USAGE OF ALOE VERA (L.) BURM. F. (SARISABIR) PLANT IN PHYTOTHERAPY

Abstract

Objective: Aloe barbadensis Miller, also known as Aloe vera is a perennial succulent plant with fleshy and jagged leaves. The chemical composition and usage areas of A. vera leaf products, gel and latex, are quite different from each other. The present study aims to investigate usage of the leaf products as topical and oral therapeutic and disease prevention.

Result and Discussion: A. vera has a wide content of chemical components and biological activities associated with these components purified from the plant. Generally reached judgment is that the whole plant is stronger in most pharmacological activity than the extracted ingredients alone, and that the plant components together exert synergistic effect. With the advancing technology, it is seen that the anti-inflammatory and antimicrobial effects of plant leaves that support wound healing shed light on wider application areas. Especially the addition of gel to the content of wound dressings, fabrics, antibacterial products and personal care products using nanotechnology and other advanced methods creates wider areas of use where we can benefit from these therapeutic properties of the plant. By following the developments in the field of industry, multidisciplinary studies should be carried out in order to develop effective, safe and natural products that we can benefit from the therapeutic qualities of the plant at the highest level.

Keywords

• Aloe vera
• Aloe vera gel
• Aloe vera latex
• Phytotherapy

ALOE VERA (L.) BURM. F. (SARISABIR) BİTKİSİNİN FİTOTERAPİDE KULLANIMI

Abstract

Amaç: Aloe barbadensis Miller veya bilinen adıyla Aloe vera, sukulent türü, etli ve dikenli yaprakları olan çok yıllık bir bitkidir. A. vera yapraklarından elde edilen jel ve usarenin kimyasal bileşen yapısı ve kullanım alanları birbirinden oldukça farklıdır. Bu çalışmada, yapraklardan elde edilen bu ürünlerin iyileştirici veya sağlığın koruması amaçlarıyla dâhilen veya haricen kullanıldığı alanlar incelenmiştir.

Sonuç ve Tartışma: A. vera’nın geniş kimyasal bileşen içeriği olduğu ve bitkiden saflaştırılan bu bileşenlerle ilişkilendirilen biyolojik aktiviteler bulunduğu bilinmektedir. Genel olarak varılan yargı, bitki bütününün çoğu farmakolojik etkinlikte, saflaştırılan bileşenlerin tek başına gösterdiği aktiviteden daha güçlü olduğu ve bitki bileşenlerinin hep birlikte sinerjik etki gösterdiği yönündedir. Gelişen teknoloji ile birlikte, bitki yapraklarının yara iyileşmesini destekleyici, antienflamatuvar ve antimikrobiyal etkilerinin, daha geniş uygulama alanlarına ışık tuttuğu görülmektedir. Özellikle jelin, nanoteknoloji ve diğer ileri yöntemler kullanılarak yara pansuman malzemelerinin, kumaşların, antibakteriyel ürünlerin, kişisel bakım ürünlerinin içeriğine eklenmesi, bitkinin bu terapötik özelliklerinden faydalanabileceğimiz daha geniş kullanım alanları yaratmaktadır. Endüstri alanındaki gelişmelerin takip edilerek, bitkinin tedavi edici niteliklerinden en üst seviyede yararlanabileceğimiz, etkili, güvenli ve doğal içerikli ürünlerin geliştirilmesi için multidisipliner çalışmaların yürütülmesi gerekmektedir.

Keywords

• Aloe vera
• Aloe vera jel
• Aloe vera usare
• Fitoterapi

References

1. 1. Smith GF, Steyn EMA. (2004). Taxonomy of Aloaceae. In: Reynolds T. (Ed), Aloes: The Genus Aloe, (p. 31-52). Boca Raton: CRC Press.
2. 2. Chase MW, De Bruijn AY, Cox A V., Reeves G, Rudall PJ, Johnson MAT, et al. (2000). Phylogenetics of Asphodelaceae (Asparagales): An analysis of plastid rbcL and trnL-F DNA sequences. Ann Bot. 86 (5), p. 935–51.
3. 3. Foster M, Hunter D, Samman S. (2011). Evaluation of the Nutritional and Metabolic Effects of Aloe vera. In: Benzie IFF, Wachtel-Galor S. (Eds), Herbal Medicine: Biomolecular and Clinical Aspects (p. 37–54). Boca Raton: CRC Press.
4. 4. Mahor G, Ali SA. (2016). Recent update on the medicinal properties and use of Aloe vera in the treatment of various ailments. Biosci Biotech Res Comm, 9(2), 273–288.
5. 5. Davis, P. (1984). Flora of Turkey and the East Aegean Islands, Vol. 8. (p. 355-356). Edinburgh: Edinburgh University Press.
6. 6. Upton R, Axentiev P, Swisher D. (2012). Aloe vera Leaf, Aloe vera Leaf Juice, Aloe vera Inner Leaf Juice. In: Upton R. (Ed), American Herbal Pharmacopoeia (p. 1–52). California. Available from: www.herbal-ahp.org
7. 7. Gruenwald J, Brendler T, Jaenicke C. (2000). Aloe vera. In : Fleming T (Ed). Physician’s Desk Reference (PDR) for Herbal Medicines: Herbal Monographs (p. 16–20). Montvale, New Jersey; Medical Economics Company.
8. 8. Zeybek U, Haksel M. (2011). Türkiye’de ve Dünyada Önemli Tıbbi Bitkiler ve Kullanımları, ARGEFAR&Helvacızade Sağlık Yayınları, İzmir. p . 167–172

9. 9. Baruah A, Bordoloi M, Deka Baruah HP. (2016). Aloe vera: A multipurpose industrial crop. Ind Crops Prod, 94, 951–963.
10. 10. IARC Monographs (Online) (2015). Vol. 108. International Agency for Research on Cancer (IARC), Lyon. p. 37–71. https://monographs.iarc.fr/ENG/Monographs/vol108/mono108-01.pdf
11. 11. World Health Organization (WHO) (1999). WHO Monographs on Selected Medicinal Plants (Vol. 1). In: WHO Monographs on Selected Medical Plants. World Health Organization: Geneva, Switzerland. p. 33–49.
12. 12. Femenia A, Sanchez ES, Simal S, Rossello C. (1999). Compositional features of polysaccharides from Aloe vera (Aloe barbadensis Miller) plant tissues. Carbohydr Polym, 39, 109–117.
13. 13. Boudreau MD, Beland FA. (2006). An Evaluation of the Biological and Toxicological Properties of Aloe Barbadensis (Miller), Aloe Vera. J Environ Sci Heal Part C, 24,103–154.
14. 14. Bhuvana KB, Hema NG, Patil RT (2014). Review on Aloe vera. Int J Adv Res, 2(3), 677–91.
15. 15. Boudreau MD, Mellick PW, Olson GR, Felton RP, Thorn BT, Beland FA. (2013). Clear Evidence of Carcinogenic Activity by a Whole-Leaf Extract of Aloe barbadensis Miller ( Aloe vera ) in F344/N Rats. Toxicol Sci, 131(1), 26–39.
16. 16. Cosmetic Ingredient Review Expert Panel (2007). 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 Bar. International Journal of Toxicology, 26 (2),1-50. 17. Waller GR, Mangiafico S, Ritchey CR. (1978). A Chemical Investigation of Aloe Barbadensis Miller. Proc Okla Acad Sci, 58, 69–76.
17. 18. Raksha B, Pooja S, Babu S. (2014). Bioactive Compounds and Medicinal Properties of Aloe Vera L.: An Update. J Plant Sci (Science Publ Group), 2(3), 102–7.
18. 19. López A, De Tangil MS, Vega-Orellana O, Ramírez AS, Rico M. (2013). Phenolic constituents, antioxidant and preliminary antimycoplasmic activities of leaf skin and flowers of Aloe vera (L.) Burm. f. (syn. A. barbadensis Mill.) from the Canary Islands (Spain). Molecules, 18, 4942–4954.
19. 20. Wink M. (2003). Evolution of secondary metabolites from an ecological and molecular phylogenetic perspective. Phytochemistry, 64, 3–19.
20. 21. Hamman JH. (2008). Composition and applications of Aloe vera leaf gel. Molecules, 13(8), 1599–1616.
21. 22. Ahlawat KS, Khatkar BS. (2011). Processing, food applications and safety of aloe vera products: A review. J Food Sci Technol, 48(5), 525–533.
22. 23. Rodríguez ER, Martín JD, Romero CD. (2010). Aloe vera as a Functional Ingredient in Foods. Crit Rev Food Sci Nutr, 50, 305–26.
23. 24. Brusick D, Mengs U. (1997). Assessment of the genotoxic risk from laxative senna products. Environ Mol Mutagen, 29(1), 1–9.
24. 25. Mascolo N, Izzo AA, Borrelli F, Capasso R, Carlo G Di, Sautebin L, et al. (2004). Healing Powers of Aloes. In: Reynolds T. (Ed), Aloes: The Genus Aloe (e-Book), (p. 222–51). Boca Raton: CRC Press
25. 26. European Scientific Cooperative on Phytotherapy (ESCOP). (2014). Aloe barbadensis (Barbados Aloes). In: Mills S, Hutchins R, (Eds), ESCOP Monographs (Online series). Exeter, UK: ESCOP
26. 27. Motykie GD, Obeng MK, Heggers JP. (2004). Aloe vera in wound healing. In: Reynolds T. (Ed), Aloes: The Genus Aloe (e-Book), (p. 252–63). Boca Raton: CRC Press
27. 28. Sung, CK. (2006). The History of Aloe. In: Park YI, Lee SK. (Eds). New Perspectives on Aloe (e-Book), (p. 7–9). New York: Springer.
28. 29. Georgescu M, Marinas O, Popa M, Stan T, Lazar V, Bertesteanu SV, et al. (2016). Natural Compounds for Wound Healing. In: Worldwide Wound Healing - Innovation in Natural and Conventional Methods (Internet). IntechOpen. 61–89.
29. 30. Ross IA. (2001). Medicinal Plants of the World: Chemical constituents, traditional and modern medicinal uses. Vol. 2 (e-Book). Humana Press. https://doi.org/10.1007/978-1-59259-887-8
30. 31. Hormozi M, Assaei R, Boroujeni MB. (2017). 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, 88, 610–616.
31. 32. Subramanian S, Sathish Kumar D, Arulselvan P. (2006). Wound Healing Potential of Aloe vera Leaf Gel Studied in Experimental Rabbits. Asian J Biochem, 1(2),178–185.
32. 33. Sánchez-Machado DI, López-Cervantes J, Sendón R, Sanches-Silva A. (2017). Aloe vera: Ancient knowledge with new frontiers. Trends Food Sci Technol, 61, 94–102.
33. 34. Fox LT, Mazumder A, Dwivedi A, Gerber M, du Plessis J, Hamman JH. (2017). In vitro wound healing and cytotoxic activity of the gel and whole-leaf materials from selected aloe species. J Ethnopharmacol. 200 (January), 1–7.
34. 35. Visuthikosol V, Chowchuen B, Sukwanarat Y, Sriurairatana S, Boonpucknavig V. (1995). Effect of Aloe vera gel to healing of burn wound – a clinical and histologic study Effect of Aloe Vera Gel to Healing of Burn Wound a Clinical and Histologic Study. J Med Assoc Thai, 78(8), 403–9.
35. 36. Bahramsoltani R, Farzaei MH, Rahimi R. (2014). Medicinal plants and their natural components as future drugs for the treatment of burn wounds: An integrative review. Arch Dermatol Res, 306(7), 601–17.
36. 37. Hashemi SA, Madani SA, Abediankenari S. (2015). The review on properties of aloe vera in healing of cutaneous wounds. Biomed Res Int. Vol. 2015. https://doi.org/10.1155/2015/714216
37. 38. Kumar S, Yadav JP. (2014). Ethnobotanical and pharmacological properties of Aloe vera: a review. J Med Plants Res. 8(48), 1387–1398.
38. 39. Pugh N, Ross SA, ElSohly MA, Pasco DS. (2001). Characterization of aloeride, a new high-molecular-weight polysaccharide from Aloe vera with potent immunostimulatory activity. J Agric Food Chem. 49(2),1030–4.
39. 40. Ozsoy N, Candoken E, Akev N. (2009). Antioxidative activity, total phenols, flavonoids, ascorbic acid, β-carotene and α-tocopherol in Aloe vera. Oxid Med Cell Longev, 2(2), 99–106.
40. 41. Kaithwas G, Singh P, Bhatia D. (2014). Evaluation of in vitro and in vivo antioxidant potential of polysaccharides from Aloe vera (Aloe barbadensis Miller) gel. Drug Chem Toxicol, 37(2), 135–43.
41. 42. Rodrigues L lucy O, de Oliveira ACL, Tabrez S, Shakil S, Khan MI, Asghar MN, et al. (2018). Mutagenic, antioxidant and wound healing properties of Aloe vera. J Ethnopharmacol (Internet), 227(April), 191–7.
42. 43. Capasso F, Borrelli F, Capasso R, Di Carlo G, Izzo AA, Pinto L, et al. (1998). Aloe and its therapeutic use. Phyther Res, 12, 124–7.
43. 44. Tizard IR, Ramamoorthy L. (2004). Aloes and the immun system. In: Reynolds T. (Ed), Aloes: The Genus Aloe (e-Book), (p. 324–45). Boca Raton: CRC Press
44. 45. Lee W, Yang S, Lee C, Park EK, Kim KM, Ku SK, et al. (2019). Aloin reduces inflammatory gene iNOS via inhibition activity and p-STAT-1 and NF-κB. Food Chem Toxicol (Internet). 126 (January), 67–71
45. 46. Heng HC, Zulfakar MH, Ng PY. (2018), Pharmaceutical Applications of Aloe vera. Indones J Pharm. 29(3),101–116.
46. 47. Maan AA, Nazir A, Khan MKI, Ahmad T, Zia R, Murid M, et al. (2018). The therapeutic properties and applications of Aloe vera: A review. J Herb Med (Internet), 12,1–10.
47. 48. Salehi B, Albayrak S, Antolak H, Kręgiel D, Pawlikowska E, Sharifi-Rad M, et al. (2018). Aloe genus plants: From farm to food applications and phytopharmacotherapy. Int J Mol Sci, 19, 1–49.
48. 49. Surjushe A, Vasani R, Saple D. (2008). Aloe vera: A short review. Indian J Dermatol (Internet), 53(4), 163–6.
49. 50. Steenkamp V, Stewart MJ. (2007). Medicinal applications and toxicological activities of Aloe products. Pharm Biol. 45(5), 411–20.
50. 51. Akev N. (2007). Effect of Aloe vera pulp extract on Ehrlich ascites tumours in mice. Phyther Res. 21(11), 1070–5.
51. 52. El-Shemy H, Aboul-Soud M, Aboul-Enein K, Nassr-Allah A, Kabash A, Yagi A. (2010). Antitumor Properties and Modulation of Antioxidant Enzymes Activity by Aloe vera Leaf Active Principles Isolated via Supercritical Carbon Dioxide Extraction. Curr Med Chem. 17(2), 129–38.
52. 53. Tomasin R, Gomes-Marcondes MCC. (2011). Oral administration of Aloe vera and honey reduces walker tumour growth by decreasing cell proliferation and increasing apoptosis in tumour tissue. Phyther Res. 25, 619–23.
53. 54. Liu RH. (2004). Potential synergy of phytochemicals in cancer prevention: mechanism of action. Am Soc Nutr Sci (Internet). 134, 3479–85.
54. 55. Akaberi M, Sobhani Z, Javadi B, Sahebkar A, Emami SA. (2016). Therapeutic effects of Aloe spp. in traditional and modern medicine: A review. Biomed Pharmacother (Internet). 84, 759–72.
55. 56. Halder S, Mehta AK, Mediratta PK. (2013). Aloe vera improves memory and reduces depression in mice. Nutr Neurosci, 16(6), 250–4.
56. 57. Abdollahnejad F, Mosaddegh M, Nasoohi S, Mirnajafi-Zadehc J, Kamalinejadd M, Faizi M. (2016). Study of Sedative-Hypnotic Effects of Aloe vera L. Aqueous Extract through Behavioral Evaluations and EEG Recording in Rats. Iran J Pharm Res. 15(1), 293–300.
57. 58. Shida T, Yagi A, Nishimura H, Nishioka I. (1985). Effect of Aloe Extract on Peripheral Phagocytosis in Adult Bronchial Asthma. Planta Med. 51(3), 273–5.
58. 59. Kar A, Panda S, Bharti S. (2002). Relative efficacy of three medicinal plant extracts in the alteration of thyroid hormone concentrations in male mice. J Ethnopharmacol. 81(2), 281–5. 60. EMA Committee on Herbal Medicinal Products (HMPC). (2017). European Union herbal monograph on Aloe barbadensis Mill . and on Aloe ( various species , mainly Aloe ferox Mill . and its hybrids ), folii succus siccatus. European Medicines Agency: London.
59. 61. Gıda ve Kontrol Genel Müdürlüğü. (2018). Aloe vera (L.) Burm. f.’nin Yapraklarından Elde Edilen Aloe Vera Jel ve Renksizleştirilmiş Yaprak Usaresi’nin Gıdalarda Kullanımının Güvenilirliğinin Değerlendirilmesi Hakkında Bilimsel Görüş.
60. 62. U.S. FDA. (2002). U.S. Food and Drug Administration - Status of Certain Additional Over-the-Counter Drug Category II and III Active Ingredients (Internet). Vol. 67.
61. 63. Shahzad MN, Ahmed N. (2013). Effectiveness of Aloe Vera Gel compared with 1% silver sulphadiazine cream as burn wound dressing in second degree burns. J Pak Med Assoc, 63(2), 225–30.
62. 64. Irani PS, Varaie S. (2016).Comparison of the Effect of Aloe Vera Gel and Nitrofurazone 2% on Epithelialization and Granulation Tissue Formation Regarding Superficial Second-Degree Burns. Iran J Med Sci (Internet). 41(3), S3.
63. 65. Najafian Y, Khorasani ZM, Najaf najafi M, Hamedi S, Mahjour M, Feyzabadi Z. (2018). Efficacy of Aloe vera/ Plantago major gel in Diabetic Foot Ulcer: a randomized double-blind clinical trial. Curr Drug Discov Technol (Internet). 15, 2018–9.
64. 66. Avijgan M, Alinaghian M, Esfahani MH. (2017). Aloe Vera Gel as a Traditional and Complementary Method for Chronic Skin Burn: A Case Report. Adv Infect Dis (Internet). 07(01), 19–25.
65. 67. Avijgan M, Kamran A, Abedini A. (2016). Effectiveness of Aloe Vera Gel in Chronic Ulcers in Comparison with Conventional Treatments (Poster). Iran J Med Sci (Internet). 41(3), S30.
66. 68. Panahi Y. (2015). Comparative trial of Aloe vera / olive oil combination cream versus phenytoin cream in the treatment of chronic wounds. J Wound Care. 24(10), 62–5.
67. 69. Molazem Z, Mohseni F, Younesi M, Keshavarzi S. (2014). Aloe Vera Gel and Cesarean Wound Healing; A Randomized Controlled Clinical Trial. Glob J Health Sci (Internet). 7(1), 203–9.
68. 70. Syed TA. (1996). Management of psoriasis with Aloe vera extract in a hydrophilic cream: A placebo-controlled, double-blind study. Trop Med Int Heal. 1(4), 505–9.
69. 71. Seyger MMB, Van De Kerkhof PCM, Van Vlijmen-Willems IMJJ, De Bakker ESM, Zwiers F, De Jong EMGJ. (1998). The efficacy of a new topical treatment for psoriasis: Mirak. J Eur Acad Dermatology Venereol, 11, 13–8.
70. 72. Haddad P, Amouzgar-Hashemi F, Samsami S, Chinichian S, Oghabian MA.( 2013). Aloe vera for prevention of radiation-induced dermatitis: A self-controlled clinical trial. Curr Oncol. 20, 345–8.
71. 73. Yogi V, Singh OP, Mandloi V, Ahirwar M. (2018). Role of topical aloe vera gel in the recovery of high-grade, radiation-induced dermatitis. Clin Cancer Investig J. 7, 167–70.
72. 74. Paulsen E, Korsholm L, Brandrup F. (2005). A double-blind, placebo-controlled study of a commercial Aloe vera gel in the treatment of slight to moderate psoriasis vulgaris. J Eur Acad Dermatology Venereol. 19, 326–31.
73. 75. Choonhakarn C, Busaracome P, Sripanidkulchai B, Sarakarn P. (2010). A prospective, randomized clinical trial comparing topical aloe vera with 0.1% triamcinolone acetonide in mild to moderate plaque psoriasis. J Eur Acad Dermatology Venereol, 24, 168–72.
74. 76. Ahmadloo N, Kadkhodaei B, Omidvari S, Mosalaei A, Ansari M, Nasrolahi H, et al.( 2017). Lack of Prophylactic Effects of Aloe Vera Gel on Radiation Induced Dermatitis in Breast Cancer Patients. Asian Pacific J Cancer Prev, 18(4), 1139–43.
75. 77. Merchant TE, Bosley C, Smith J, Baratti P, Pritchard D, Davis T, et al. (2007). 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. 2(45), 1–8.
76. 78. Olsen DL, Raub W, Bradley C, Johnson M, Macias JL, Love V, et al. (2001). The effect of aloe vera gel/mild soap versus mild soap alone in preventing skin reactions in patients undergoing radiation therapy. Oncol Nurs Forum. 28(3), 543-547.
77. 79. Hoopfer D, Holloway C, Gabos Z, Alidrisi M, Chafe S, Krause B, et al. (2015). Three-arm randomized phase III trial: Quality aloe and placebo cream versus powder as skin treatment during breast cancer radiation therapy. Clin Breast Cancer. 15(3), 181-190.e4.
78. 80. Farrugia C-JE, Burke ES, Haley ME, Bedi KT, Gandhi MA. (2019). The use of aloe vera in cancer radiation: An updated comprehensive review. Complement Ther Clin Pract (Internet). 35(January), 126–30.
79. 81. Yee C, Wang K, Asthana R, Drost L, Lam H, Lee J, et al. (2018). Radiation-induced Skin Toxicity in Breast Cancer Patients: A Systematic Review of Randomized Trials. Clin Breast Cancer, 18(5), 825–40.
80. 82. Chew Y-L, Al-Nema M, Ong VW-M. (2018). Management and treatment of atopic dermatitis with modern therapies, complementary and alternative medicines: a review. Orient Pharm Exp Med, 18, 67–76.
81. 83. Hajheydari Z, Saeedi M, Morteza-Semnani K, Soltani A. (2014). 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. 25(2), 123–9.
82. 84. Mazzarello V, Donadu M, Ferrari M, Piga G, Usai D, Zanetti S, et al. (2018). Treatment of acne with a combination of propolis, tea tree oil, and Aloe vera compared to erythromycin cream: two double-blind investigations. Clin Pharmacol Adv Appl. 10, 175–81.
83. 85. Syed TA. (1996). Aloe vera extract 0.5% in hydrophilic cream versus Aloe vera gel for the management of genital herpes in males. A placebo-controlled, douhle- blind, comparative study. J Eur Acad Dermatol Venereol. 7, 294–5.
84. 86. Syed TA, Afza M, Ahmad SA, Holt A, Ahmad SA, Ahmad S. (1997). Management of genital herpes in men with 0.5% Aloe vera extract in a hydrophilic cream: A placebo-controlled double-blind study. J Dermatolog Treat, 8, 99–102.
85. 87. Vardy D, Cohen A, Tchetov T, Medvedovsky E, Biton A. (1999). A double-blind, placebo-controlled trial of an Aloe vera ( A . barbadensis ) emulsion in the treatment of seborrheic dermatitis. J Dermatolog Treat, 10 (1), 7–11.
86. 88. Panahi Y, Sharif MR, Sharif A, Beiraghdar F, Zahiri Z, Amirchoopani G, et al. (2012). A Randomized Comparative Trial on the Therapeutic Efficacy of Topical Aloe vera and Calendula officinalis on Diaper Dermatitis in Children. Sci World J. 2012, 1–5.
87. 89. Badelbuu SG, Javadzadeh Y, Jabraeili M, Heidari S, Bostanabad MA. (2018). Evaluation of the Effect of Aloe Vera Ointment with Chamomile Ointment on Severity of Children’s Diaper Dermatitis : A Randomized, Double-Blind Clinical Trial. World Fam Med, 16(3), 47–51.
88. 90. Zhang Y, Liu W, Liu D, Zhao T, Tian H. (2016). Efficacy of aloe vera supplementation on prediabetes and early non-treated diabetic patients: A systematic review and meta-analysis of randomized controlled trials. Nutrients. 8, 1–10.