A wound is an injury that breaks the skin or other body tissues.
It is majorly of two types: Open wound and Closed wound.
Open wound involves an external or internal break in body tissues and skin.
It includes tear, cut, stab, puncture (small hole caused by long pointy objects like needles, nail or ice pick), incisions (piercing caused by sharp objects like knife, glass, blades), abrasions (occurs when skin rubs against a hard or rough surface), avulsions (partial or complete tearing away of the skin) and lacerations (deep tear or cut in skin).
Closed wound includes crushing of tissues or a blood tumour beneath the epidermis, without actually creating an opening outside.
Other types of wounds include thermal wounds (exposure to extreme hot or cold temperatures like burns, sunburns and frostbite), chemical wounds (by contacting or inhaling concentrated acids or other chemicals that cause skin or lung damage), electrical wounds (caused by passing of high-voltage electric current in the body), bites ( from humans, dogs, bats, rodents, monkeys and other animals) and stings (from snakes, scorpions, etc.).
Wounds can also occur by radiation, diabetes and skin or soft tissue cancers, fractures, sprains or strains.
Wounds may be caused by accidents by sharp objects or tools, road accidents, falls, hits, weapons, surgery and other things.
The symptoms of a wound depend on site and severity of an injury and generally causes pain, swelling, redness, bleeding and impairment of the function of the wounded area.
Wounds may lead to certain complications such as inflammation, infection, scarring and loss of function of the injured area.
An open wound is more dangerous as it has a risk of developing an infection. The infection causes pus deposits, heat, fever and delay in healing.
Wound Healing requires the following:
- Removal of pathogens or foreign substances from the wound site.
- Reduction of inflammation and pain.
- Regeneration of damaged skin or body tissue.
Aloe vera is universally known as a healing herb. It has been traditionally used for the treatment of various ailments.
Aloe barbadensis miller, known as Aloe vera, is famous for its rejuvenating properties.
It is a xerophytic plant that grows in a dry climate. This herb, belonging to the Lily family, has thick and fleshy leaves that contain the Aloe gel.
It has been traditionally used all over the world for the treatment of various ailments. Recently, scientific studies conducted prove its therapeutic value.
Aloe vera is proven to possess anti-inflammatory, anti-microbial, anti-oxidant and rejuvenating properties, all of which are required for healing a wound. Here is how the properties of Aloe vera benefit in Wound Healing:
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Benefits of Aloe Vera in Wound Healing
Aloe vera shows promising benefits in wound healing. It is a great combination of anti-inflammatory, antioxidant, anti-microbial and immuno-modulating properties.
1. It reduces inflammation
A wound often causes inflammation and pain in a particular area.
It is the body’s attempt at self-recovery where it eliminates the harmful pathogens and initiates tissue repair.
When an injury is caused, the immune system produces cells to fight against any pathogens that might have entered the site during injury. These cells are also involved in the process of repair and healing.
Aloe vera is considered anti-inflammatory.
Prostaglandins are compounds in our tissues that send signals to the cells of the immune system to accumulate at the injury site and produce substances to fight pathogens.
Aloe vera inhibits the cyclooxygenase pathway and reduces prostaglandin E2 production from arachidonic acid.
Aloe vera contains compounds such as C-glysocyl chromone and Lupeol, both of which have anti-inflammatory properties.
Bradykinin, a peptide found in our body is an inflammatory modulator that induces pain. The peptidase bradykinase found in aloe vera breaks down this bradykinin and thereby relieves pain.
What does this mean? The inflammation, swelling, redness and pain caused by wound can be relieved by application of Aloe vera.
2. It improves antioxidant defences
Phenolic compounds in Aloe vera which are known to have antioxidant properties prevents or inhibits cell damage caused by the free radicals produced as a result of Oxidation.
If the antioxidants in the body are not enough to stabilize the free radicals, they may end up causing cell damage and subsequently, diseases.
Oxidation stress, which is the imbalance between free radicals and antioxidants has a detrimental effect on wound healing.
Several low-molecular-weight compounds in Aloe vera inhibit the release of reactive oxygen free radicals from WBC’s at the wound site.
These antioxidant effects may be due to the presence of glutathione peroxides activity, superoxide dismutase enzymes and a phenolic antioxidant in Aloe vera.
What does this mean? Aloe vera, being an antioxidant prevents the free radicals of oxidation from harming the wound healing process.
3. It accelerates wound healing
Aloe gel has hormones such as Auxins and Gibberellins that promote wound healing and have anti-inflammatory effects.
It has a direct role in wound contraction. The mannose-6-phosphate present in Aloe vera gel leads to the contraction of the wound.
This helps in the early closure of the wound and prevents infection that can happen if the wound is open for a long time.
It also helps in collagen synthesis. Collagen is the main structural protein found in the skin.
The polysaccharides present in Aloe vera increase the production of fibroblasts. Fibroblasts are cells that help in the production of collagen and stimulate tissue repair.
The polysaccharides also increase the hyaluronic acid and hydroxyproline in fibroblasts. This helps in remodeling the extracellular matrix that was damaged in the injury.
The polysaccharides also induce the expression of the gene responsible for the process of skin wound repair.
One such polysaccharide called Glucomannan, a mannose-rich polysaccharide and the growth hormone Giberellin stimulate the activity and proliferation of fibroblasts by interacting with its growth factor receptor.
Even the allantoin gel derived from Aloe vera stimulates the functioning of fibroblasts and production of collagen.
In addition to increasing the collagen in the body, Aloe vera gel also promotes cross-linking between amino acids of collagen, which creates a stronger tissue.
The stronger bonds between collagen thus created, help the wound to contract and close quickly.
Aloe vera gel contains a glycoprotein which performs cell proliferating and cell-promoting activities.
Aloe gel also increases the blood supply, thereby increasing oxygenation and promoting healing of the wound.
Burn wounds treated with Aloe vera heal faster than other chemical based creams.
A study conducted in patients with second-degree burn wounds revealed that patients who were treated with aloe vera gel as a dressing for burn wounds healed faster than patients who were treated with 1% silver sulphadiazine cream, which is generally used to treat burn wounds.
What does this mean? The presence of various active components in Aloe vera promote wound healing and can be used externally as well as orally for treatment of wounds.
4. It supports skin regeneration
Aloe vera gels are widely used in skin moisturizing creams.
The skin moisture prevents the eventual scarring of the healed wound.
A lack of moisture at the surface of the wound will stop cell migration in that area, so essential immune cells will not reach or able to function in that area.
Also, the nutrients required for healing will not be able to reach there and delay the healing process.
The mucopolysaccharides present in Aloe vera bind the moisture into the skin. By means of humectants, which retain moisture and reduce water activity, Aloe vera gel improves skin hydration.
It increases fibroblast activity. Fibroblasts produce collagen and elastin fibres which makes skin more elastic and less wrinkled.
It sticks the flaking epidermal cells together and softens the hardened skin. It contracts skin cells and tightens the pores which help in retaining moisture.
A study was conducted to determine the effect of Aloe vera on people who get dry skin or dermatitis owing to exposure at work or factory.
They were given dry-coated Aloe vera glove to wear in one hand for 30 days. These gloves provided gradual delivery of Aloe vera to the skin.
It was found that Aloe vera gel gloves helped to keep intact and improve skin integrity.
They also decreased skin redness caused by injury and also prevented wrinkles to appear.
Aloe vera which is rich in antioxidants, vitamins, minerals and fatty acids improves skin conditions and maintain good skin health.
What does this mean? Moisture is an important component of the wound healing process for proper functioning and transfer of nutrients and cells. Aloe vera is an excellent moisturizer and aids in this process. It also helps in skin rejuvenation by improving the damaged skin cells.
5. It is a natural anti-microbial agent
The wound is a potential site of infection.
If the wound is open or not healed properly, it can cause the growth of several microbes in the area which provides a warm and humid area, suitable for their growth.
The bacteria may interfere with the healing process, consume the host nutrients and may even cause other diseases. This may further result in serious complications like a fever.
It is important to keep the wound site free of contamination by microbes using antiseptic and anti-microbial agents.
Aloe vera is a good anti-septic. It acts against the proliferation of bacteria, fungi and viruses.
It contains 6 antiseptic agents: Lupeol, salicylic acid, urea nitrogen, cinnamonic acid, phenols and sulfur.
They all have an inhibitory action on microbes.
It stimulates the immune system which targets these microbes by the immune cells which kill or digest them by phagocytic activity.
It also contains the anthraquinone Aloin which inactivates various enveloped viruses.
What does this mean? Application of aloe vera on wound site and treating with it will not only advance the healing, but also prevent infection and contamination by bacteria owing to its anti-microbial nature.
Research Study - Aloe Vera Remedies Drug-Resistant Leg Ulcers
Leg ulcers may cause severe health risks leading to morbidity among people.
They affect around 1% of the middle-aged and elderly people, according to the study on the effectiveness of Aloe vera in the treatment of leg ulcers infected by multi-drug resistant bacteria.
What happened in the study?
A study was conducted to determine whether Aloe vera shows antibacterial properties against multi-drug resistant organisms which are present in leg ulcers.
The organisms resistant to three or more antibiotics are known as multi-drug resistant organisms.
In this study, 30 people were chosen who were suffering from leg ulcers.
Out of these 30 different kinds of ulcers, 8 were diabetic, 12 were post-traumatic or severe wounds, 6 were varicose ulcers which are caused by improper functioning of the venous valves of the legs, and 4 were wounds caused by burns.
The patients suffering from these chronic leg ulcers which were infected with multi-drug resistant organisms were treated with Aloe vera.
The gel extracted from the leaves of the aloe vera plant was applied directly to the ulcer. This group of people was the study group.
Another group of people, the control group, consisted of 30 people with the same sex and age as the study group.
These people were treated with topical antibiotics.
Before the treatment, all the patients were examined and their detailed history was studied.
After the removal of the dead tissue from the wound, the material from the deeper parts of the ulcer was collected every alternate day.
This material was cultured every time.
Culture means to cultivate the tissue. This cultured material was observed for any growth and tests were done every alternate day for ten days.
The color of the ulcer, the area it covered and the improvement in the tissue under the ulcer were observed and analyzed.
What were the results of the study?
It was found that in the study group, the culture of the ulcers treated with Aloe vera showed no growth of bacteria by the fifth day in 10 patients, seventh day in 16 patients, ninth day in 2 patients and there was no decrease in the bacterial growth in the remaining 2 patients.
The bacterial growth had completely stopped in 28 cases.
So basically, the growth of bacteria decreased from 100% in the 30 patients to 6.7% in 10 days after Aloe vera was applied to the wounds.
On the other hand, there was no decrease in the bacterial growth of the cultures from the control group.
The growth of the bacteria remained constant during the period of 10 days.
The material culture on the first day from the study group of 30 cases isolated the following bacteria-
- Staphylococcus aureus in 14 cases, out of which 10 were Methicillin-resistant
- Staphylococcus aureus (MRSA)
- Pseudomonas aeruginosa in 8 cases
- Citrobacterkoserii in 4 cases
- Proteus vulgaris in 2 cases
- Enterobacter in 2 cases
It was found that these organisms were resistant to multi-drugs, and hence, the antibiotics were ineffective.
How did this occur?
Aloe vera contains healing properties because of the presence of chemical substances anthraquinones.
According to a study to determine the use of Aloe vera in the treatment of leg ulcers, it was found that the gel of Aloe vera consists of Aloin.
Aloin, a bitter substance, includes many active ingredients of anthranol structure which is responsible for the medicinal properties of Aloe vera.
It contains antiseptic and antibacterial properties. It has an inhibitory effect on Pseudomonas aeruginosa and Staphylococcus aureus which are known to cause skin infections especially at burn sites, wounds, and ulcers.
An experiment was conducted in Iran to compare the effects of Aloe vera gel and the conventional methods of treatment of chronic ulcers.
It was inferred that Aloe vera healed the ulcer at the same time as other methods and it was a cost-effective and safe method.
Another study on the effects of polyherbal formulations (containing aloe vera) on wounds revealed that they are safer as compared to other chemical formulations. It promotes the healing of wounds.
The gel of the Aloe vera plant penetrates deep inside the tissues of the skin, which increases its ability to control the infection. It contains polysaccharides which catalyze the healing properties of Aloe vera.
When this gel enters the tissue, it treats the infection by attacking the multi-drug resistant bacteria causing the ulcer.
What does this mean?
The conclusion of this study is that Aloe vera is effective against multi-drug resistant bacteria. Hence, it can be used for the treatment of chronic ulcers which don’t respond to topical antibiotics.
It is advantageous over antibiotics because it does not have any side effects. Also, it does not cause drug resistance.
Aloe vera is cheap and beneficial as compared to the normally used antibiotics. It can be obtained easily and is very simple to use and apply.
Read the full study here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3395293/
Research Study - Aloe Vera-Olive Oil In Chronic Wounds
This study compares the wound healing effects of a combination cream containing aloe vera gel and olive oil (AVO) and phenytoin cream.
What happened in the study?
The study was conducted to assess the effectiveness of a topical cream containing aloe vera gel and olive oil versus phenytoin cream as the standard treatment for healing wounds.
The clinical trial included 60 subjects. The combination cream contained aloe vera and olive oil in a ratio of 3:2 in an oil/water emulsion base. It is very important to get the right formulation to receive the maximum benefit from this combination cream.
30 subjects were treated with aloe vera and olive oil combination cream and another 30 with phenytoin twice a day for 30 days. Wound healing was evaluated using Bates-Jensen Assessment Tool.
It was used to observe changes that occurred regularly in wounds. The location of the wounds and the size, shape, pattern of the wounds were also assessed.
The severity of pain was assessed using a visual analog scale (VAS) which is 100mm in length. 0 meant 'no pa, in' and 100 meant 'unbearable pain.' In this way, the patients could tell how severe the pain was or if there was no pain at all.
This was a useful tool to observe and compare the reductions in pain severities for both aloe vera-olive oil combination cream and phenytoin cream.
Statistical tests were performed to observe the progress in the wound healing process in patients within the group and between groups. This made the comparisons easier.
What were the results of this study?
After one month of topical application, it was observed that the aloe vera-olive oil cream was better in improving the parameters of the wound.
It was significantly better in reducing the size of the wound and some exudates, and in improving the color of wound surroundings, when compared with phenytoin cream.
The process of wound healing was significantly improved with both phenytoin and aloe vera-olive oil combination creams, although the latter was more efficacious.
Both phenytoin and aloe vera-olive oil combination creams had pain-relieving effects. Again the efficacy of the latter was significantly greater than the phenytoin cream.
How did this occur?
Aloe vera gel and olive oil play a role in healing chronic wounds and reduce pain severity.
Olive oil decreases arachidonic acid (it is a polyunsaturated fatty acid which leads to inflammation) synthesis and also increases nitric oxide synthesis, secreted via sweat glands with antibacterial tissue activity.
Nitric oxide as a signaling molecule accelerates wound healing via its antimicrobial properties, modulation of cytokine function, vasodilatory effects and promotion of angiogenesis.
The presence of active mucopolysaccharide and acemannan (a major carbohydrate fraction) in aloe vera gel induce the production of keratinocyte growth factor, endothelial growth factor, and type 1 collagen which accelerates collagen synthesis and wound healing process.
Aloe vera gel is also proven to have anti-inflammatory effects because of certain mechanisms. The first mechanism is the chromone derivative, aloesin present in aloe vera gel.
Aloesin is an antioxidant compound that inhibits thromboxane A2 synthesis and cyclooxygenase II enzyme and hence provides anti-inflammatory effects.
The inhibition of neutrophil migration (neutrophils are white blood cells which when releasing high levels of protease cause tissue damage) and prostaglandin E2 synthesis by aloe vera gel is the second mechanism which is responsible for the local anti-inflammatory properties.
Lastly, lupeol and brady kinase present in aloe vera gel provide analgesic and anti-inflammatory properties respectively.
What does this mean?
This study implies that AVO cream has promising effects on biological healing of chronic wounds.
It was safe, well-tolerated, and did not show any adverse effects on patients.
Both AVO cream and phenytoin cream reduce pain severity but AVO combination cream has a higher efficacy.
This implies a promise for the application of AVO cream as an effective wound dressing in clinical practice.
Read Paper here: https://www.ncbi.nlm.nih.gov/pubmed/26488737
The dosage of Aloe Vera
Aloe vera has both external and internal uses. Externally, one can apply Aloe vera gel as an ointment on the affected area. Internally, it can be taken orally in the form of juice or pills.
There are two main preparations of Aloe vera available commercially: Aloe gel or Aloe juice
Aloe gel is extracted from the leaf pulp of the plant, Aloe barbadensis.
Aloe vera consists of the juice of the entire leaf including gel and latex. Aloe latex is the yellow liquid found under the leaf.
Oral dosage should be consulted with a doctor, who can prescribe according to your prevailing condition and symptoms.
Precautions to be taken
- Some people may have allergic reactions to Aloe vera due to the presence of anthraquinones like aloin and barbaloin. Therefore, one must first test by applying to a small area and checking for any redness, burning, stinging sensations, dermatitis or other sensitivities.
- People having known allergy to plants of Lilacae family shown also avoid its application.
- If taking orally, it may cause laxative effects and abdominal cramps, and subsequent electrolyte imbalances.
- Aloe vera treatment is also not advisable during pregnancy as it may stimulate uterine contractions and breastfeeding women, as it may cause gastrointestinal distress in the baby.
- In diabetic patients, the application may reduce blood sugar levels and interact with hypoglycemic drugs and insulin.
- It is important to check the purity and source of Aloe vera for better results and lesser side effects.
- It is always advisable to consult a medical professional before using it for serious ailments, to check if it is suitable for that particular disease and symptoms.
Aloe vera shows promising benefits in wound healing. It is correctly known as a healing herb and is a great combination of anti-inflammatory, antioxidant, anti-microbial and immuno-modulating properties.
In addition, it quickens the wound healing process and helps in skin rejuvenation and repair. It can act as good alternative medicine for wound healing.
It also has lesser side effects and cost as compared to other drugs.
With so many proven benefits, Aloe vera shows great potential in the healing of various types of wounds if taken with care and precautions.