VOL: 103, ISSUE: 10, PAGE NO: 40
Joanna L. Ford, PhD, is research and development officer; Pete Phillips, BPharm, MRPharmS, is director, Surgical Material Testing Laboratory, BridgendFord, J.L., Phillips, P. (2007) Are aloe-coated gloves effective in healthcare? Nursing Times; 103: 10, 40-41.
Ford, J.L., Phillips, P. (2007) Are aloe-coated gloves effective in healthcare? Nursing Times; 103: 10, 40-41.
The moisturising properties of aloe vera have long been known. Examination gloves with aloe coatings are now available on the UK market for use in healthcare settings. This article examines the evidence surrounding the use of these gloves in the workplace to prevent dry, sore hands.
Glove use in the NHS is growing continuously due to increased concern regarding hospital-acquired infection and the adoption of universal precautions. Healthcare staff are encouraged to change gloves between patients, which results in repeated glove changes throughout the day. Frequent handwashing or the use of alcohol gels accompanies this process in order to further reduce infection risks. As a result, staff may develop dry, sore or irritated hands. This, in turn, has stimulated manufacturers to supply examination gloves with coatings on their internal surfaces that aim to retain hand moisture, keeping hands soft and supple. One of the most popular components used in such coatings is aloe vera (hereafter 'aloe').
This article identifies some of the 'aloe-coated' gloves on the market and reviews information on the perceived benefits and potential concerns regarding their use. Table 1 summarises medical gloves available with aloe coatings.
The properties of aloe
The benefits of aloe in healing burns and other wounds has been demonstrated in the literature (Visuthikosol et al, 1995; Swaim et al, 1992; Rodriguez-Bigas et al, 1988). It has been reported that aloe appears to accelerate healing compared with other products such as antibiotic ointment (Swaim et al, 1992) or vaseline gauze (Visuthikosol et al, 1995) - although it should be understood that antibiotic ointments and vaseline gauze are not considered best-practice treatments in the UK.
Research over the last 15 years has identified active compounds in aloe that possess various tissue-repair properties that increase collagen deposition, enhance tissue tensile strength and possess anti-inflammatory properties (Davis et al, 1989a,b). Aloe's most active compounds appear to be aloe polysaccharides (West and Zhu, 2003).
The main published study investigating the effect of aloe-coated gloves on hand condition (West and Zhu, 2003) was conducted using 29 female factory line workers with dry, irritated skin on their hands that was attributed to occupational exposure. Subjects wore an aloe-coated glove on one hand and no glove on the other every day (eight hours per day) for 30 days, followed by 30 days without gloves. Following this, they wore aloe-coated gloves on the same hand as before for a further 10 days. Two dermatologists carried out a blinded photographic assessment of the skin condition of the subjects' hands (gloved and non-gloved) throughout the study period.
Results indicated that wearing aloe-coated gloves leads to improved skin condition in all cases, with visible improvement of the skin on the hand in contact with aloe by day 10 (mean). A statistical difference (p<0.0001, using="" the="" wilcoxon="" signed="" rank="" test)="" was="" found="" between="" the="" scores="" for="" gloved="" and="" non-gloved="" hands.="">0.0001,>
Issues with using aloe-coated gloves
A letter (Mitchell, 2003) written in response to West's study raised the concern that the subjects were factory workers and not clinical staff. As clinical staff should wash their hands and change gloves between attending each patient, the author was concerned that:
The benefits of the aloe would be eliminated if hands were washed often during the day;
The 'nice feel' of hands following glove removal may discourage hand-washing (we assume this 'feel' is associated with residual aloe remaining on the hands after glove removal).
Another letter raised concerns that aloe does not have zero toxicity (Watts, 2002), although no further detail was provided to support this claim. The letter also raised concerns about the potential interaction of aloe with other medicines as well as its possible ingestion by patients, although it is difficult to see how the latter can be a real concern with aloe-coated gloves.
Toxicity of aloe
Ingestion of aloe has been associated with various adverse health conditions such as diarrhoea and even renal failure but only a very small number of individual case studies have been published (Boudreau and Beland, 2006; Willems et al, 2003). As the aloe is usually taken as part of a herbal remedy containing other plant extracts, the adverse effects may be due to other compounds present. Studies reporting adverse conditions to externally applied aloe are scarce. In one case study a man developed eczema after ingesting aloe as well as applying it to his skin (Morrow et al, 1980). Another case study reported that a patient experienced a severe burning sensation when she applied aloe to her skin following chemical peel and dermabrasion treatment (Hunter and Frumkin, 1991).
In one of the few clinical studies carried out in this area, researchers patch-tested 702 subjects with the gel, oily leaf extract and whole plant extract of the aloe plant; they found no subject had any reaction to them (Reider et al, 2005).
Aloecorp (a company that supplies aloe and manufactures products containing aloe) has stated that only 'a handful of (allergic) cases spanning five decades' have resulted from exposure to aloe. It claims aloe contains none of the allergens listed by the European Cosmetic Directive (personal communication with the director of research and development, Aloecorp).
Effect of the manufacturing processes
Authors have asked if the manufacturing process affects aloe's activity and if the coating is in an active form when it reaches the user (Adenna Inc, 2005).
Medline, a major manufacturer of aloe-coated gloves, said it adds aloe after curing the gloves, as a last step in the process. It also said it conducts rigorous testing to ensure active levels of aloe are present on the gloves produced (personal communication with the Medline product manager).
We asked Charlton Scientific, the manufacturer of Omega Aloe-Plus gloves, about its processing methods; it explained that, 'aloe vera is added to the glove post-dipping, after initial leaching and before gloves are placed in the curing oven.' As the gloves are cured after aloe is added, it is unclear whether the aloe would still be active. To date, the authors are unaware of any independent data published on glove processing's impact on aloe activity.
Adding a coating during the manufacturing process may have an impact on glove performance, while chemical interactions between the coating and the glove may also alter the material properties. It appears that no study to date has investigated whether the coatings alter the properties of the gloves in any way (such as reducing tensile strength or barrier properties).
Aloe vera has been used for centuries and its hydrating properties are well documented. However, examination gloves with aloe coatings are fairly new to the market and research on their effectiveness is scarce. Although no reports of adverse reactions to these gloves have been published, further research in a range of workplaces would be beneficial. Whether the coating contains active aloe, whether the aloe affects the physical or chemical properties of the gloves, and the effect that long-term usage and repeated exposure may have on users have yet to be established.
Adenna Inc. (2005) Aloe Vera - Heal or Hype? www.adenna.com/company_press_releases_04-25-01.htm
Boudreau, M.D., Beland, F.A. (2006) An evaluation of the biological and toxicological properties of Aloe barbadensis (miller), Aloe vera. Journal of Environmental Science and Health. Part C, Environmental Carcinogenesis & Ecotoxicology Reviews; 24: 1, 103-154.
Davis, R. et al (1989a) Anti-inflammatory activity of aloe vera against a spectrum of irritants. Journal of the American Podiatric Medical Association; 79: 6, 263-276.
Davis, R. et al (1989b) Wound healing. Oral and topical activity of Aloe vera. Journal of the American Podiatric Medical Association; 79: 11, 559-562.
Hunter, D., Frumkin, A. (1991) Adverse reactions to vitamin E and aloe vera preparations after dermabrasion and chemical peel. Cutis; Cutaneous Medicine for the Practitioner; 47: 3, 193-196.
Mitchell, H. (2003) Evaluation of aloe vera gel gloves in the treatment of dry skin associated with occupational exposure. Letter to the editor. American Journal of Infection Control; 31: 8, 516.
Morrow, D. et al (1980) Hypersensitivity to aloe. Archive of Dermatology; 116: 9, 1064-1065.
Reider, N. et al (2005)
Absence of contact sensitization to Aloe vera (L.) Burm. f. Contact Dermatitis; 53: 6, 332-334.
Rodriguez-Bigas, M. et al (1988) Comparative evaluation of aloe vera in the management of burn wounds in guinea pigs. Plastic and Reconstructive Surgery; 81: 3, 386-389.
Swaim, S. et al (1992) Effects of topical medications on the healing of open pad wounds in dogs. Journal of the AmericanAnimalHospital Association; 28: 6, 499-502.
Visuthikosol, V. et al (1995) Effect of aloe vera gel to healing of burn wound a clinical and histologic study. Journal of the Medical Association of Thailand; 78: 8, 403-409.
Watts, T. (2002) Gloves and aloe vera. Letter to the editor. British Dental Journal; 193: 2, 62.
West, D., Zhu, Y. (2003) Evaluation of aloe vera gel gloves in the treatment of dry skin associated with occupational exposure. American Journal of Infection Control; 31: 1, 40-42.
Willems, M. et al (2003) Anthranoid self-medication causing rapid development of melanosis coli. The Netherlands Journal of Medicine; 61: 1, 22-24.