Aloe
Aloe vera extract has shown impressive effects in cutaneous injury and wound healing, especially those associated with burn and frostbite.13,17,20,21  Since antiquity, aloe has been known by many as “the healing plant,”16 and it is ultimately the most studied species of the Aloe genus.15-18,20,21 Recent research has revealed that in addition to its hypoglycemic, gastroprotective and “antimalignancy properties, it has been shown to exhibit anti-inflammatory, antifungal, and antimicrobial properties.”15-18,20,21    

It is through these essential properties that aloe is able to exert its skin protective activities, including stimulating primary epidermal keratinocyte proliferation that is crucial in the first hours of wound healing.14,20

The gel formulation of aloe is derived from the succulent leaves of the plant, whereas aloe juice is obtained from the peripheral bundle sheath cells.20 Aloe gel, the active ingredient of which is an organically active compound known as aloin, increases aloe’s stability, basic structure, and water solubility, making it attractive to study in wound healing.18 Consisting of 99% water with long-chain polysaccharides, aloe gel prevents skin dryness and bacterial growth, largely due to its high osmotic composition.15  Furthermore, aloe gel has been found to increase epithelialization, thereby shortening the duration of wound healing; this has been most prominently studied in first- and second-degree burns.17


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Conventional strategies of wound management have included aloe in both simple and complex wound care regimens, including dressings. Such dressing, historically composed of pectin and gelatin with success, were recently studied using aloe vera as part of their matrix.  The results supported aloe’s strong anti-inflammatory effect, enhanced cell migration, and scar prevention, as well as orderly collagen formation and neovascularization.21

Further studies of the effect of aloe vera gel on wound healing continue to support significant acceleration in the healing process due to increased proliferation of fibroblasts and keratin, increased collagen synthesis, and reduction of inflammation.15,18 While higher-potency applications have demonstrated impressive findings in healing time, these outcomes were consistently observed across all spectra of wound management and potency of gel, including low-potency aloin vehicles.18 Overall, clinical research has supported that aloin solution, especially that of aloe gel, promotes faster rate of wound closure and inhibited scar tissue formation and should be considered an essential component within the continuum of topical wound management.

Honey

The use of honey for wounds, burns, and skin ulcers dates back many centuries. In the wake of progressive medical breakthroughs, including antibiotics and advanced surgical techniques, the use of honey as a foundational intervention has all but ceased.22 However, renewed interest has been observed, due largely to rising antibiotic resistance and desire for favorable adjuncts to topical wound therapy, of which honey has anecdotal, historical evidence of benefit.22

Beyond its low cost and availability, honey has properties that make it an attractive topical treatment option, including: improved tolerance of the patient to dressing changes, wound odor, swelling, hypertrophy, and contracture reduction, as well as prohibitive microbial growth properties.23 These properties would be particularly beneficial for burn injuries for which necrotic tissue can result in complex infections.23 As a vehicle, topical honey has proven anti-inflammatory and antimicrobial to both bacterial and fungal elements due mainly to its acidic viscosity, which not only allows a “moist healing environment that absorbs exudates [and accelerates] healing, but also improves patient tolerance and comfort.”22,23

Studies have compared honey with contemporary wound therapies with promising success. In several studies comparing the use of pure undiluted honey vs conventional silver sulfadiazine (SSD), honey was found to have superior healing effects.23 Healing time was significantly lower (18.1 vs 32.6 days), swab cultures became negative in less than 7 days whereas none in the SSD group became negative, and a majority of the honey group recovered completely (81% vs 45%).23 However, in additional clinical trials, it was demonstrated that burn severity contributed to the effectiveness of honey and SSD.  When considering superficial and partial-thickness burn wounds, it was noted that the honey group had better healing rates and properties; however, when studying mixed partial-thickness and full-thickness burn wounds, honey did not seem to improve healing. As few studies have been conducted, more trials are needed to elucidate the benefit of honey for burn wound healing. 22

Conclusion

Complications of wound healing coupled with multidrug resistance and cost effectiveness beg the idea of researching new and perhaps even past methods of care that could contribute to effective wound care.  Essential oils, aloe, and honey have demonstrated efficacy when used independently and synergistically with pharmacotherapy.  The broad availability and low risk of side effects make such alternatives an attractive solution to wound care.  Further trials to explore efficacy and consistency with specific essential oils and susceptible organisms would be beneficial, as would deeper exploration of aloe and honey for burns and more expansive wound management.

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Bethany Helm, MPAS, PA-C, is a surgical PA and is employed by the Guam Seventh-day Adventist Clinic with a special passion for wound care. At the time of this writing she was a graduate student at Kettering College Master of Physician Assistant Studies program. Christopher Howell, DSc, MPAS, PA-C, MBA, is associate professor at Kettering College Master of Physician Assistant Studies, in Dayton, Ohio.  Dr Howell is also a staff clinician in the Emergency Department with Team Health; North Dayton Addiction Recovery; and East Indiana Addiction Recovery.

References

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