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Oral Medicine

Feature Article

Steven M. Hayes, DDS, FAGD Lichen planus—Report of


successful treatment with aloe vera
Abstract Lichen planus is a disease that in- consumption. Some studies show
Lichen planus is a disease that volves the skin and mucous mem- that aloe-based products were safe
involves the skin and mucous branes. It is characterized by the to use on skin and that they were
membranes. It is characterized by unique eruptions of symmetrical- able to help promote healing.3 The
unique eruptions. The cause of this ly distributed, flat-topped, poly- following case report documents
disease is unknown, but has been hedral, violaceous or red papules, the use of aloe-based products for
linked to emotional stress, and which are scaly and pruritic.1 treating lichen planus.
has also been attributed to viral These lesions usually involve flex-
infections. A case is described of a ural surfaces and mucous mem- Case report
successful treatment of lichen planus. branes, either alone or in groups.2 A dermatologist and a medical
Almost all patients with lichen clinic diagnosed a 52-year-old
Received: April 17, 1998 planus have oral lesions, which woman as having psoriasis. Their
Accepted: September 24, 1998 may precede or follow the appear- treatment consisted of Lidex
ance of lesions on the skin. How- cream (Medicis—The Dermatol-
ever, lesions may be limited to the ogy Company, Phoenix, AZ; num-
oral cavity. Clinically, the oral le- ber not available) where there was
sions appear as white or yellow- fungal involvement with the skin
ish–white lines that are arranged lesions, and a topical application
in a lace-like pattern. The cause of cortisone cream. When the pa-
of this disease is unknown, but tient was seen three months later
has been linked to emotional for her regular cleaning and
stress, and has also been attrib- check-up appointment, intraoral
uted to viral infections. The aver- lesions were noted pathognomon-
age duration of the disease is ic with the pattern of lichen
about 45 months. planus, during the clinical exami-
The treatment is usually symp- nation (Fig. 1).
tomatic, including topical, intrale- In addition, the patient pointed
sional, and systemic cortico- out the skin lesions on the palms
steroids, depending on the severity of her lands (Fig. 2). The patient
of the symptoms. Although topi- stated that the prescriptions of
cal steroids have some degree of Lidex cream and cortisone had not
success in relieving the itching, worked for her and that her con-
systemic steroids must be used to dition had worsened. She still had
make the patient comfortable in the itching and burning sensations
most instances. However, ex- on her hands, and she stated that
treme caution should be taken her lips also had these symptoms.
when using systemic steroids be- The clinical impression, based on
cause of the serious side effects examination of the intraoral soft
encountered and the possibility of tissues which were characterized
adrenal crisis. by lichen planus-type lesions, was
Because of these side effects, the that the condition was not psoria-
possibility of prolonged treatment sis. As for the lesions on her
with steroids, and the fact that the hands, these were believed to be
disease process could still last for another sign of the disease process.
years, an alternative therapy is de- The proposed therapy involved
sirable. Treatment with aloe-based drinking 2.0 oz of stabilized aloe
products has been proposed and vera juice (Carrington Laborato-
used because the Food and Drug ries, Dallas, TX; 800/527-5216)
Administration has considered the daily for three months. After this
gel of the aloe vera plant safe for period, the progress of this therapy

268 GENERAL DENTISTRY/MAY-JUNE 1999


Benefits of
aloe vera
Peter G. Sturm, DDS, MAGD
Associate Editor

Fig. 1. Initial examination of the Fig. 2. Initial examination of the hand.


mouth. The fresh gel from the aloe
vera plant has been used inter-
nally and externally since at
Table. Constituents of aloe vera gel. least 400 B.C. This tropical
plant, a member of the succu-
The principal ingredients Amino acids: Monosaccharides
lent lily family, has been exam-
in addition to water are: Lysine and polysaccharides:
Aloin Histidine Glucose ined repeatedly and studies
Barbaloin Arginine Mannose conclude this most durable
Etheral oil Hydroxyproline Uronic acid plant has amazing qualities.
Cinnamic acid Aspartic acid Aloe vera is seen in carvings
Isobarbaloin Threonine Vitamins: on temple walls dating to the
Emodin Serine Vitamin B1 Fourth Millenium B.C.1 The
Emoding lucosides Glutamic acid Niacinamide Egyptians referred to this plant
of d-Arabinose Proline Vitamin B2 as “The Plant of Immortality.”
Ester of cinnamic acid Glyccine Vitamin B6 It has been suggested that the
Resitannol Alanine Vitamin C
secret of ancient embalming
Valine Choline
may lie with the plant whose
Inorganic ingredients: one-half cystine
Calcium Methione drawings adorn the sides of sar-
Potassium Isoleucine cophagi. The first documented
Chlorine Leucine indication of the broad spec-
Tyrosine trum uses attributed to the aloe
Phenylalanine vera plant are found in first-
century records of the Greek
physician Disocordes and the
would be evalutated. The patient and an emulsifier), and hydrogen Roman naturalist Pliny.
received a complete explanation of peroxide were each applied to hu- The benefits of aloe vera
the safety of the suggested treat- man fibroblast cells. After 15 min- have been confirmed by re-
ment, and was told of success with utes of treatment, CDWG killed no search in medical schools, inde-
aloe vera in dealing with other more than 5% of the cells. In the pendent laboratories, and by
dental problems.4,5 In addition, she same time, each of the other large numbers of clinical cases.
was told that aloe vera had been agents killed 100% of the cells.3 Aloe vera gel 1) anesthetizes tis-
used for over 2000 years without In another study, Rodriguez- sue, 2) is bactericidal, 3) is
any reported adverse reaction.6 Bigas et al. studied the healing virucidal, 4) is fungicidal, 5) is
It should be noted here that two effects of various agents on ther- hemostatic, 6) is an antipyretic,
recent studies have supported mal burns. Animals were subject- 7) is an anti-inflammatory, 8) is
such claims. Johnson et al. ed to controlled burns and then an antipruretic, 9) is a capillary
demonstrated the safety of treating treated with either CDWG, sali- dilator, 10) is an enhancer of
human skin fibroblasts with aloe- cylic acid, silver sulfadiazine normal cell proliferation and
based gel (Carrington Dermal cream (Silvadine), or plain gauze epithelialization, and 11) is a
Wound Gel, or CDWG). CDWG, dressing (control group). The aver- tissue moisturizer.2-9
Betadine, Granulex, Hibiclens, age time required for complete In recent years, a method of
(povidone-iodine; chlorhexidine healing of these full-thickness stabilizing the aloe’s gel was
gluconate; and a combination of wounds was 50 days in the control perfected. This permitted
trypsin, balsam peru, castor oil, group, 45 days in the salicylic acid

GENERAL DENTISTRY/MAY-JUNE 1999 269


HAYES: LICHEN PLANUS

products to be created which


duplicated the effects available
directly from a fresh plant.
Until then, the limited few
hours of freshness of a leaf was
the best we had; now, for the
first time, the special properties
could be maintained to permit
new uses and extended access.
Aloe products have been Fig. 3. One month application and Fig. 4. One month application and
found to have specific benefits progress of the mouth. progress of the hand.
for dental needs. Lips can be
treated with aloe to aid angular
cheilitis, dry lips, and even her-
pes. Using a liquid aloe is ef-
fective in reducing discomfort
following oral or periodontal
surgery, ulcers, sore throats,
and other ills. Using a thick-
ened, cream aloe product in-
side an immediate denture re-
duces bleeding time as well as
reducing swelling and inflam- Fig. 5. Two months application and Fig. 6. Three months application and
mation. A jelly version is use- progress of the hand. progress of the hand.
ful when placed within an ex-
traction socket to accelerate the
entire healing response.
The liquid, or gel, version is
dramatic when a gauze soaked
in it is placed over an extrac-
tion site immediately after a
tooth is removed. Post-opera-
tive pain, swelling, and bleed-
ing are significantly reduced.
The gel can also be used over Fig. 7. Six months application and Fig. 8. Seven months application and
sites of periodontal surgery or progress of the hand, showing some progress of the hand, barely revealing
other surgery. scar tissue. scar tissue.

Is all aloe the same? group, and 47 days in the Silvadine stress factors are somewhat linked
The meat or gel of an aloe group. An average of only 30 days to complex interrelated biochemi-
plant oxidizes when exposed to was required for complete healing cal reactions which are directly
oxygen for several hours (simi- in CDWG-treated animals.7 dependent upon the availability of
lar to what happens to a sliced The gel of this plant contains all many of the components con-
apple). Manufacturers must the essential amino acids, as well tained in the gel of the aloe-vera
process the plant in a timely as numerous monosaccaride and plant.
manner. Whole leaf aloe prod- polysaccarides; vitamins B1, B2, B6, In addition, it was hoped that
ucts include the outer part of and C; niacinamide and choline; the pharmacological properties of
the leaf which has no nutri- several inorganic ingredients; en- the aloe vera gel would improve
tional value and thus acts as a zymes including acid phosphatase, the condition. That is, if the dis-
filler and should be avoided. alkaline phosphatase, amylase, ease is a result of a virus, then the
To function at its optimum, lactic dehydrogenase, lipase, virucidal properties of the gel over
aloe must be stabilized with- SGOT, and SGPT; and numerous a period of time would reverse the
out chemicals or heat. Aloe organic compounds.6 condition; the anti-inflammatory
barbadensis miller is the most It was believed that the patient properties of the gel would help
potent and nutritious species of might be deficient in some of the inflammatory response; and
aloe vera. Many products these components, thereby con- the anti-pruritic properties would
available in today’s market are tributing to her inability to cope help relieve the itching and burn-
with certain stress factors. These ing sensations.4,8

270 GENERAL DENTISTRY/MAY-JUNE 1999


ORAL MEDICINE

The patient began drinking her skin was getting tanner but
2.0 oz of stabilized aloe vera juice her hands were getting worse. watered down or improperly
daily starting the day of her first The patient decided to continue stabilized, creating a product
appointment. She was given aloe the original course of treatment ranging from useless to mini-
vera lip balm, which is a prepara- which had already cleared up the mally better than water itself.
tion to soothe burning and itching oral lesions and slowly began to
lips, and aloe creme to help with have a beneficial effect on her Too good to be true?
the itching of her hands. Aloe hands. She was started back on Many people learning about
creme is an aloe vera-based creme the aloe vera juice; however, this aloe tend to doubt it can be ca-
containing 75% stabilized aloe time the dose was doubled to pable of all that is attributed to
vera. 4.0 oz per day. When the patient it. But it is important to study
The patient returned after two returned in three weeks, now six its history and evaluate the
weeks for evaluation. Some of the months after starting treatment, product for yourself. Utilizing
striations in the mouth were dis- she was very happy and delighted the proper aloe product can be-
appearing; a slight decrease in to show that the skin lesions were come exciting to watch. Find a
edema in the palms of the hands disappearing (Fig. 7). In addition, source of this aloe vera and ap-
was noted. The patient also re- her itching and burning sensations ply it to your sunburn or to a
ported that the aloe vera lip balm were subsiding. Her only com- blister. Watch it perform in its
and the aloe creme helped to re- plaint was that her hands felt dry. unique way.
lieve the itching and burning sen- A few weeks later her hands began
sations better than anything she to take on a more natural texture The true secret
had tried previously. and softness (Fig. 8), seven months After many years of using sta-
The patient returned again after the original diagnosis of bilized as well as fresh aloe,
two weeks later. The oral lesions lichen planus was made and aloe certain subtle observations
had disappeared (Fig. 3) and her vera treatment initiated. The pa- have been made. These will be
hands were beginning to show tient noted that all of her symp- shared for the first time now.
slight signs of improvement (Fig. 4). toms were gone and that her hands There is a direct relationship
The lesions on her hands were felt soft and smooth once again. between the time post-trauma
probably another systemic mani- before application and the suc-
festation of lichen planus and by Conclusion cess of aloe’s use. If you get a
continuing with the aloe vera pro- A case of oral lichen planus with cut and wait hours to apply
gram, these lesions might resolve. severe systemic involvement was aloe, the healing response will
It was worth trying. treated successfully using a very not be uniquely special. Put it
From this point on, the patient conservative and safe method of over a wound immediately af-
returned to the office for evalua- treatment—the consumption of ter it occurs and aloe performs
tion at regular one month intervals. and the topical application of sta- as it should. Do NOT apply to
And even though the oral lesions bilized aloe vera. It must be not- puncture wounds.
cleared up in one month, the sys- ed that no other dietary supple- One of aloe’s characteristics is
temic lesions were more difficult ment, antimicrobial, or steroid its ability to penetrate tissue.
to bring under control. The con- agent was used. The oral lesions This brings the medicament to
tinued improvement in her hands cleared up very quickly within the area needing it; however, it
is shown after two months (Fig. 5) four weeks. However, the sys- can carry puncture contami-
and after three months (Fig. 6). temic lesions took much longer, nants deeper and is, therefore,
At this point the patient, being owing in part to the fact that the contraindicated in such in-
quite restless with the slowness of patient sought an alternate source stances (for example, stepping on
the response in her hands, stopped of treatment while discontinuing a nail; not a tooth socket). And,
taking the aloe vera juice, and the suggested therapy. This inter- finally, apply small amounts at
went to seek treatment for psoria- rupted the gradual improvement frequent intervals. Let the aloe
sis at a dermatology clinic, where she was getting using aloe vera, soak into the tissue. The excep-
they started her on UV light treat- and ultimately increased the length tion to this is when an immedi-
ment. However, owing to frustra- of treatment. However, complete ate denture is lined with aloe
tion and the lack of progress in success was still achieved. creme or a socket is packed with
their treatment, the medical clinic Although there are very few the jelly version. Good luck.
suggested and in fact performed a clinical reports in the literature, it
biopsy of the skin lesions; the di- is hoped that other health practi- References
agnosis was lichen planus. The tioners will consider using aloe 1. Coats BC. The silent healer—
patient returned to the dentist a vera when treating their patients A modern study of aloe vera. Bill C.
few weeks later because the only with lichen planus or any other Coats. Garland, Texas. 1979.
result she could observe was that dental problem, and, if successful,

GENERAL DENTISTRY/MAY-JUNE 1999 271


HAYES: LICHEN PLANUS

report their findings. Only in this 10. Blitz J, Smith JW, Gerard JR.
2. Lorenzetti L, Salisbury R, Beal manner will the true potential of Peptic ulcer therapy by aloe vera gel.
JN, Baldwin JN. Bacteriostatic prop- aloe vera in treating this dreadful JAOA 1973;62.
erties of aloe vera. Jour Amer Pharm disease be known. 11. Bovik EG. Aloe vera—Panacea
Sci 1964;53:1287. or old wives’ tale? Tex Dent Jour 1966;
3. Hayes SM. Tic doulereaux— Author information 13-16.
A report of successful treatment of a Dr. Hayes practices restorative and 12. Brasher J, Zimmerman E,
case with aloe vera. Gen Dent prosthetic dentistry in Pleasant Hill, Collings CK. Effects of prednisolone,
1984;32:441-442. CA. He received his Fellowship in the indomethacin, and aloe vera gel on tis-
4. Zimmermann ER. Germicidal Academy of General Dentistry in 1977 sue culture cells. Oral Surg Oral Med
properties of aloe vera against three and has been using aloe vera-based Oral Pathol 1969;27:122-128.
bacterial organisms, one fungal, and products in his practice for over 15 13. Brown J. Use of aloe vera on
two viral agents. (Thesis submitted years with great success. radiation burns. Cancer Jour Clin
to Baylor University College of Address correspondence to: Steven 1963;14:14-15.
Dentistry, Department of Microbiol- M. Hayes, DDS, FAGD, 1952 Contra 14. Collins CE. Avagel as a thera-
ogy.) Dallas, Texas. 1969. Costa Blvd., Pleasant Hill, CA 94523. peutic agent of roentgen and radium
5. Zawahry EM, Hegazy RM, burns. Radiological Rev Chi Med Rec
Helal M. Uses of aloe in treating leg References 1935;57:137-138.
ulcers and dermatosis. Int Jour 1. Bhaskar SN. Synopsis of oral 15. Crewe JE. Aloe treatment for
Derm 1973;12:68-73. pathology, ed. 2. St. Louis: C.V. Mosby; aplonar excema, pruritus vulva, exter-
6. Brasher J, Zimmerman E, 1965:301-304. nal ulcers, poison ivy, and burns. Minn
Collings CK. Effects of prednisolone, 2. Osol A, Rovertson P, Altschule Jour Med 1937:670-673.
indomethacin, and aloe vera gel on M, eds. The United States dispensatory, 16. Crewe JE. External use of aloes.
tissue culture cells. Oral Surg Oral ed. 26. Philadelphia: J.B. Lippincott; Minn Jour Med 1937;20:538-539.
Med Oral Pathol 1969;27:122-128. 1967:42-43. 17. Danhof IE, McAnally BH. Stabi-
7. Rodriguez-Bigas M, Cruz N, 3. Johnson AR, White AC, McAnal- lized aloe vera: effect on human skin
Suarez A. Comparative evaluation ly B. Comparison of common topical cells. Drug Cosmet Ind 1983;133:52.
of aloe vera in the management of agents for wound treatment: cytotoxici- 18. Lorenzetti L, Salisbury R, Beal
burn wounds in guinea pigs. Jour ty for human fibroblasts in culture. JN, Baldwin JN. Bacteriostatic proper-
Plast Reconstr Surg 1988;81:386- Wounds 1989;1:186. ties of aloe vera. Jour Amer Pharm Sci
389. 4. Hayes SM. Tic doulereaux— 1964;53:1287.
8. Johnson AR, White AC, A report of successful treatment of a 19. Mandeville F. Aloe vera in the
McAnally B. Comparison of case with aloe vera. Gen Dent 1984; treatment of radiation ulcers of mucous
common topical agents for wound 32:441-442. membranes. J Radiol 1939;32:
treatment: cytotoxicity for human 5. Sturm PG, Hayes SM. Aloe vera 598-599.
fibroblasts in culture. Wounds in dentistry. The Journal of the Bergen 20. Payne, JM. Tissue response to
1989;1:186. County Dental Society 1984:11-14. aloe vera gel following periodontal
9. Rowe T, Parks LM, Lovell BK. 6. Coats BC. The silent healer— therapy. (Thesis submitted to faculty of
Further observations on the use of A modern study of aloe vera. Bill C. Baylor University in partial fulfillment
aloe vera leaf in the treatment of Coats. Garland, Texas. 1979. of the requirements for the degree of
third degree x-ray reactions. J Am 7. Rodriguez-Bigas M, Cruz N, Master of Science.) Dallas, Texas. 1970.
Pharm Assoc 1941;62: 269-270. Suarez A. Comparative evaluation of 21. Rose L, Kaye D. Intern Med
aloe vera in the management of burn Dent 1983:938-939.
wounds in guinea pigs. Jour Plast 22. Rowe T, Parks LM, Lovell BK.
Reconstr Surg 1988;81:386-389. Further observations on the use of
8. Zimmermann ER. Germicidal aloe vera leaf in the treatment of third
properties of aloe vera against three degree x-ray reactions. J Am Pharm
bacterial organisms, one fungal, and Assoc 1941;62: 269-270.
two viral agents. (Thesis submitted to 23. Wright CS. Aloe vera in the
Baylor University College of Dentistry, treatment of roentgen ulcers and telan-
Department of Microbiology.) Dallas, giectasis. JAMA 1936;106:1363-1364.
Texas. 1969. 24. Zawahry EM, Hegazy RM, Helal
9. Barnes TC. The healing action of M. Uses of aloe in treating leg ulcers
extracts of aloe vera leaf on abrasions of and dermatosis. Int Jour Derm 1973;12:
human skin. Amer Jour Bot 1947;34:597. 68-73.

272 GENERAL DENTISTRY/MAY-JUNE 1999

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