Comparative efficacy of aloe vera in the treatment of oral lichen planus: a systematic review and meta-analysis of randomized controlled trials

Abstract

Oral lichen planus (OLP) is a chronic immune-mediated disorder that negatively affects oral function and quality of life. Corticosteroids are the standard therapy but may cause adverse effects with prolonged use. Aloe vera, a natural agent with anti-inflammatory and wound-healing properties, has been proposed as a safer alternative. Following PRISMA 2020 guidelines, a comprehensive search of PubMed, Scopus, Cochrane Library and Google Scholar was performed up to September 2025. Eligible studies were RCTs comparing Aloe vera (gel, paste or mouthwash) with placebo, corticosteroids or other therapies. Primary outcomes included post-treatment Visual Analogue Scale (VAS) pain scores and Thongprasom clinical scores; secondary outcomes were treatment response and lesion size reduction. A random-effects model was used to calculate pooled mean difference (MD) and risk ratio (RR) with 95% confidence intervals (CI). Nine RCTs involving 752 patients met the inclusion criteria. Aloe vera was associated with a significantly higher overall treatment response (RR=1.34, 95% CI 1.12–1.61; I²=28%). No significant differences were found for VAS pain scores (MD=−0.01, 95% CI −0.19 to 0.16; I²=90%), Thongprasom clinical scores (MD=−0.49, 95% CI −1.36 to 0.38; I²=96%) or lesion size (MD=0.81, 95% CI −0.57 to 2.19; I²=99%). Aloe vera demonstrates a favourable safety profile and may enhance overall treatment response in oral lichen planus compared with placebo or corticosteroids. However, its benefits on pain relief and lesion healing remain inconsistent across studies. Future multi-center RCTs with standardized Aloe vera formulations, longer follow-up and biomarker-based outcomes are warranted to confirm its clinical utility as a reliable adjunct or alternative to corticosteroids in OLP management.