Friday Favorites: Is Aloe Vera Gel the Best Treatment for Lichen Planus?

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

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 two, three, six, seven months later, after drinking two 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. “[B]ut oral use also is 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 two teaspoons of aloe vera juice a day. She started feeling “unjustifiably tired.” Lab work 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? Topical aloe vera gel was superior—”more effective” than the steroids, a significant difference appearing within two weeks. So, “[a]lthough corticosteroids are still [considered] the gold standard, aloe vera shows promising results especially with no adverse effects [when applied topically] compared with various adverse [side] effects of 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 nine out of ten responded, and one woman had a complete clinical remission. They conclude that “[a]loe vera gel [is] a safe and effective treatment.”

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Image credit: Cari Corbet-Owen via Unsplash. Image has been modified.

Motion graphics by Avocado Video