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Aloe vera for treating acute and chronic wounds

  1. Anthony D Dat1,*,
  2. Flora Poon1,
  3. Kim BT Pham1,
  4. Jenny Doust2

Editorial Group: Cochrane Wounds Group

Published Online: 15 FEB 2012

Assessed as up-to-date: 9 SEP 2011

DOI: 10.1002/14651858.CD008762.pub2


How to Cite

Dat AD, Poon F, Pham KBT, Doust J. Aloe vera for treating acute and chronic wounds. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD008762. DOI: 10.1002/14651858.CD008762.pub2.

Author Information

  1. 1

    Bond University, Faculty of Health Sciences and Medicine, Gold Coast, Queensland, Australia

  2. 2

    Bond University, Centre for Research in Evidence Based Practice, Gold Coast, Queensland, Australia

*Anthony D Dat, Faculty of Health Sciences and Medicine, Bond University, 103 Pioneer Crescent, Gold Coast, Queensland, 4070, Australia. adat@student.bond.edu.au. anthony_dat@hotmail.com.

Publication History

  1. Publication Status: New
  2. Published Online: 15 FEB 2012

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Characteristics of included studies [ordered by study ID]
Akhtar 1996

MethodsSingle-centre RCT


ParticipantsCountry: India
100 participants who had first or second degree burns to 10% to 40% of total body surface area
Exclusion criteria: electrical, chemical and radiation burns, 3rd and 4th degree burns, patients with systemic diseases like diabetes, malignancy or on immunosuppressants or vitamin deficient


Interventions1) Aloe vera cream applied every third day (n = 50)
2) Framycetin cream applied every third day (n = 50)

Duration: until fully healed


OutcomesMean wound healing time (no standard deviation was stated)
1) 18 days
2) 30.9 days


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskMethod of randomisation: block size of 8. "Allocation to intervention was done by block randomisation of 8 subjects"

Allocation concealment (selection bias)Unclear riskNot reported

Blinding (performance bias and detection bias)
All outcomes - participants blinded
Unclear riskNot reported

Blinding (performance bias and detection bias)
All outcomes - caregivers blinded
Unclear riskNot reported

Blinding (performance bias and detection bias)
All outcomes - outcome assessors blinded
Unclear riskNot reported

Incomplete outcome data (attrition bias)
All outcomes - levels of attrition reported and acceptable
Unclear riskNot reported

Selective reporting (reporting bias)Unclear riskNo protocol was available for the study and there was insufficient information to permit a clear judgement. The study report was available in abstract form only.

Free of other bias? - as specified in the descriptionUnclear riskThis could not be assessed as the study report was available in abstract form only

Eshghi 2010

MethodsSingle-centre RCT


ParticipantsCountry: Iran
49 participants who had symptomatic III and IV degree haemorrhoidal disease and underwent surgical haemorrhoidectomy
Exclusion criteria: pregnancy, anal fissure, heart and liver disease


Interventions1) Aloe vera cream (with 0.5% Aloe vera gel powder) applied 12 hours post-haemorrhoidectomy and 3 times a day up to 28 days post-operation (n = 24)
2) Placebo cream applied 12 hours post-haemorrhoidectomy and 3 times a day up to 28 days post-operation (n = 25)
Duration: 28 days


OutcomesProportion of participants with completely healed wound at 14 days classified by Grade 3 wound (completed layer of epithelial covering on wound)
1) 24/24 (100%)
2) 1/24 (4%)


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskMethod of randomisation not reported although the study was referred to as a "prospective, randomized, double-blind placebo-controlled trial"

Allocation concealment (selection bias)Unclear riskNot reported

Blinding (performance bias and detection bias)
All outcomes - participants blinded
Low riskPatients blinded to treatment allocation, "both the nurse and patients were blinded"

Blinding (performance bias and detection bias)
All outcomes - caregivers blinded
Low riskCare givers (nurses) blinded to treatment allocation, "both the nurse and patients were blinded"

Blinding (performance bias and detection bias)
All outcomes - outcome assessors blinded
Unclear riskNot stated

Incomplete outcome data (attrition bias)
All outcomes - levels of attrition reported and acceptable
Unclear riskData on the proportion of participants with completely healed wound at the conclusion of the study (28 days) were not given

Selective reporting (reporting bias)High riskNo protocol was available for the study and there was insufficient information to permit a clear judgement

Free of other bias? - as specified in the descriptionLow riskBaseline characteristics were comparable. Trial not stopped early.

Khorasani 2009

MethodsSingle-centre RCT


ParticipantsCountry: Iran
30 patients with 60 second degree-burns
Inclusion criteria: the burn had to have occurred within 24 hours before the initiation of treatment; the patient had to have 2 same site burns, which only were the feet or hands; the burns had to be of second degree with respect to depth and similar burned surface areas in 2 different parts of the body; and the patients had to have less than 40% total burn surface area (TBSA) burns

Exclusion criteria: patients with diabetes, immunodeficiency, pregnancy and kidney diseases. Also excluded were patients with electrical and chemical burns


Interventions1) Aloe vera cream (0.5% aloe vera gel powder), twice daily (n = 30)
2) Silver sulfadiazine 1% cream, twice daily (n = 30)
Duration: until healed


OutcomesMean wound healing time
1) 15.9 days (SD 2)
2) 18.73 days (SD 2.65)

Also reported the proportion of patients with a completely healed wound at 19 weeks
1) 30/30 (100%)
2) 24/30 (80%)


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskMethod of randomisation was not reported, however the paper states "randomised controlled study"

Allocation concealment (selection bias)Unclear riskNot reported

Blinding (performance bias and detection bias)
All outcomes - participants blinded
Unclear riskNot reported

Blinding (performance bias and detection bias)
All outcomes - caregivers blinded
Unclear riskNot reported

Blinding (performance bias and detection bias)
All outcomes - outcome assessors blinded
Unclear riskNot reported

Incomplete outcome data (attrition bias)
All outcomes - levels of attrition reported and acceptable
Low riskAll the participants' results were accounted for at the end of the study

Selective reporting (reporting bias)Unclear riskNo protocol was available for the study and there was insufficient information to permit a clear judgement

Free of other bias? - as specified in the descriptionLow riskBaseline characteristics were comparable. Trial not stopped early.

Phillips 1995

MethodsSingle-centre RCT


ParticipantsCountry: United States of America
49 patients who recently underwent shave biopsies to remove benign skin tumours
Exclusion criteria: patients were excluded if their shave biopsies showed malignant carcinoma


Interventions1) Aloe vera derivative gel dressing containing acemannan (Carrasyn hydrogel), changed twice daily (n = 26)
2) Conventional therapy (hydrogen peroxide, antibiotic ointment (bacitracin) and adhesive dressing), changed twice daily (n = 23)
Duration: 2 weeks


OutcomesProportion of participants with a completely healed wound
1) 26/26 (100%)
2) 23/23 (100%)


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low risk"Computer generated"

Allocation concealment (selection bias)Unclear riskNot reported

Blinding (performance bias and detection bias)
All outcomes - participants blinded
Unclear riskNot reported

Blinding (performance bias and detection bias)
All outcomes - caregivers blinded
Unclear riskNot reported

Blinding (performance bias and detection bias)
All outcomes - outcome assessors blinded
Low risk"The observer was blinded"

Incomplete outcome data (attrition bias)
All outcomes - levels of attrition reported and acceptable
Low riskAll the participants' results were accounted for

Selective reporting (reporting bias)Unclear riskNo protocol was available for the study and there was insufficient information to permit a clear judgement

Free of other bias? - as specified in the descriptionLow riskBaseline characteristics were comparable. Trial not stopped early.

Schmidt 1991

MethodsSingle-centre RCT


ParticipantsCountry: United States of America
40 women with complications of wound healing after gynaecological surgery
Exclusion criteria: diabetes mellitus, cancer, required treatment with glucocorticoids or immunosuppressive drugs, history of abdominal irradiation or chronic debilitating disease


Interventions1) Standard wound care plus Aloe vera dermal gel, given every 8 to 12 hours (n = 10)
2) Standard wound care (wet-to-dry dressing was applied using a solution with equal parts of saline and sodium hypochlorite 0.025%) (n = 11)
Duration: until healed


OutcomesMean wound healing time
1) 83 days (SD 28)
2) 53 days (SD 24)


Notes19 participants dropped out of the study and were not accounted for in the final analysis


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low risk"random number sequence generated by a computer program"

Allocation concealment (selection bias)Unclear riskNot reported

Blinding (performance bias and detection bias)
All outcomes - participants blinded
High risk"The study was not blinded"

Blinding (performance bias and detection bias)
All outcomes - caregivers blinded
High risk"The study was not blinded"

Blinding (performance bias and detection bias)
All outcomes - outcome assessors blinded
High risk"The study was not blinded"

Incomplete outcome data (attrition bias)
All outcomes - levels of attrition reported and acceptable
High riskReported a significant loss of 19 patients from a sample size of 41, with no reasons given; this loss represents a 47.5% dropout rate

Selective reporting (reporting bias)Unclear riskNo protocol was available for the study and there was insufficient information to permit a clear judgement

Free of other bias? - as specified in the descriptionHigh risk"terminated early due to an observed delay in healing within the experimental group"

Thamlikitkul 1991

MethodsMulti-centre RCT


ParticipantsCountry: Thailand
38 patients with minor burns
Inclusion criteria: patients of any age with thermal first or second-degree burns of less than 30% of the body surface area and within 24 hours of admission. Patients must have also not yet received any antibiotics or topical treatment.
Exclusion criteria: patients with diabetes mellitus or those in a moribund state


Interventions1) Aloe vera mucilage applied twice daily (n = 20)
2) Silver sulfadiazine cream applied twice daily (n = 18)
Duration: until burns healed or patient had to leave the hospital


OutcomesProportion of participants with a completely healed wound (no standard deviation was stated)
1) 11/20 (55%)
2) 7/18 (39%)


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low risk"stratified randomisation"

Allocation concealment (selection bias)Unclear riskNot reported

Blinding (performance bias and detection bias)
All outcomes - participants blinded
Unclear riskNot reported

Blinding (performance bias and detection bias)
All outcomes - caregivers blinded
Unclear riskNot reported

Blinding (performance bias and detection bias)
All outcomes - outcome assessors blinded
Unclear riskNot reported

Incomplete outcome data (attrition bias)
All outcomes - levels of attrition reported and acceptable
Low riskAll participants' results were accounted for at the end of the trial

Selective reporting (reporting bias)Unclear riskNo protocol was available for the study and there was insufficient information to permit a clear judgement

Free of other bias? - as specified in the descriptionLow riskBaseline characteristics were comparable. Trial not stopped early.

Thomas 1998

MethodsMulti-centre RCT


ParticipantsCountry: United States of America
41 patients with pressure ulcers were enrolled
Inclusion criteria: patients who had a stage II, III or IV pressure ulcer with an area of greater or equal to 1 cm2
Excluded criteria: ulcers resulting from venous or arterial insufficiency of other non-pressure aetiology (e.g. vasculitis or diabetic ulcer) were excluded. Wounds with sinus tracts and/or undermining greater than 1 cm were also excluded. Clinically infected wounds were also excluded. Concomitant use of other topical medications to the study ulcer or steroids was not allowed. Patients with a severe generalised medical condition and estimate survival of less than 6 months were excluded. Patients who were HIV-positive, currently abusing alcohol or drugs, pregnant, breast feeding, not on acceptable means of contraception in perimenopausal women, had a current diagnosis of cancer or were receiving chemotherapy were also excluded.


Interventions1) Acemannan hydrogel dressing derived from the aloe plant, applied daily (n = 16)
2) Saline gauze dressing, applied daily (n = 14)
Duration: 10 weeks, unless the wounds healed earlier


OutcomesMean wound healing time
1) 5.3 weeks (SD 2.3)
2) 5.2 weeks (SD 2.4)

Also reported the percentage of participants to be fully healed at 10 weeks
1) 10/16 (63%)
2) 9/14 (64%)


Notes11 patients (6 from the control group and 5 from the experimental group) failed to complete the study and were not included in the statistical analysis


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskNot reported

Allocation concealment (selection bias)Unclear riskNot reported

Blinding (performance bias and detection bias)
All outcomes - participants blinded
Unclear riskNot reported

Blinding (performance bias and detection bias)
All outcomes - caregivers blinded
Unclear riskNot reported

Blinding (performance bias and detection bias)
All outcomes - outcome assessors blinded
Unclear riskNot reported

Incomplete outcome data (attrition bias)
All outcomes - levels of attrition reported and acceptable
High riskEven though all participants' results were accounted for at the end of the study, there was a significant loss to follow up (25% drop out rate)

Selective reporting (reporting bias)Unclear riskNo protocol was available for the study and there was insufficient information to permit a clear judgement

Free of other bias? - as specified in the descriptionLow riskBaseline characteristics were similar

 
Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Fulton 1990Study design - controlled clinical trial

Sun 1994Article could not be obtained for assessment

Visuthikosol 1995Study design - controlled clinical trial

 
Comparison 1. Burns: Aloe vera cream versus silver sulfadiazine cream

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Proportion of patients with a completely healed wound1Risk Ratio (M-H, Random, 95% CI)Totals not selected

 
Comparison 2. Burns: Aloe vera mucilage versus silver sulfadiazine cream

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Proportion of patients with a completely healed wound1Risk Ratio (M-H, Random, 95% CI)Totals not selected

 
Comparison 3. Acute surgical wound: Aloe vera cream versus placebo cream

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Proportion of patients with a completely healed wound1Risk Ratio (M-H, Random, 95% CI)Totals not selected

 
Comparison 4. Skin biopsy: Aloe vera gel dressing versus conventional therapy

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Proportion of patients with a completely healed wound1Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 
Comparison 5. Pressure ulcer: Aloe vera dressing versus saline gauze dressing

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Proportion of patients with a completely healed wound1Risk Ratio (M-H, Random, 95% CI)Totals not selected