Is Aloe Vera Gel the Best Treatment for Lichen Planus?

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“Is Aloe Vera Gel the Best
Treatment for Lichen Planus?” Lichen planus is a chronic
autoimmune disease, typically of our moist membranes,
such as the inside of our mouth, but can also affect other body surfaces, and it’s not that rare, around 1%, making it one of the
commoner conditions seen in oral medicine clinics. Current treatments are not curative but rather palliative,
aimed at relieving pain. We’ve tried steroids, antibiotics,
chemotherapy, and surgery, and none appear to be
particularly effective. So, even for palliative pain relief, we don’t have great options; that’s why case reports
like this are so exciting. Here’s the before, and
here’s the after, one month, then 2, 3, 6, 7 months later, after drinking 2 ounces
of aloe vera juice a day and applying aloe topically as well, with these kinds of
before and after cases leading to journal
articles with titles like “Aloe Vera as Cure for Lichen Planus.” But, is ingested oral aloe
vera a potion or poison? Internal use of aloe may cause acute hepatitis—liver inflammation, as well as electrolyte imbalances, and you should definitely not inject aloe. But oral use is also not
recommended either. This is primarily because of case reports of aloe-induced hepatitis. Aloe is, ironically, presented
as a detoxifying product but can actually end
up causing liver damage, like in this guy who was
trying to protect his liver and ended up in the hospital. How do we know it was the aloe, though? The assessment of suspected
herbal-induced liver injury is challenging, because
there’s hundreds of things out there that can damage your liver. Here’s the kind of checklist you have to go through as a doctor to rule out other causes before
you blame it on the plant. Do you have some kind of viral hepatitis, or other kind of liver infection, or it could be various drugs
or toxins and diseases. So, maybe it was one
of these other things, and it was just a coincidence that the problem started
after drinking aloe. The gold standard, in terms of trying to prove cause-and-effect, is
a positive re-exposure test— that’s how you can diagnose
drug-induced liver injury. Liver inflammation disappears
when you remove the drug, and then reappears when
you add the drug back, which is rarely done,
for obvious reasons. Well, has there ever been a re-challenge case published for aloe? Yes. Aloe-induced toxic
hepatitis that shot up again after stopping then
restarting aloe ingestion. Aloe consumption has also been
linked to thyroid dysfunction. A women with lichen
planus started swallowing 2 teaspoons of aloe vera juice a day. She started feeling unjustifiably tired. Labwork showed her
thyroid function was low, but she perked right back
up after stopping the aloe, and her thyroid function
returned to normal. What if, instead of swallowing, though, she just swished the
aloe around in her mouth to try to help the lichen planus and then spit it out? We didn’t know… until it was put to the test. A randomized, double-blind,
placebo-controlled trial: 54 patients randomized to
a topical aloe vera gel or placebo gel for 8 weeks. 81% in the aloe group got better compared to just 4% in the placebo group. Furthermore, two patients
treated with aloe had a complete clinical remission. That’s rare. It’s considered a chronic condition; yet, a few weeks applying aloe, and the nasty erosive
lesions disappeared. How about compared to a
steroid ointment, though? Topical aloe vera gel was superior— more effective than the steroids, a significant difference
appearing within 2 weeks. So, although corticosteroids are still considered the gold standard, aloe vera shows promising results, especially with no adverse effects, when applied topically,
compared to various adverse side effects of the corticosteroids. That’s for oral lichen planus, though. What about the efficacy of aloe vera gel in the treatment of lichen
planus of the genitals? Lichen planus of the
vulva is quite common, affecting 1-2% of the population, and it may be even harder to treat. There are flares and partial remission but no tendency for complete remission. And, indeed, that’s what they
saw in the placebo group. One woman had a good response,
but most had little or no response, but applying aloe vera gel instead, and 9 out of 10 responded, and one woman had a
complete clinical remission. They conclude that aloe vera gel is a safe and effective treatment.

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