 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, surgery, and none appear to be particularly effective. So even for palliative pain relief, we don't have great options, so 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 a 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. But oral use is also 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 could be various drugs or toxins or diseases? So maybe it was one of these other things. 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 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-challenged case published for aloe? Yes, aloe-induced toxic hepatitis that shot up again after stopping and then restarting aloe ingestion. Aloe consumption has also been linked to thyroid dysfunction. A woman 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 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-blinded, placebo-controlled trial 54 patients randomized to a topical aloe vera gel, or placebo gel, for eight 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. I mean, it's considered a chronic condition. Yet a few weeks applying aloe, these nasty erosive lesions disappeared. How about compared to a steroid ointment, though? Topical aloe vera gel was superior, more effective than the steroids, a significant difference appearing within two weeks. So although corticosteroids are still considered the gold standard, aloe vera shows promising results, especially with no adverse effects when applied topically compared to various adverse side effects of the 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 to 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, without applying aloe vera gel instead. And 9 out of 10 responded, and one woman had a complete clinical remission. They conclude that aloe vera gel is a safe and effective treatment.