study the efficacy of different formulations of Aloe vera (spp. Aloe barbadensis) on wound healing in rats. Res J Pharm Biol Chem Sci  2015; 6: 432-40.
[41] 
Cock IE. The genus aloe: Phytochemistry and therapeutic uses including treatments for gastrointestinal conditions and chronic inflammation. Prog Drug Res  2015; 70: 179-235.
[http://dx.doi.org/10.1007/978-3-0348-0927-6_6] [PMID:  26462368] 
[42] 
Dal’Belo SE, Gaspar LR, Maia Campos PM, Campos GM. Moisturizing effect of cosmetic formulations containing Aloe vera extract in different concentrations assessed by skin bioengineering techniques. Skin Res Technol  2006; 12(4): 241-6.
[http://dx.doi.org/10.1111/j.0909-752X.2006.00155.x] [PMID:  17026654] 
[43] 
Sator P-G, Schmidt JB, Hönigsmann H. Comparison of epidermal hydration and skin surface lipids in healthy individuals and in patients with atopic dermatitis. J Am Acad Dermatol  2003; 48(3): 352-8.
[http://dx.doi.org/10.1067/mjd.2003.105] [PMID:  12637914] 
[44] 
Rawlings AV, Harding CR. Moisturization and skin barrier function. Dermatol Ther  2004; 17(Suppl. 1): 43-8.
[http://dx.doi.org/10.1111/j.1396-0296.2004.04S1005.x] [PMID:  14728698] 
[45] 
Ruiz MA, Pleguezuelos M, Muñoz M, Gallardo V. Moisturizing capacity of Aloe vera gel in skin creams made with silicone-based and olive oil-based latex preparations. J Appl Cosmetol  2004; 22: 25-33.
[46] 
Joseph B, Raj SJ. Pharmacognostic and phytochemical properties of Aloe vera Linn – an overview. Int J Pharm Sci Rev Res  2010; 4: 106-10.
[47] 
Sánchez-Machado DI, López-Cervantes J, Sendón R, Sanches-Silva A. Aloe vera: Ancient knowledge with new frontiers. Trends Food Sci Technol  2017; 61: 94-102.
[http://dx.doi.org/10.1016/j.tifs.2016.12.005] 
[48] 
Cosmetic ingredient review expert panel (CIR). Final report on the safety assessment of Aloe andongensis extract, Aloe andongensis leaf juice, Aloe arborescens leaf extract, Aloe arborescens leaf juice, Aloe arborescens leaf protoplasts, Aloe barbadensis flower extract, Aloe barbadensis leaf, Aloe barbadensis leaf extract, Aloe barbadensis leaf juice, Aloe barbadensis leaf polysaccharides, Aloe barbadensis leaf water, Aloe ferox leaf extract, Aloe ferox leaf juice, and Aloe ferox leaf juice extract. Int J Toxicol  2007; 26: 1-50.
[http://dx.doi.org/10.1080/10915810701351186] 
[49] 
Reynolds T, Dweck AC. Aloe vera leaf gel: a review update. J Ethnopharmacol  1999; 68(1-3): 3-37.
[http://dx.doi.org/10.1016/S0378-8741(99)00085-9] [PMID:  10624859] 
[50] 
Food and Drug Administration. HHS. Status of certain additional over-thecounter drug category II and III active ingredients. Final rule. Fed Regist  2002; 67(90): 31125-7.
[51] 
Eshun K, He Q. Aloe vera: A valuable ingredient for the food, pharmaceutical and cosmetic industries--a review. Crit Rev Food Sci Nutr  2004; 44(2): 91-6.
[http://dx.doi.org/10.1080/10408690490424694] [PMID:  15116756] 
[52] 
Akaberi M, Sobhani Z, Javadi B, Sahebkar A, Emami SA. Therapeutic effects of Aloe spp. in traditional and modern medicine: A review. Biomed Pharmacother  2016; 84: 759-72.
[http://dx.doi.org/10.1016/j.biopha.2016.09.096] [PMID:  27716590] 
[53] 
Nandal U, Bhardwaj RL. Aloe vera: a valuable wonder plant for food, medicine and cosmetic use – review. Int J Pharm Sci Rev Res  2012; 13: 59-67.
[54] 
Basmatker G, Jais N, Daud F. Aloe vera: A valuable multifunctional cosmetic ingredient. Int J Med Arom Plants  2011; 2: 338-41.
[55] 
Meadows TP. Aloe as a humectant in new skin preparations. Cosm Toil  1980; 95: 51-6.
[56] 
Surjushe A, Vasani R, Saple DG. Aloe vera: A short review. Indian J Dermatol  2008; 53(4): 163-6.
[http://dx.doi.org/10.4103/0019-5154.44785] [PMID:  19882025] 
[57] 
Lucini L, Pellizzoni M, Pellegrino R, Molinari GP, Colla G. Phytochemical constituents and in vitro radical scavenging activity of different Aloe species. Food Chem  2015; 170: 501-7.
[http://dx.doi.org/10.1016/j.foodchem.2014.08.034] [PMID:  25306376] 
[58] 
Chandegara VK, Varshney AK. Aloe vera L. Processing and products: A review. Int J Med Arom Plants  2013; 3: 492-506.
[59] 
Akhtar N, Khan BA, Khan MS, et al. Formulation development and moisturising effects of a topical cream of Aloe vera extract. Inter J Med Health Biomed Bioeng Pharm Eng  2011; 5: 128-36.
[60] 
Fox LT, du Plessis J, Gerber M, van Zyl S, Boneschans B, Hamman JH. In Vivo skin hydration and anti-erythema effects of Aloe vera, Aloe ferox and Aloe marlothii gel materials after single and multiple applications. Pharmacogn Mag  2014; 10(Suppl. 2): S392-403.
[http://dx.doi.org/10.4103/0973-1296.133291] [PMID:  24991119] 
[61] 
Mukherjee PK, Maity N, Nema NK, Sarkar BK. Bioactive compounds from natural resources against skin aging. Phytomedicine  2011; 19(1): 64-73.
[http://dx.doi.org/10.1016/j.phymed.2011.10.003] [PMID:  22115797] 
[62] 
Bogdan Allemann I, Baumann L. Antioxidants used in skin care formulations. Skin Therapy Lett  2008; 13(7): 5-9.
[PMID:  18839043] 
[63] 
Kang M-C, Kim SY, Kim YT, et al. In vitro and in vivo antioxidant activities of polysaccharide purified from aloe vera (Aloe barbadensis) gel. Carbohydr Polym  2014; 99: 365-71.
[http://dx.doi.org/10.1016/j.carbpol.2013.07.091] [PMID:  24274519] 
[64] 
Chun-hui L, Chang-hai W, Zhi-liang X, Yi W. Isolation, chemical characterization and antioxidant activities of two polysaccharides from the gel and the skin of Aloe barbadensis Miller irrigated with sea water. Process Biochem  2007; 42: 961-70.
[http://dx.doi.org/10.1016/j.procbio.2007.03.004] 
[65] 
Minjares-Fuentes R, Rodríguez-González VM, González-Laredo RF, Eim V, González-Centeno MR, Femenia A. Effect of different drying procedures on the bioactive polysaccharide acemannan from Aloe vera (Aloe barbadensis Miller). Carbohydr Polym  2017; 168: 327-36.
[http://dx.doi.org/10.1016/j.carbpol.2017.03.087] [PMID:  28457457] 
[66] 
Benson KF, Newman RA, Jensen GS. Antioxidant, anti-inflammatory, anti-apoptotic, and skin regenerative properties of an Aloe vera-based extract of Nerium oleander leaves (nae-8(®)). Clin Cosmet Investig Dermatol  2015; 8: 239-48.
[PMID:  26005354] 
[67] 
Loots T, van der Westhuizen FH, Botes L. Aloe ferox leaf gel phytochemical content, antioxidant capacity, and possible health benefits. J Agric Food Chem  2007; 55(17): 6891-6.
[http://dx.doi.org/10.1021/jf071110t] [PMID:  17661490] 
[68] 
Frum Y, Viljoen AM. In vitro 5-lipoxygenase and anti-oxidant activities of South African medicinal plants commonly used topically for skin diseases. Skin Pharmacol Physiol  2006; 19(6): 329-35.
[http://dx.doi.org/10.1159/000095253] [PMID:  16931900] 
[69] 
Barrantes E, Guinea M. Inhibition of collagenase and metalloproteinases by aloins and Aloe gel. Life Sci  2003; 72(7): 843-50.
[http://dx.doi.org/10.1016/S0024-3205(02)02308-1] [PMID:  12479983] 
[70] 
Cho S, Lee S, Lee M-J, et al. Dietary Aloe vera supplementation improves facial wrinkles and elasticity and it increases the type I procollagen gene expression in human skin in vivo. Ann Dermatol  2009; 21(1): 6-11.
[http://dx.doi.org/10.5021/ad.2009.21.1.6] [PMID:  20548848] 
[71] 
Rajashree S, Rose C. Studies on an anti-aging formulation prepared using Aloe vera blended collagen and chitosan. Int J Pharm Sci Res  2018; 9: 582-8.
[72] 
Tanaka M, Misawa E, Yamauchi K, Abe F, Ishizaki C. Effects of plant sterols derived from Aloe vera gel on human dermal fibroblasts in vitro and on skin condition in Japanese women. Clin Cosmet Investig Dermatol  2015; 8: 95-104.
[http://dx.doi.org/10.2147/CCID.S75441] [PMID:  25759593] 
[73] 
Bae J-H, Kim O-Y. Skin adhesive cosmetics for removing wrinkles, containing vitamins and Aloe extract United States Patent US005723138A 1998.
[74] 
Jones K, Hughes J, Hong M, Jia Q, Orndorff S. Modulation of melanogenesis by aloesin: a competitive inhibitor of tyrosinase. Pigment Cell Res  2002; 15(5): 335-40.
[http://dx.doi.org/10.1034/j.1600-0749.2002.02014.x] [PMID:  12213089] 
[75] 
Zhu W, Gao J. The use of botanical extracts as topical skin-lightening agents for the improvement of skin pigmentation disorders. J Investig Dermatol Symp Proc  2008; 13(1): 20-4.
[http://dx.doi.org/10.1038/jidsymp.2008.8] [PMID:  18369335] 
[76] 
Choi S, Lee SK, Kim JE, Chung MH, Park YI. Aloesin inhibits hyperpigmentation induced by UV radiation. Clin Exp Dermatol  2002; 27(6): 513-5.
[http://dx.doi.org/10.1046/j.1365-2230.2002.01120.x] [PMID:  12372097] 
[77] 
Rathi V, Rathi JC, Tamizharasi S, Pathak AK. Plant used for hair growth promotion: A review. Phcog Rev  2008; 2: 185-7.
[78] 
Shelton RM. Aloe vera. Its chemical and therapeutic properties. Int J Dermatol  1991; 30(10): 679-83.
[http://dx.doi.org/10.1111/j.1365-4362.1991.tb02607.x] [PMID:  1823544] 
[79] 
Jain R, Jain NK, Singh N, Gnanachandran AK, Gokulan PD. Development and evaluation of polyherbal ointment for hair growth activity. Int J Pharm Pharm Sci  2011; 3: 180-2.
[80] 
Miroddi M, Navarra M, Calapai F, et al. Review of clinical pharmacology of Aloe vera in the treatment of psoriasis. Phytother Res  2015; 29(5): 648-55.
[http://dx.doi.org/10.1002/ptr.5316] [PMID:  25756474] 
[81] 
Choonhakarn C, Busaracome P, Sripanidkulchai B, Sarakarn P. A prospective, randomized clinical trial comparing topical aloe vera with 0.1% triamcinolone acetonide in mild to moderate plaque psoriasis. J Eur Acad Dermatol Venereol  2010; 24(2): 168-72.
[http://dx.doi.org/10.1111/j.1468-3083.2009.03377.x] [PMID:  19686327] 
[82] 
West DP, Zhu YF. Evaluation of aloe vera gel gloves in the treatment of dry skin associated with occupational exposure. Am J Infect Control  2003; 31(1): 40-2.
[http://dx.doi.org/10.1067/mic.2003.12] [PMID:  12548256] 
[83] 
Finberg MJ, Muntingh GL, van Rensburg CE. 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  2015; 23(6): 337-41.
[http://dx.doi.org/10.1007/s10787-015-0251-2] [PMID:  26510768] 
[84] 
Panahi Y, Sharif MR, Sharif A, et al. A randomized comparative trial on the therapeutic efficacy of topical aloe vera and Calendula officinalis on diaper dermatitis in children. Sci World J  2012; 2012810234
[http://dx.doi.org/10.1100/2012/810234] [PMID:  22606064] 
[85] 
Lalla JK, Nandedkar SY, Paranjape MH, Talreja NB. Clinical trials of ayurvedic formulations in the treatment of acne vulgaris. J Ethnopharmacol  2001; 78(1): 99-102.
[http://dx.doi.org/10.1016/S0378-8741(01)00323-3] [PMID:  11585696] 
[86] 
Hajheydari Z, Saeedi M, Morteza-Semnani K, Soltani A. Effect of Aloe vera topical gel combined with tretinoin in treatment of mild and moderate acne vulgaris: A randomized, double-blind, prospective trial. J Dermatolog Treat  2014; 25(2): 123-9.
[http://dx.doi.org/10.3109/09546634.2013.768328] [PMID:  23336746] 
[87] 
O’Connor MJ. Targeting the DNA damage response in cancer. Mol Cell  2015; 60(4): 547-60.
[http://dx.doi.org/10.1016/j.molcel.2015.10.040] [PMID:  26590714] 
[88] 
Delaney G, Jacob S, Featherstone C, Barton M. The role of radiotherapy in cancer treatment: Estimating optimal utilization from a review of evidence-based clinical guidelines. Cancer  2005; 104(6): 1129-37.
[http://dx.doi.org/10.1002/cncr.21324] [PMID:  16080176] 
[89] 
McQuestion M. Evidence-based skin care management in radiation therapy. Semin Oncol Nurs  2006; 22(3): 163-73.
[http://dx.doi.org/10.1016/j.soncn.2006.04.004] [PMID:  16893745] 
[90] 
Bray FN, Simmons BJ, Wolfson AH, Nouri K. Acute and chronic cutaneous reactions to ionizing radiation therapy. Dermatol Ther (Heidelb)  2016; 6(2): 185-206.
[http://dx.doi.org/10.1007/s13555-016-0120-y] [PMID:  27250839] 
[91] 
Bolderston A, Lloyd NS, Wong RK, Holden L, Robb-Blenderman L. The prevention and management of acute skin reactions related to radiation therapy: A systematic review and practice guideline. Support Care Cancer  2006; 14(8): 802-17.
[http://dx.doi.org/10.1007/s00520-006-0063-4] [PMID:  16758176] 
[92] 
Salvo N, Barnes E, van Draanen J, et al. Prophylaxis and management of acute radiation-induced skin reactions: A systematic review of the literature. Curr Oncol  2010; 17(4): 94-112.
[PMID:  20697521] 
[93] 
González Sanchis A, Brualla González L, Sánchez Carazo JL, et al. Evaluation of acute skin toxicity in breast radiotherapy with a new quantitative approach. Radiother Oncol  2017; 122(1): 54-9.
[http://dx.doi.org/10.1016/j.radonc.2016.09.019] [PMID:  27825796] 
[94] 
Roberts DB, Travis EL. Acemannan-containing wound dressing gel reduces radiation-induced skin reactions in C3H mice. Int J Radiat Oncol Biol Phys  1995; 32(4): 1047-52.
[http://dx.doi.org/10.1016/0360-3016(94)00467-Y] [PMID:  7607925] 
[95] 
Olsen DL, Raub W Jr, Bradley C, et al. The effect of aloe vera gel/mild soap versus mild soap alone in preventing skin reactions in patients undergoing radiation therapy. Oncol Nurs Forum  2001; 28(3): 543-7.
[PMID:  11338761] 
[96] 
Haddad P, Amouzgar-Hashemi F, Samsami S, Chinichian S, Oghabian MA. Aloe vera for prevention of radiation-induced dermatitis: a self-controlled clinical trial. Curr Oncol  2013; 20(4): e345-8.
[http://dx.doi.org/10.3747/co.20.1356] [PMID:  23904773] 
[97] 
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)  2017; 4(3)E44
[http://dx.doi.org/10.3390/medicines4030044] [PMID:  28930258] 
[98] 
Williams MS, Burk M, Loprinzi CL, et al. Phase III double-blind evaluation of an aloe vera gel as a prophylactic agent for radiation-induced skin toxicity. Int J Radiat Oncol Biol Phys  1996; 36(2): 345-9.
[http://dx.doi.org/10.1016/S0360-3016(96)00320-3] [PMID:  8892458] 
[99] 
Heggie S, Bryant GP, Tripcony L, et al. A Phase III study on the efficacy of topical aloe vera gel on irradiated breast tissue. Cancer Nurs  2002; 25(6): 442-51.
[http://dx.doi.org/10.1097/00002820-200212000-00007] [PMID:  12464836] 
[100] 
Merchant TE, Bosley C, Smith J, et al. A phase III trial comparing an anionic phospholipid-based cream and aloe vera-based gel in the prevention of radiation dermatitis in pediatric patients. Radiat Oncol  2007; 2: 45.
[http://dx.doi.org/10.1186/1748-717X-2-45] [PMID:  18093332] 
[101] 
Hoopfer D, Holloway C, Gabos Z, et al. Three-arm randomized phase III trial: quality aloe and placebo cream versus powder as skin treatment during breast cancer radiation therapy. Clin Breast Cancer  2015; 15(3): 181-90.
[http://dx.doi.org/10.1016/j.clbc.2014.12.006] [PMID:  25619686] 
[102] 
Glover D, Harmer V. Radiotherapy-induced skin reactions: assessment and management Br J Nurs 2014; 23(4 Suppl 2): S28- S35, S30-S35.
[http://dx.doi.org/10.12968/bjon.2014.23.Sup2.S28] [PMID:  24619051] 
[103] 
Kodiyan J, Amber KT. Topical antioxidants in radiodermatitis: A clinical review. Int J Palliat Nurs  2015; 21(9): 446-52.
[http://dx.doi.org/10.12968/ijpn.2015.21.9.446] [PMID:  26412275] 
[104] 
Baron ED, Suggs AK. Introduction to photobiology. Dermatol Clin  2014; 32(3): 255-66.
[http://dx.doi.org/10.1016/j.det.2014.03.002] [PMID:  24891049] 
[105] 
Matsumura Y, Ananthaswamy HN. Toxic effects of ultraviolet radiation on the skin. Toxicol Appl Pharmacol  2004; 195(3): 298-308.
[http://dx.doi.org/10.1016/j.taap.2003.08.019] [PMID:  15020192] 
[106] 
Koehler MJ, Kellner K, Hipler UC, Kaatz M. Acute UVB-induced epidermal changes assessed by multiphoton laser tomography. Skin Res Technol  2015; 21(2): 137-43.
[http://dx.doi.org/10.1111/srt.12168] [PMID:  25066913] 
[107] 
Sklar LR, Almutawa F, Lim HW, Hamzavi I. Effects of ultraviolet radiation, visible light, and infrared radiation on erythema and pigmentation: A review. Photochem Photobiol Sci  2013; 12(1): 54-64.
[http://dx.doi.org/10.1039/C2PP25152C] [PMID:  23111621] 
[108] 
Narayanan DL, Saladi RN, Fox JL. Ultraviolet radiation and skin cancer. Int J Dermatol  2010; 49(9): 978-86.
[http://dx.doi.org/10.1111/j.1365-4632.2010.04474.x] [PMID:  20883261] 
[109] 
Vilela FM, Oliveira FM, Vicentini FT, et al. Commercial sunscreen formulations: UVB irradiation stability and effect on UVB irradiation-induced skin oxidative stress and inflammation. J Photochem Photobiol B  2016; 163: 413-20.
[http://dx.doi.org/10.1016/j.jphotobiol.2016.09.007] [PMID:  27627683] 
[110] 
Young AR, Claveau J, Rossi AB. Ultraviolet radiation and the skin: Photobiology and sunscreen photoprotection. J Am Acad Dermatol  2017; 76(3)(Suppl. 1): S100-9.
[http://dx.doi.org/10.1016/j.jaad.2016.09.038] [PMID:  28038885] 
[111] 
Yaar M, Gilchrest BA. Photoageing: Mechanism, prevention and therapy. Br J Dermatol  2007; 157(5): 874-87.
[http://dx.doi.org/10.1111/j.1365-2133.2007.08108.x] [PMID:  17711532] 
[112] 
Pillai S, Oresajo C, Hayward J. Ultraviolet radiation and skin aging: roles of reactive oxygen species, inflammation and protease activation, and strategies for prevention of inflammation-induced matrix degradation - a review. Int J Cosmet Sci  2005; 27(1): 17-34.
[http://dx.doi.org/10.1111/j.1467-2494.2004.00241.x] [PMID:  18492178] 
[113] 
Nada AS, Hawas AM, Abd Elmageed ZY, Amin NE. Protective value of Aloe vera extract against γ-irradiation-induced some biochemical disorders in rats. J Radiat Res Appl Sci  2013; 6: 31-7.
[http://dx.doi.org/10.1016/j.jrras.2013.10.003] 
[114] 
Sharma P, Kharkwal A, Kharkwal H, Abdin M, Varma A. A review on pharmacological properties of aloe vera. Int J Pharm Sci Rev Res  2014; 29: 31-7.
[115] 
Byeon SW, Pelley RP, Ullrich SE, Waller TA, Bucana CD, Strickland FM. Aloe barbadensis extracts reduce the production of interleukin-10 after exposure to ultraviolet radiation. J Invest Dermatol  1998; 110(5): 811-7.
[http://dx.doi.org/10.1046/j.1523-1747.1998.00181.x] [PMID:  9579551] 
[116] 
Choi S, Chung MH. A review on the relationship between Aloe vera components and their biologic effects. Sem Integ Med  2003; 1: 53-62.
[http://dx.doi.org/10.1016/S1543-1150(03)00005-X] 
[117] 
Tirant M, Lotti T, Gianfaldoni S, Tchernev G, Wollina U, Bayer P. Integrative Dermatology - The use of herbals and nutritional supplements to treat dermatological conditions. Open Access Maced J Med Sci  2018; 6(1): 185-202.
[http://dx.doi.org/10.3889/oamjms.2018.041] [PMID:  29484023] 
[118] 
Lee CK, Han SS, Mo YK, et al. Prevention of ultraviolet radiation-induced suppression of accessory cell function of Langerhans cells by Aloe vera gel components. Immunopharmacology  1997; 37(2-3): 153-62.
[http://dx.doi.org/10.1016/S0162-3109(97)00042-8] [PMID:  9403333] 
[119] 
Lee CK, Han SS, Shin YK, et al. Prevention of ultraviolet radiation-induced suppression of contact hypersensitivity by Aloe vera gel components. Int J Immunopharmacol  1999; 21(5): 303-10.
[http://dx.doi.org/10.1016/S0192-0561(99)00012-0] [PMID:  10408627] 
[120] 
Reuter J, Jocher A, Stump J, Grossjohann B, Franke G, Schempp CM. Investigation of the anti-inflammatory potential of Aloe vera gel (97.5%) in the ultraviolet erythema test. Skin Pharmacol Physiol  2008; 21(2): 106-10.
[http://dx.doi.org/10.1159/000114871] [PMID:  18253066] 
[121] 
Hwang E, Kim SH, Lee S, et al. A comparative study of baby immature and adult shoots of Aloe vera on UVB-induced skin photoaging in vitro. Phytother Res  2013; 27(12): 1874-82.
[http://dx.doi.org/10.1002/ptr.4943] [PMID:  23505091] 
[122] 
Kumar MS, Datta PK, Dutta Gupta S. In vitro evaluation of UV opacity potential of Aloe vera L. gel from different germplasms. J Nat Med  2009; 63(2): 195-9.
[http://dx.doi.org/10.1007/s11418-008-0299-z] [PMID:  19034609] 
[123] 
Springsteen A, Yurek R, Frazier M, Carr KF. In vitro measurement of sun protection factor of sunscreens by diffuse transmittance 1. Anal Chim Acta  1999; 380: 155-64.
[http://dx.doi.org/10.1016/S0003-2670(98)00577-7] 
[124] 
Yao R, Tanaka M, Misawa E, et al. Daily ingestion of aloe vera gel powder containing aloe sterols prevents skin photoaging in ovx hairless mice. J Food Sci  2016; 81(11): H2849-57.
[http://dx.doi.org/10.1111/1750-3841.13527] [PMID:  27732760] 
[125] 
Silva MA, Trevisan G, Klafke JZ, et al. Antinociceptive and anti-inflammatory effects of Aloe saponaria Haw on thermal injury in rats. J Ethnopharmacol  2013; 146(1): 393-401.
[http://dx.doi.org/10.1016/j.jep.2012.12.055] [PMID:  23333747] 
[126] 
Silva MA, Trevisan G, Hoffmeister C, et al. Anti-inflammatory and antioxidant effects of Aloe saponaria Haw in a model of UVB-induced paw sunburn in rats. J Photochem Photobiol B  2014; 133: 47-54.
[http://dx.doi.org/10.1016/j.jphotobiol.2014.02.019] [PMID:  24681774] 
[127] 
Agung VL, Mappiasse AA, Wahab S, Alam G, Cangara MH, Patellongi I. Anti-inflammatory effect of aloe vera (l) burm, f. on cox-2 and histamine expression in mice skin exposed to UVB. Am J Clin Exp Med  2016; 4: 94-7.
[http://dx.doi.org/10.11648/j.ajcem.20160404.11] 
[128] 
Simões MCF, Sousa JJS, Pais AACC. Skin cancer and new treatment perspectives: A review. Cancer Lett  2015; 357(1): 8-42.
[http://dx.doi.org/10.1016/j.canlet.2014.11.001] [PMID:  25444899] 
[129] 
Madan V, Lear JT, Szeimies RM. Non-melanoma skin cancer. Lancet  2010; 375(9715): 673-85.
[http://dx.doi.org/10.1016/S0140-6736(09)61196-X] [PMID:  20171403] 
[130] 
Rigel DS, Carucci JA. Malignant melanoma: prevention, early detection, and treatment in the 21st century. CA Cancer J Clin  2000; 50(4): 215-36.
[http://dx.doi.org/10.3322/canjclin.50.4.215] [PMID:  10986965] 
[131] 
Green AC, Beardmore GL. Home treatment of skin cancer and solar keratoses. Australas J Dermatol  1988; 29(3): 127-30.
[http://dx.doi.org/10.1111/j.1440-0960.1988.tb00383.x] [PMID:  3272119] 
[132] 
Çandöken E, Kuruca SE, Akev N. Evaluation of the anticancer effects of Aloe vera and aloe emodin on B16F10 murine melanoma and NIH3T3 mouse embryogenic fibroblast cells. Istanbul J Pharmacy  2017; 47: 77-83.
[133] 
Di Luccia B, Manzo N, Vivo M, et al. A biochemical and cellular approach to explore the antiproliferative and prodifferentiative activity of Aloe arborescens leaf extract. Phytother Res  2013; 27(12): 1819-28.
[http://dx.doi.org/10.1002/ptr.4939] [PMID:  23418125] 
[134] 
Huang XZ, Wang J, Huang C, et al. Emodin enhances cytotoxicity of chemotherapeutic drugs in prostate cancer cells: the mechanisms involve ROS-mediated suppression of multidrug resistance and hypoxia inducible factor-1. Cancer Biol Ther  2008; 7(3): 468-75.
[http://dx.doi.org/10.4161/cbt.7.3.5457] [PMID:  18285700] 
[135] 
Harlev E, Nevo E, Lansky EP, Ofir R, Bishayee A. Anticancer potential of aloes: antioxidant, antiproliferative, and immunostimulatory attributes. Planta Med  2012; 78(9): 843-52.
[http://dx.doi.org/10.1055/s-0031-1298453] [PMID:  22516934] 
[136] 
Wasserman L, Avigad S, Beery E, Nordenberg J, Fenig E. The effect of aloe emodin on the proliferation of a new merkel carcinoma cell line. Am J Dermatopathol  2002; 24(1): 17-22.
[http://dx.doi.org/10.1097/00000372-200202000-00003] [PMID:  11803275] 
[137] 
Fenig E, Nordenberg J, Beery E, Sulkes J, Wasserman L. Combined effect of aloe-emodin and chemotherapeutic agents on the proliferation of an adherent variant cell line of Merkel cell carcinoma. Oncol Rep  2004; 11(1): 213-7.
[http://dx.doi.org/10.3892/or.11.1.213] [PMID:  14654928] 
[138] 
Tabolacci C, Rossi S, Lentini A, et al. Aloin enhances cisplatin antineoplastic activity in B16-F10 melanoma cells by transglutaminase-induced differentiation. Amino Acids  2013; 44(1): 293-300.
[http://dx.doi.org/10.1007/s00726-011-1166-x] [PMID:  22139409] 
[139] 
Lin SY, Yang JH, Hsia TC, et al. Effect of inhibition of aloe-emodin on N-acetyltransferase activity and gene expression in human malignant melanoma cells (A375.S2). Melanoma Res  2005; 15(6): 489-94.
[http://dx.doi.org/10.1097/00008390-200512000-00002] [PMID:  16314733] 
[140] 
Tabolacci C, Lentini A, Mattioli P, et al. Antitumor properties of aloe-emodin and induction of transglutaminase 2 activity in B16-F10 melanoma cells. Life Sci  2010; 87(9-10): 316-24.
[http://dx.doi.org/10.1016/j.lfs.2010.07.003] [PMID:  20624404] 
[141] 
Chou T-H, Liang C-H. The molecular effects of aloe-emodin (AE)/liposome-AE on human nonmelanoma skin cancer cells and skin permeation. Chem Res Toxicol  2009; 22(12): 2017-28.
[http://dx.doi.org/10.1021/tx900318a] [PMID:  19928967] 
[142] 
Tabolacci C, Cordella M, Turcano L, et al. Aloe- emodin exerts a potent anticancer and immunomodulatory activity on BRAFmutated human melanoma cells. Eur J p Pharmacol 2015 2015; 762: 283-92.
[143] 
Reynolds T, Ed. Aloes: The genus Aloe. CRC Press: Boca Raton 2004.
[144] 
Im SA, Oh ST, Song S, et al. Identification of optimal molecular size of modified Aloe polysaccharides with maximum immunomodulatory activity. Int Immunopharmacol  2005; 5(2): 271-9.
[http://dx.doi.org/10.1016/j.intimp.2004.09.031] [PMID:  15652758] 
[145] 
Ghafouri-Fard S, Ghafouri-Fard S. Immunotherapy in nonmelanoma skin cancer. Immunotherapy  2012; 4(5): 499-510.
[http://dx.doi.org/10.2217/imt.12.29] [PMID:  22642333] 
[146] 
Chaudhary G, Saini MR, Goyal PK. Chemopreventive potential of Aloe vera against 7,12-dimethylbenz(a)anthracene induced skin papillomagenesis in mice. Integr Cancer Ther  2007; 6(4): 405-12.
[http://dx.doi.org/10.1177/1534735407309079] [PMID:  18048889] 
[147] 
Saini M, Goyal PK, Chaudhary G. Anti-tumor activity of Aloe vera against DMBA/croton oil-induced skin papillomagenesis in Swiss albino mice. J Environ Pathol Toxicol Oncol  2010; 29(2): 127-35.
[http://dx.doi.org/10.1615/JEnvironPatholToxicolOncol.v29.i2.60] [PMID:  20932247] 
[148] 
Shimpo K, Ida C, Chihara T, Beppu H, Kaneko T, Kuzuya H. Aloe arborescens extract inhibits TPA-induced ear oedema, putrescine increase and tumour promotion in mouse skin. Phytother Res  2002; 16(5): 491-3.
[http://dx.doi.org/10.1002/ptr.938] [PMID:  12203274] 
[149] 
Lazarus GS, Cooper DM, Knighton DR, et al. Definitions and guidelines for assessment of wounds and evaluation of healing. Arch Dermatol  1994; 130(4): 489-93.
[http://dx.doi.org/10.1001/archderm.1994.01690040093015] [PMID:  8166487] 
[150] 
Barek A, Haque SMT. Medicolegal aspects of hurt, injury and wound. AKMMC J  2013; 4(2): 37-41.
[http://dx.doi.org/10.3329/akmmcj.v4i2.16941] 
[151] 
Lazarus GS, Cooper DM, Knighton DR, Percoraro RE, Rodeheaver G, Robson MC. Definitions and guidelines for assessment of wounds and evaluation of healing. Wound Repair Regen  1994; 2(3): 165-70.
[http://dx.doi.org/10.1046/j.1524-475X.1994.20305.x] [PMID:  17156107] 
[152] 
Ross R. The fibroblast and wound repair. Biol Rev Camb Philos Soc  1968; 43(1): 51-96.
[http://dx.doi.org/10.1111/j.1469-185X.1968.tb01109.x] [PMID:  4229841] 
[153] 
Amini-Nik S, Yousuf Y, Jeschke MG. Scar management in burn injuries using drug delivery and molecular signaling: Current treatments and future directions. Adv Drug Deliv Rev  2018; 123: 135-54.
[http://dx.doi.org/10.1016/j.addr.2017.07.017] [PMID:  28757325] 
[154] 
Eming SAM, Koch M, Krieger A, et al. Differential proteomic analysis distinguishes tissue repair biomarker signatures in wound exudates obtained from normal healing and chronic wounds. J Proteome Res  2010; 9(9): 4758-66.
[http://dx.doi.org/10.1021/pr100456d] [PMID:  20666496] 
[155] 
Moriyama M, Moriyama H, Uda J, et al. Beneficial effects of the genus Aloe on wound healing, cell proliferation, and differentiation of epidermal keratinocytes. PLoS One  2016; 11(10)e0164799
[http://dx.doi.org/10.1371/journal.pone.0164799] [PMID:  27736988] 
[156] 
Fox LT, Mazumder A, Dwivedi A, Gerber M, du Plessis J, Hamman JH. In vitro wound healing and cytotoxic activity of the gel and whole-leaf materials from selected aloe species. J Ethnopharmacol  2017; 200: 1-7.
[http://dx.doi.org/10.1016/j.jep.2017.02.017] [PMID:  28229920] 
[157] 
Topman G, Lin FH, Gefen A. The natural medications for wound healing - Curcumin, Aloe-Vera and Ginger - do not induce a significant effect on the migration kinematics of cultured fibroblasts. J Biomech  2013; 46(1): 170-4.
[http://dx.doi.org/10.1016/j.jbiomech.2012.09.015] [PMID:  23084784] 
[158] 
Yao H, Chen Y, Li S, Huang L, Chen W, Lin X. Promotion proliferation effect of a polysaccharide from Aloe barbadensis Miller on human fibroblasts in vitro. Int J Biol Macromol  2009; 45(2): 152-6.
[http://dx.doi.org/10.1016/j.ijbiomac.2009.04.013] [PMID:  19409414] 
[159] 
Wahedi HM, Jeong M, Chae JK, Do SG, Yoon H, Kim SY. Aloesin from Aloe vera accelerates skin wound healing by modulating MAPK/Rho and Smad signaling pathways in vitro and in vivo. Phytomedicine  2017; 28: 19-26.
[http://dx.doi.org/10.1016/j.phymed.2017.02.005] [PMID:  28478809] 
[160] 
Kumar V, Khan AA, Nagarajan K. Animal models for the evaluation of wound healing activity. Int Bullet Drug Res  2013; 3(5): 93-107.
[161] 
Dorsett-Martin WA. Rat models of skin wound healing: a review. Wound Repair Regen  2004; 12(6): 591-9.
[http://dx.doi.org/10.1111/j.1067-1927.2004.12601.x] [PMID:  15555049] 
[162] 
Ignacio G, El-Amin I, Mendenhall V. Animal models for wound healingSkin tissue engineering and regenerative medicine.  NC: Academic Press 2016; pp. 387-400.
[http://dx.doi.org/10.1016/B978-0-12-801654-1.00019-X] 
[163] 
Mendonça FA, Passarini Junior J.R., Esquisatto MA, Mendonça JS, Franchini CC, Santos GM. 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): 150-5.
[http://dx.doi.org/10.1590/S0102-86502009000200013] [PMID:  19377785] 
[164] 
Hajhashemi V, Ghannadi A, Heidari AH. Anti-inflammatory and wound healing activities of Aloe littoralis in rats. Res Pharm Sci  2012; 7(2): 73-8.
[PMID:  23181083] 
[165] 
Rodrigues LLO, de Oliveira ACL, Tabrez S, et al. Mutagenic, antioxidant and wound healing properties of Aloe vera. J Ethnopharmacol  2018; 227: 191-7.
[http://dx.doi.org/10.1016/j.jep.2018.08.034] [PMID:  30172901] 
[166] 
Tarameshloo M, Norouzian M, Zarein-Dolab S, Dadpay M, Mohsenifar J, Gazor R. Aloe vera gel and thyroid hormone cream may improve wound healing in Wistar rats. Anat Cell Biol  2012; 45(3): 170-7.
[http://dx.doi.org/10.5115/acb.2012.45.3.170] [PMID:  23094205] 
[167] 
Gebremeskel L, Bhoumik D, Sibhat GG, Tuem KB. In vivo wound healing and anti-inflammatory activities of leaf latex of Aloe megalacantha Baker (Xanthorrhoeaceae). Evid Based Complement Alternat Med  2018; 20185037912
[http://dx.doi.org/10.1155/2018/5037912] [PMID:  30057643] 
[168] 
Takzaree N, Hadjiakhondi A, Hassanzadeh G, Rouini MR, Manayi A, Zolbin MM. Transforming growth factor-β (TGF-β) activation in cutaneous wounds after topical application of aloe vera gel. Can J Physiol Pharmacol  2016; 94(12): 1285-90.
[http://dx.doi.org/10.1139/cjpp-2015-0460] [PMID:  27660884] 
[169] 
Prakoso YA. Kurniasih. Kurniasih. The effects of Aloe vera cream on the expression of CD4+ and CD8+ lymphocytes in skin wound healing. J Trop Med  2018; 20186218303
[http://dx.doi.org/10.1155/2018/6218303] [PMID:  29666657] 
[170] 
Oryan A, Naeini AT, Nikahval B, Gorjian E. Effect of aqueous extract of Aloe vera on experimental cutaneous wound healing in rat. Vet Arh  2010; 80: 509-22.
[171] 
Oryan A, Mohammadalipour A, Moshiri A, Tabandeh MR. Topical application of Aloe vera accelerated wound healing, modeling, and remodeling: An experimental study. Ann Plast Surg  2016; 77(1): 37-46.
[http://dx.doi.org/10.1097/SAP.0000000000000239] [PMID:  25003428] 
[172] 
Brandão ML, Reis PR, Araújo LA, Araújo AC, Santos MH, Miguel MP. Evaluation of wound healing treated with latex derived from rubber trees and Aloe Vera extract in rats. Acta Cir Bras  2016; 31(9): 570-7.
[http://dx.doi.org/10.1590/S0102-865020160090000001] [PMID:  27737341] 
[173] 
Drudi D, Tinto D, Ferranti D, Fiorelli F, Pozzo MD, Capitani O. Aloe barbadensis miller versus silver sulfadiazine creams for wound healing by secondary intention in dogs and cats: A randomized controlled study. Res Vet Sci  2018; 117: 1-9.
[http://dx.doi.org/10.1016/j.rvsc.2017.10.010] [PMID:  29131970] 
[174] 
Atiba A, Nishimura M, Kakinuma S, et al. Aloe vera oral administration accelerates acute radiation-delayed wound healing by stimulating transforming growth factor-β and fibroblast growth factor production. Am J Surg  2011; 201(6): 809-18.
[http://dx.doi.org/10.1016/j.amjsurg.2010.06.017] [PMID:  21396624] 
[175] 
Atiba A, Ueno H, Uzuka Y. The effect of aloe vera oral administration on cutaneous wound healing in type 2 diabetic rats. J Vet Med Sci  2011; 73(5): 583-9.
[http://dx.doi.org/10.1292/jvms.10-0438] [PMID:  21178319] 
[176] 
Tabandeh MR, Oryan A, Mohammadalipour A. Polysaccharides of Aloe vera induce MMP-3 and TIMP-2 gene expression during the skin wound repair of rat. Int J Biol Macromol  2014; 65: 424-30.
[http://dx.doi.org/10.1016/j.ijbiomac.2014.01.055] [PMID:  24491493] 
[177] 
Davis SC, Mertz PM, Eaglstein WH. Second-degree burn healing: the effect of occlusive dressings and a cream. J Surg Res  1990; 48(3): 245-8.
[http://dx.doi.org/10.1016/0022-4804(90)90220-V] [PMID:  2314098] 
[178] 
Akhoondinasab MR, Khodarahmi A, Akhoondinasab M, Saberi M, Iranpour M. Assessing effect of three herbal medicines in second and third degree burns in rats and comparison with silver sulfadiazine ointment. Burns  2015; 41(1): 125-31.
[http://dx.doi.org/10.1016/j.burns.2014.04.001] [PMID:  24907191] 
[179] 
Akhoondinasab MR, Akhoondinasab M, Saberi M. Comparison of healing effect of aloe vera extract and silver sulfadiazine in burn injuries in experimental rat model. World J Plast Surg  2014; 3(1): 29-34.
[PMID:  25489521] 
[180] 
Cuttle L, Kempf M, Kravchuk O, et al. The efficacy of Aloe vera, tea tree oil and saliva as first aid treatment for partial thickness burn injuries. Burns  2008; 34(8): 1176-82.
[http://dx.doi.org/10.1016/j.burns.2008.03.012] [PMID:  18603378] 
[181] 
Lin LX, Wang P, Wang YT, Huang Y, Jiang L, Wang XM. Aloe vera and Vitis vinifera improve wound healing in an in vivo rat burn wound model. Mol Med Rep  2016; 13(2): 1070-6.
[http://dx.doi.org/10.3892/mmr.2015.4681] [PMID:  26677006] 
[182] 
Barkat MA. Harshita, Pottoo FH, Singh SP, Ahmad FJ. Harshita, Pottoo FH, Singh SP, Ahmad FJ. Therapeutic intervention of Aloe gel containing nano-sized and micron-sized silver sulfadiazine gel on second-degree burn: a comparative study. Int J Low Extrem Wounds  2018; 17(3): 176-83.
[http://dx.doi.org/10.1177/1534734618791860] [PMID:  30111204] 
[183] 
Farzadinia P, Jofreh N, Khatamsaz S, et al. Anti-inflammatory and wound healing activities of Aloe vera, honey and milk ointment on second-degree burns in rats. Int J Low Extrem Wounds  2016; 15(3): 241-7.
[http://dx.doi.org/10.1177/1534734616645031] [PMID:  27217089] 
[184] 
Collins CE, Collins C. Roentgen dermatitis treated with fresh whole leaf Aloe vera. AJR Am J Roentgenol  1935; 33: 396-7.
[185] 
Serebrakian AT, Pickrell BB, Varon DE, et al. Meta-analysis and systematic review of skin graft donor-site dressings with future guidelines. Plast Reconstr Surg Glob Open  2018; 6(9)e1928
[http://dx.doi.org/10.1097/GOX.0000000000001928] [PMID:  30349793] 
[186] 
Khorasani G, Ahmadi A, Jalal Hosseinimehr S, Ahmadi A, Taheri A, Fathi H. The effects of Aloe vera cream on split-thickness skin graft donor site management: A randomized, blinded, placebo-controlled study. Wounds  2011; 23(2): 44-8.
[PMID:  25881055] 
[187] 
Burusapat C, Supawan M, Pruksapong C, Pitiseree A, Suwantemee C. 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  2018; 142(1): 217-26.
[http://dx.doi.org/10.1097/PRS.0000000000004515] [PMID:  29649056] 
[188] 
Akhtar M, Hatwar S. Efficacy of Aloe vera extract cream in management of burn wound. J Clin Epidemiol  1996; 49(Suppl. 1): 24.
[http://dx.doi.org/10.1016/0895-4356(96)89241-9] 
[189] 
Moghbel A, Ghalambor A, Allipanah S. A wound healing and toxicity evaluation of Aloe vera cream on outpatients with second degree burns. Indian J Pharm Sci  2007; 3(3): 157-60.
[190] 
Khorasani G, Hosseinimehr SJ, Azadbakht M, Zamani A, Mahdavi MR. Aloe versus silver sulfadiazine creams for second-degree burns: A randomized controlled study. Surg Today  2009; 39(7): 587-91.
[http://dx.doi.org/10.1007/s00595-008-3944-y] [PMID:  19562446] 
[191] 
Varaei S, Mohaddes Ardabili F, Sabaghzadeh Irani P, Ranjbar H. The effect of Aloe vera gel and nitrofurazone on dressing related pain of superficial burn wounds. World J Plast Surg  2017; 6(2): 254-6.
[PMID:  28713723] 
[192] 
Eshghi F, Hosseinimehr SJ, Rahmani N, Khademloo M, Norozi MS, Hojati O. Effects of Aloe vera cream on posthemorrhoidectomy pain and wound healing: results of a randomized, blind, placebo-control study. J Altern Complement Med  2010; 16(6): 647-50.
[http://dx.doi.org/10.1089/acm.2009.0428] [PMID:  20569031] 
[193] 
Molazem Z, Mohseni F, Younesi M, Keshavarzi S. Aloe vera gel and cesarean wound healing; a randomized controlled clinical trial. Glob J Health Sci  2014; 7(1): 203-9.
[http://dx.doi.org/10.5539/gjhs.v7n1p203] [PMID:  25560349] 
[194] 
Schmidt JM, Greenspoon JS. Aloe vera dermal wound gel is associated with a delay in wound healing. Obstet Gynecol  1991; 78(1): 115-7.
[PMID:  2047051] 
[195] 
Rahmani N, Khademloo M, Vosoughi K, Assadpour S. Effects of Aloe vera cream on chronic anal fissure pain, wound healing and hemorrhaging upon defection: a prospective double blind clinical trial. Eur Rev Med Pharmacol Sci  2014; 18(7): 1078-84.
[PMID:  24763890] 
[196] 
Hekmatpou D, Mehrabi F, Rahzani K, Aminiyan A. 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  2018; 18(1): 264.
[http://dx.doi.org/10.1186/s12906-018-2326-2] [PMID:  30268162] 
[197] 
Duansak D, Somboonwong J, Patumraj S. Effects of Aloe vera on leukocyte adhesion and TNF-alpha and IL-6 levels in burn wounded rats. Clin Hemorheol Microcirc  2003; 29(3-4): 239-46.
[PMID:  14724347] 
[198] 
Deshmane SL, Kremlev S, Amini S, Sawaya BE. Monocyte chemoattractant protein-1 (MCP-1): An overview. J Interferon Cytokine Res  2009; 29(6): 313-26.
[http://dx.doi.org/10.1089/jir.2008.0027] [PMID:  19441883] 
[199] 
Hormozi M, Assaei R, Boroujeni MB. The effect of aloe vera on the expression of wound healing factors (TGFβ1 and bFGF) in mouse embryonic fibroblast cell: In vitro study. Biomed Pharmacother  2017; 88: 610-6.
[http://dx.doi.org/10.1016/j.biopha.2017.01.095] [PMID:  28142117] 
[200] 
Penn JW, Grobbelaar AO, Rolfe KJ. The role of the TGF-β family in wound healing, burns and scarring: A review. Int J Burns Trauma  2012; 2(1): 18-28.
[PMID:  22928164] 
[201] 
Barrientos S, Stojadinovic O, Golinko MS, Brem H, Tomic-Canic M. Growth factors and cytokines in wound healing. Wound Repair Regen  2008; 16(5): 585-601.
[http://dx.doi.org/10.1111/j.1524-475X.2008.00410.x] [PMID:  19128254] 
[202] 
Takzare N, Hosseini MJ, Hasanzadeh G, Mortazavi H, Takzare A, Habibi P. Influence of Aloe Vera gel on dermal wound healing process in rat. Toxicol Mech Methods  2009; 19(1): 73-7.
[http://dx.doi.org/10.1080/15376510802442444] [PMID:  19778236] 
[203] 
Moon EJ, Lee YM, Lee OH, et al. A novel angiogenic factor derived from Aloe vera gel: beta-sitosterol, a plant sterol. Angiogenesis  1999; 3(2): 117-23.
[http://dx.doi.org/10.1023/A:1009058232389] [PMID:  14517429] 
[204] 
Bashir A, Saeed B, Mujahid TY, Jehan N. Comparative study of antimicrobial activities of Aloe vera extracts and antibiotics against isolates from skin infections. Afr J Biotechnol  2011; 10: 3835-40.
[205] 
Cook IE. Antimicrobial activity of Aloe barbadensis Miller leaf gel components. Internet J Microbiol  2008; 4.
[206] 
Tsuboi R, Ko IJ, Matsuda K, Ogawa H. A new keratinolytic proteinase from clinical isolates of Trichophyton mentagrophytes. J Dermatol  1987; 14(5): 506-8.
[http://dx.doi.org/10.1111/j.1346-8138.1987.tb03616.x] [PMID:  3325542] 
[207] 
Tsuboi R, Ko I, Takamori K, Ogawa H. Isolation of a keratinolytic proteinase from Trichophyton mentagrophytes with enzymatic activity at acidic pH. Infect Immun  1989; 57(11): 3479-83.
[PMID:  2478474] 
[208] 
Ohmi T, Konaka S, Uchida M, Yamaguchi H. Antifungal activity of the new agent latoconazole in two tinea models. Arzneimittelforschung  1991; 41(8): 847-51.
[PMID:  1781809] 
[209] 
Martinez-Rossi NM, Bitencourt TA, Peres NTA, et al. Dermatophyte resistance to antifungal drugs: mechanisms and prospectus. Front Microbiol  2018; 9: 1108.
[http://dx.doi.org/10.3389/fmicb.2018.01108] [PMID:  29896175] 
[210] 
Arunkumar S, Muthuselvam M. Analysis of phytochemical constituents and antimicrobial activities of Aloe vera L. against clinical pathogens. World J Agric Sci  2009; 5: 572-6.
[211] 
Kawai K, Beppu H, Shimpo K, et al. In Vivo effects of aloe arborescens miller var. natalensis berger (Kidachi aloe) on experimental tinea pedis in guinea-pig feet. Phytother Res  1998; 12: 178-82.
[http://dx.doi.org/10.1002/(SICI)1099-1573(199805)12:3<178::AID-PTR218>3.0.CO;2-F] 
[212] 
Shamim S, Ahmed SW, Azhar I. Antifungal activity of Allium, Aloe, and Solanum species. Pharm Biol  2004; 42(7): 491-8.
[http://dx.doi.org/10.3109/13880200490891845] 
[213] 
Rosca-Casian O, Parvu M, Vlase L, Tamas M. Antifungal activity of aloe vera leaves. Fitoterapia  2007; 78(3): 219-22.
[http://dx.doi.org/10.1016/j.fitote.2006.11.008] [PMID:  17336466] 
[214] 
Shireen F, Manipal S, Prabu D. Anti-fungal activity of Aloe vera: In vitro study. SRM J Res Dental Sci  2015; 6(2): 92-5.
[http://dx.doi.org/10.4103/0976-433X.155464] 
[215] 
Saniasiaya J, Salim R, Mohamad I, Harun A. Antifungal effect of malaysian aloe vera leaf extract on selected fungal species of pathogenic otomycosis species in in vitro culture medium. Oman Med J  2017; 32(1): 41-6.
[http://dx.doi.org/10.5001/omj.2017.08] [PMID:  28042402] 
Cite As
Current Pharmaceutical Design

Treatment of Skin Disorders with Aloe Materials

Abstract
