Can Aloe Vera gel be used to treat wounds?

Aloe Vera Gel for Wound Treatment: Not Recommended Based on Current Evidence

Do not use Aloe vera gel for wound healing, as high-quality systematic reviews and international guidelines consistently demonstrate insufficient evidence of benefit and, in some cases, evidence of harm including delayed healing. 1, 2

Guideline-Based Recommendations

Diabetic Foot Ulcers (Strongest Evidence Against Use)

• The International Working Group on the Diabetic Foot (IWGDF) 2023 guidelines explicitly recommend against using herbal or traditional medicinal preparations, including Aloe vera, for diabetic foot ulcer healing (Strong recommendation; Low quality evidence) 1
• The 2024 IWGDF update reaffirms this position, noting that all trials evaluating herbal preparations were at moderate to high risk of bias, with no two studies evaluating the same product 1
• Multiple RCTs showed no demonstrable benefit on complete wound healing, ulcer area reduction, amputation rates, or mortality 1

General Wound Healing

• A 2012 Cochrane systematic review of Aloe vera for acute and chronic wounds found no high-quality evidence supporting its use 2
• The Cochrane review identified that in surgical wounds healing by secondary intention, Aloe vera significantly delayed healing by 30 days (95% CI 7.59 to 52.41 days) 2
• A 2020 meta-review of Cochrane reviews examining surgical wound care interventions listed Aloe vera for treating acute and chronic wounds but found insufficient evidence to recommend its use 1

Evidence Quality Assessment

Critical Limitations in Available Studies

• All identified RCTs evaluating Aloe vera for wound healing were deemed at high risk of bias due to lack of blinding, small sample sizes, and per-protocol analysis rather than intention-to-treat 1, 2
• Clinical heterogeneity across studies prevented meta-analysis, making it impossible to draw definitive conclusions 2
• Significant variability existed in wound types studied, standard of care provided, and Aloe vera preparations used 1

Specific Wound Types Evaluated

Burns: One trial comparing Aloe vera mucilage to silver sulfadiazine showed no difference in healing (RR 1.41,95% CI 0.70 to 2.85) 2

Pressure Ulcers: No statistically significant difference in healing was found (RR 0.10,95% CI -1.59 to 1.79) 2

Surgical Wounds: Evidence of harm, with delayed healing by approximately one month compared to standard care 2

Periodontal Applications (Different Context)

• While Aloe vera shows some benefit for periodontal conditions (gingivitis, plaque reduction) when used as mouthwashes or gels, this evidence does not translate to cutaneous wound healing 1
• The antibacterial properties demonstrated against oral pathogens do not establish efficacy for skin wound healing 1

Common Pitfalls to Avoid

Do Not Confuse Laboratory Data with Clinical Efficacy

• In vitro studies and animal models suggest potential wound-healing properties through anti-inflammatory and antimicrobial mechanisms 3, 4, 5
• However, these laboratory findings have not translated into clinical benefit in properly designed human trials 2

Do Not Assume Safety Equals Efficacy

• While Aloe vera is generally considered safe with minimal adverse effects reported, safety does not justify use in the absence of proven benefit 1
• The opportunity cost of using ineffective treatments may delay appropriate wound care 2

Do Not Use as Complementary Therapy Without Evidence

• Despite suggestions in some reviews that Aloe vera could serve as "complementary treatment," no high-quality evidence supports this approach for wound healing 3
• Standard evidence-based wound care should not be supplemented with unproven interventions 1

Practical Clinical Approach

For diabetic foot ulcers: Use evidence-based interventions such as appropriate offloading, moisture control with standard dressings, and consider sucrose-octasulfate impregnated dressings for non-infected neuro-ischemic ulcers that fail to respond to standard care 1

For surgical wounds: Employ standard moist wound healing principles with cost-effective dressings that control exudate 1

For burns: Use established treatments like silver sulfadiazine rather than Aloe vera 2

For chronic wounds: Focus on addressing underlying pathophysiology (vascular insufficiency, pressure relief, infection control) rather than topical herbal preparations 1

Cost-Effectiveness Considerations

• No formal cost-effectiveness data exists for Aloe vera in wound healing 1
• Resource use is similar to standard care, but without demonstrated benefit, expenditure cannot be justified 1
• Select dressings based on exudate control, comfort, and cost rather than unproven additives 1