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Allergic contact dermatitis to Aloe vera

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Abstract

We present the case of a 72-year-old woman observed for dermatitis on the legs followed by apperance of erythema on the eyelids. She had a past history of peripheral venous insufficiency and had been using self home-made Aloe vera juice over the legs for relief from pain. Patch tests showed positive reactions to the leaf of Aloe, the macerated Aloe jelly, and nickel sulfate. Although most manufacturers process Aloe products avoiding its irritant extracts, and probably as a consequence reports of allergic reactions are rare, one must remember that the growing popularity on the use of Aloe products may stimulate its use 'as is' by the patients. Furthermore, it is important to specifically ask patients about the use of these products, because they consider it as innocuous and thus would not spontaneously provide such information.
Allergic contact dermatitis to Aloe vera
Márcia Ferreira, Marta Teixeira, Elvira Silva, Manuela Selores
Contact Dermatitis, Volume 57, Issue 4, pages 278279, October 2007
Abstract
We present the case of a 72-year-old woman observed for dermatitis on the legs followed by apperance of
erythema on the eyelids. She had a past history of peripheral venous insufficiency and had been using self
home-made Aloe vera juice over the legs for relief from pain. Patch tests showed positive reactions to the
leaf of Aloe, the macerated Aloe jelly, and nickel sulfate. Although most manufacturers process Aloe
products avoiding its irritant extracts, and probably as a consequence reports of allergic reactions are rare,
one must remember that the growing popularity on the use of Aloe products may stimulate its use ‘as is’ by
the patients. Furthermore, it is important to specifically ask patients about the use of these products,
because they consider it as innocuous and thus would not spontaneously provide such information.
Keywords: allergic contact dermatitis; Aloe vera; medicinal plants; sensitization
Aloe barbadensis (Miller), commonly referred as Aloe vera (‘aloe’ derived from the Arabic word ‘alloeh’
meaning ‘bitter and shiny substance’, and ‘vera’ from the Latin word for ‘truth’), native to the North African
and the Arabian peninsula is the most potent of the approximately 420 Aloe species and one of the most
widely used herbal products throughout the world. It contains pharmacologically active ingredients
advocated for the healing of several diseases. Despite its widespread use, reports of allergic reactions are
rare.
Case report
A 72-year-old woman was observed for a 3-month history of pruriginous erythema of the legs, followed by
intense itching, erythema, and desquamation of the eyelids (Figs 1 and 2). Shortly before, she had started
applying self home-made Aloe vera leaf juice over the legs for the treatment of chronic peripheral venous
insufficiency. There was no history of atopy or other relevant medical condition.
Figure 1: Mild unilateral swollen right leg. Mottled hyperpigmentation over the legs, erythema, and
desquamation predominantly affecting the lower third.
Figure 2.:Chronic dermatitis of the eyelids.
She was patch tested with the Portuguese Contact Dermatitis Group standard series (Chemotechnique,
Malmö, Sweden), Aloe jelly ‘as is’ (liquid extract from the macerated plant) and Aloe pulvis (the whole
macerated leave) ‘as is’, which were mounted on Finn Chambers (Scanpor Alpharma AS, Norgesplaster
Facility, Kristiansand, Norway) and fixed on the upper back with Mefix (Molnlycke Health Care, Götenborg,
Sweden). Her own hygiene personal products (bath gel and shampoo) were tested ‘as is’ semi-open: a
minute amount of the products were directly applied with a Q-tip on the skin, left to dry completely and
covered with Micropore® tape. The patch tests were removed after 2 days and test readings were recorded
1 day later, according to the International Contact Dermatitis Research Group terminology (1). Patch test
results showed positive reactions to Aloe jelly (++) and Aloe pulvis (++) ‘as is’ and to nickel sulfate (+) on
day 3, as summarized in Table 1. The Aloe extracts were applied in the same way on 20 volunteers; none
of them experienced an irritant or allergic reaction.
Table 1. Results of the patch tests on day 3
Day 3
Aloe jelly as is
++
Aloe pulvis as is
++
Nickel sulfate (5% pet.)
+
The application of Aloe was strongly dissuaded and topical costicosteroids were prescribed
(hydrocortisone 1% cream for the eyelids and methylprednisolone aceponate 0.1% ointment for the legs).
The lesions gradually improved with total resolution in 2 weeks, without recurrence in an 8-month follow-up
period.
Discussion
Aloe vera, used for several centuries, is a well-known medicinal plant belonging to the family Liliaceae.
Through human trade and migration, this plant came to be known and was widely used to cure burns and
wounds throughout ancient civilizations. Several supposed properties, such as potent anti-inflammatory,
antimicrobial and even anti-tumoral effects apply to its growing popularity, and nowadays it is advocated
for the healing of injuries, psoriasis, radiation dermatitis, and several other diseases. Besides this, Aloe is
believed to balance the pH of the skin and is therefore used in hundreds of medicines and over-the-
counter products such as shampoos, soaps, shaving creams, deodorants, sunscreens, and moisturizers
(2, 3). However, randomized double-blind casecontrol studies to quantify any benefits of Aloe as a
primary active ingredient are warranted.
Allergic contact dermatitis due to other Liliaceae, such as Allim and Tulipa are well known, but reactions
resulting from the application or intake of Aloe vera are extremely rare, mostly reported more than 15
years ago (4, 5). This might be explained by considering the 2 components of the plant: the bark of the
leaves containing antrachinones with a considerable irritant and allergic potential, and the pulp in the
centre of the leaves with high water content and carbohydrates. Nowadays, most manufacturers of Aloe
products process the Aloe gel from the centre of the leaves, avoiding the irritant extracts (6). Given the
rarity on recent reports of truly adverse cutaneous reactions and its widespread use, one can suppose that
the use of properly processed topical products containing Aloe vera is relatively safe.
In the case presented in this study, the sensitizing capacity of the plant ‘as is’ was shown by the induction
of an allergic contact dermatitis over the legs and the eyelids, in the later probably due to hand transfer. It
also reflects the growing popularity of the ‘so-called’ natural products, conducting to their uncontrolled use
and aware to the lack of effective regulation on these products.
Therefore, adverse effects of herbal medicines need to be suspected and investigated, as these are rare
but real causes of allergic contact dermatitis.
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... There have been reports of severe allergic reaction to homemade Aloe Vera gels which have not been purified from irritant compounds [68]. ...
Article
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Aloe Vera is a tender and succulent type of plant belonging to the Liliaceae family and genus Aloe. It has been used as a medicinal plant for its healing and soothing properties for more than 2000 years. Properties of the Aloe Vera are not only specie dependent but also on how it is handled after being collected. Due to the adverse effects associated with conventional drugs, researchers are again interested in pursuing plant-based therapies for diseases.
... As a type of laxative, the application of Aloe vera latex also resulted in functional damage, such as colorectal lesions and kidney dysfunction (Cholongitas et al., 2005;GORKOM et al., 1999). Although there were no severe adverse effects or carcinogenicity reported owing to the application of Aloe vera gel, the occurrence of allergy or hypersensitivity of skin might be an obstacle limiting the extensive use for this specific portion of it (Ferreira et al., 2007;Morrow et al., 1980). Overall, the current state of Aloe vera application is a controversial issue. ...
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Ethnopharmacological relevance Aloe vera (L.) Burm. f. is a typical traditional Chinese medicine (TCM) collected in the Pharmacopoeia of the People's Republic of China (version 2015). It has been traditionally used for the treatment of constipation, and its potential therapeutic activities have been widely evaluated, including anti-tumor, anti-inflammatory and immune regulatory effects. The wide application of Aloe vera in food and therapy has raised safety issues and there are multiple safety assessments with a diverse toxicity and adverse effects from clinics and animals. Aim of the study This study aimed to investigate the safety of Aloe vera barbadensis extract C (AVBEC) in rats and analyze its anticancer activity in cell lines. Materials and methods We administrated AVBEC orally in an acute toxicity study and a 6-month chronic toxicity study to observe and confirm its safety in Sprague-Dawley (SD) rats. Additionally, we explored the cytotoxicity of AVBEC in cancer cells and non-cancer cells. We further investigate the anti-tumor activity of AVBEC, and in the meantime, probe the function of component from AVBEC. Results No deaths or substance-relative toxicity were observed in the acute toxic study or the 6-month chronic toxicity study with doses of 44.8 g·kg-1 and 4.48 g·kg-1, respectively. In the chronic toxicity study, AVBEC did not cause organ toxicity, including crucial organ structure and chemical function, and peripheral and central immune system damage. Additionally, we found that AVBEC could induce cancer cell apoptosis with a relatively higher apoptotic ratio than in non-cancer cells by decreasing adenosine triphosphate (ATP) concentration and enhancing reactive oxygen species (ROS) production. We also identified components in AVBEC using high-performance liquid chromatography with tandem mass spectrometry (HPLC-MS/MS) and probed the function of malic acid. This demonstrated that under the same circumstances, malic acid induced cell necrosis in cancer cells and non-cancer cells, while AVBEC did not. Conclusions These results reveal a novel mechanism of aloe gel extract in regulating cancer cell apoptosis via modulating the mitochondrial metabolism and imply a possible application of AVBEC for the treatment of malignant cancer with the safety evaluation from rats and anticancer investigation from cancer cell and non-cancer cells.
... Patch test showed positive reactions to the leaf of Aloe, the macerated Aloe jelly, and nickel sulfate. [3] Hypersensitivity manifested by generalized nummular eczematous and papular dermatitis developed in a 47-year-old man after using oral and topical aloe. Patch tests for Aloe were positive. ...
... Aloe vera may cause a flush, burning, and tingling sensation or allergic reaction when used topically. [38] Allergic reactions are mostly occurred due to the presence of anthraquinones. [39] Three case reports of Aloe vera-induced toxic hepatitis have also been received. ...
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Oral lichen planus Oral submucous fibrosis Recurrent aphthous stomatitis A B S T R A C T Background and aim: Aloe vera is also called Aloe barbadensis Miller. Aloe vera has been utilized for its numerous salutary properties. It has been utilized for fast wound healing and pain alleviation. There are few clinical studies recorded where Aloe vera is utilized in the treatment of oral mucosal diseases. The rationale for this review is to study clinical trials to assess the adequacy of Aloe vera in the treatment of oral mucosal diseases. Materials and methods: PubMed (Central), Wiley online library, Elsevier, Google scholar, and Hinary were used from the electronic databases using keywords until December 2020 to perform systematic literature. The quest was based on the terms of Mesh. Randomized or quasi-randomized clinical trials, cross-sectional and case-control studies included in this review. Literatures in English were only considered for this review. Review articles, experimental studies, and in-vitro studies were excluded in this review. Results: A total of 20 articles met the inclusion criteria. These articles were clinical trials for assessing the efficiency of Aloe vera in oral mucosal diseases that showed the efficacy of Aloe vera in oral submucous fibrosis, oral lichen planus, burning mouth syndrome, recurrent aphthous stomatitis, and chemotherapy-induced stomatitis. It showed fewer beneficial effects on radiation-induced mucositis. Conclusion: In the future, Aloe vera can play a promising role in various oral diseases. More studies should be performed in the future to determine the appropriate dose and effects on oral mucosal diseases. Evaluating possible side effects and long-term application of Aloe vera is also recommended.
... A 72-year-old patient presented with contact dermatitis on the legs and eyelids after the application of a home-made Aloe vera juice. Patch tests were positive to this plant (Ferreira et al., 2007). In addition, there were reports of a burning sensation of the skin in four patients after applying a preparation of Aloe vera gel in areas previously subjected to chemical or surgical beauty treatments (Hunter and Frumkin, 1991;Ernst, 2000). ...
Chapter
Synonyms: Aloe barbadensis Mill., Aloe vulgaris Lam., Aloe perfoliata var. vera L. (Adams, 1972)
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Aloe barbadensis (Miller), Aloe vera, has a long history of use as a topical and oral therapeutic. The plant is the source of two products, gel and latex, which are obtained from its fleshy leaves. Aloe vera products contain multiple constituents with potential biological and toxicological activities, yet the active components elude definition. Ingestion of Aloe vera is associated with diarrhea, electrolyte imbalance, kidney dysfunction, and conventional drug interactions; episodes of contact dermatitis, erythema, and phototoxicity have been reported from topical applications. This review examines the botany, physical and chemical properties, and biological activities of the Aloe vera plant.
Dermatoses due to plants
  • T W Mcgovern
  • L Bologniaj
  • Rapinir L P Jorizzoj
  • D Hornt
  • M Mascaroj
  • J Mancinia
  • J Salasches
  • Sauratj
McGovern T W. Dermatoses due to plants. In: Dermatology, 1st edition, BologniaJ L, JorizzoJ L, RapiniR P, HornT D, MascaroJ M, ManciniA J, SalascheS J, SauratJ H, StinglG. Edinburgh, Mosby, 2003: 265– 283.