Aloe vera

What it is

Aloe vera is a succulent whose thick leaves hold a clear inner gel that is mostly water, with sugars, amino acids and enzymes. Just under the leaf skin runs a yellow sap called latex, rich in a bitter laxative compound called aloin. In skin care, "aloe vera gel" should mean the inner gel; whole-leaf products can contain latex unless it has been filtered out.

What the evidence says

Evidence: limited. A few small trials support aloe for minor burns and as a companion to acne medicines; there is no good evidence that it treats acne, eczema or dark spots by itself.

The clearest signal is for burns. A systematic review of four controlled trials in 371 people found that minor burns treated with aloe healed roughly nine days sooner than controls, though the products varied so much that the authors stopped short of a firm conclusion³. A Cochrane review of aloe for wounds in general rated the trials poor quality and found no reliable benefit⁴.

For acne, aloe is a helper rather than a treatment. In an eight-week trial of 60 people with mild to moderate acne, adding a 50% aloe gel to prescription tretinoin cream reduced spots more than tretinoin alone and left the skin less red². The NIH's complementary health centre agrees: some evidence for burns and for aloe alongside other acne treatments, and not enough to judge much else¹. Our natural acne care guide shows where it fits.

How people use it

• As a light, cooling moisturiser or after-sun gel on clean skin, once or twice a day. Pick one with aloe first on the ingredient list rather than alcohol and fragrance.
• As a buffer under drying actives such as benzoyl peroxide, retinoids or diluted tea tree oil.
• As a carrier for diluting essential oils (about one drop of oil in a teaspoon of gel).
• Fresh gel scooped from a leaf works too; rinse off any yellow sap first and use it within a day.

Cautions

• Allergy happens. Burning, itching and eczema-like rashes have been reported with topical aloe¹. Patch test on the inner arm twice a day for seven to ten days first.
• Keep latex and whole-leaf products off broken skin. Aloin is an irritant and a laxative; the FDA removed aloe latex from over-the-counter laxatives in 2002 because its safety had not been shown¹.
• Do not drink aloe for your skin. Aloe latex taken by mouth causes cramps and diarrhoea, oral aloe leaf extracts have been linked to liver injury, and oral aloe in any form may be unsafe in pregnancy and breastfeeding¹.
• Large, deep or infected burns need urgent medical care, not gel. See when to see a dermatologist.