Application of Herbal Ingredients Aloe Vera Gel (Aloe Vera ...

Journal of Indonesian Wound Ostomy Continence Nurses Association (JIWOCNA)

Vol. 01 No. 01 (2022) pp. 42-52

e-ISSN:

Publisher : Indonesian Wound Ostomy Continence Nurses Association 42

Application of Herbal Ingredients Aloe Vera Gel (Aloe Vera) Against

Burns Healing Process (Combustio); literature review

Santi

1, Mayusef Sukmana

2

1,2Diploma of Nursing, Faculty of Medicine Mulawarman University, Indonesia

Corresponding author: [email protected]

Abstract

Background: Burns (Combustion) are damage to somebody's tissues caused by high-

temperature changes, electric shocks, explosions, or exposure to chemicals. First degree

(Superficial) burns and Second degree (Partial thickness) burns, and Aloe Vera (Aloe Vera) is

a semi-tropical plant, which has a long history and is highly rated as a versatile herb. Aloe

vera has potentially significant anti-inflammatory effects. Therefore, it can be used in treating

gingivitis, and first to second-degree burns. Objective: To determine the content and

functional substances in aloe vera gel (aloe vera) and to determine the average speed of the

healing process of burns using aloe vera gel (Aloe Vera). Methods: This research is a

literature review study by searching for journal articles through Google Search and Google

Scholar between 2010-2020. Results: Based on these three research journal articles, it shows

that the content and functional substances in aloe vera gel are saponins that function as

antiseptics, aloecin B which accelerates wound healing, and anthraquinone and quinone

which have analgesic effects. and the average speed of the burn healing process using aloe

vera gel is that in all patients the healing is complete on the 40 the day, while in animals the

average healing time is 15 days and 10 days. Conclusion: It can be concluded that the

content and functional substances in aloe vera gel are saponins that can accelerate wound

healing, and the average speed of the burn wound healing process using aloe vera gel is

complete healing on the 15th day. 10.

Keywords: Burns; Combustion; Aloe vera; Superficial first degree burns; Burn wound

healing.

Abstrak

Latar Belakang: Luka Bakar (Combustion) adalah kerusakan jaringan tubuh seseorang yang

disebabkan oleh perubahan suhu tinggi, sengatan listrik, ledakan, atau paparan bahan kimia.

Luka bakar derajat pertama (Superficial) dan luka bakar derajat Kedua (Partial thickness),

dan Aloe Vera (Aloe Vera) adalah tanaman semi-tropis, yang memiliki sejarah panjang dan

dinilai tinggi sebagai ramuan serbaguna. Lidah buaya memiliki potensi efek anti-inflamasi

yang signifikan. Oleh karena itu, dapat digunakan dalam mengobati radang gusi, dan luka

bakar tingkat pertama hingga kedua. Tujuan: Untuk mengetahui kandungan dan zat

fungsional dalam gel lidah buaya (aloe vera) dan untuk mengetahui kecepatan rata-rata proses

penyembuhan luka bakar menggunakan gel lidah buaya (Aloe Vera). Metode: Penelitian ini

merupakan studi literature review dengan mencari artikel jurnal melalui Google Search dan

Google Scholar antara tahun 2010-2020. Hasil: Berdasarkan ketiga artikel jurnal penelitian

Literature/Systematic Review


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tersebut menunjukkan bahwa kandungan dan zat fungsional dalam gel lidah buaya adalah

saponin yang berfungsi sebagai antiseptik, aloecin B yang mempercepat penyembuhan luka,

serta antrakuinon dan kuinon yang memiliki efek analgesik. dan rata-rata kecepatan proses

penyembuhan luka bakar menggunakan gel lidah buaya adalah pada semua pasien

penyembuhan selesai pada hari ke 40, sedangkan pada hewan rata-rata waktu penyembuhan

adalah 15 hari 10 hari. Kesimpulan: Dapat disimpulkan bahwa kandungan dan zat fungsional

dalam gel lidah buaya adalah saponin yang dapat mempercepat penyembuhan luka, dan

kecepatan rata-rata proses penyembuhan luka bakar menggunakan gel lidah buaya adalah

penyembuhan sempurna pada hari ke-15. 10.

Kata kunci: Luka bakar; Pembakaran; Lidah buaya; Luka bakar tingkat pertama superfisial;

Penyembuhan luka bakar.

1. INTRODUCTION

Burns is the destruction of somebody's tissues caused by high-temperature changes,

electric shocks, explosions, or exposure to chemicals. Burns cause various problems, namely

the problem of death, disability, loss of self-confidence, and relatively large costs for

healing(Nugraha & Rahayu, 2015).

According to data from the American Burn Association (2015), in the United States, there

are 486,000 cases of burns that received medical treatment, 40,000 of which had to be

hospitalized. In addition, a total of 3,240 deaths occur annually due to burns. The most

common causes of burns are trauma due to fire accidents, vehicle accidents, inhalation of

smoke, contact with electricity, chemicals, and hot objects (Atikah Fatmawati, Henry

Sudiyanto, 2020).

The process of healing or treating burns medically requires complex treatment, namely

reducing pain in the body, requiring medical treatment, or a long hospitalization with various

surgical procedures and long rehabilitation times. The process of healing or treating burns

herbally requires Aloe Vera gel as an effective therapy at a cost that is quite cheap or

affordable, the use of aloe vera gel, especially its mucus, is more effective in accelerating the

healing of burns and reducing pain in wounds(Nugraha & Rahayu, 2015).

According to Shahzad & Ahmed, 2010 treatment of burns using aloe vera is cheaper in

costs and reduces pain in patients compared to burn treatment using SSD. In another study,

12 white rats were given burns and then given aloe vera gel and their histopathology was

measured. The results show the formation of blood vessels, increasing collagenation and

proliferation(Shahzad & Ahmed, 2010)


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The effectiveness of aloe vera is better when compared to other drugs used to treat burns

and the costs incurred are more affordable. This is supported in a study comparing aloe vera

cream containing aloe vera gel powder 0.5% with silver sulfadiazine 1% cream, the rate of

re-epithelialization and healing of partial-thickness burns was significantly faster treated with

aloe vera (Aloe Vera) than treated with SSD (Silver sulfadiazine cream).(Nugraha & Rahayu,

2015).

The active substance contained in aloe vera (Aloe Vera) which acts as a burn healer is

flavonoids function as antibacterial, antioxidant, and can inhibit bleeding on the skin, as a

wound healing process. Tannins stop light bleeding, as a wound healing process(Aris Wijaya,

2013)). Saponins have anti-bacterial activity by forming protein or collagen, have an

antibiotic activity that can help in the wound healing process. Polyphenols are phenolic

antioxidants usually used to prevent damage due to oxidation reactions in food, cosmetics,

pharmaceuticals, and plastics. Polyphenols function as scavengers and scavengers of free

radicals from the destruction of metal ions. This group is very soluble in water and fat and

can react with vitamins C and E. Vitamin C can play a role in increasing collagen production

and preventing the synthesis of DNA strands, while vitamin E is a strong antioxidant in

wound healing. Steroids are an important part of organic compounds and often function as a

nucleus. One type of steroid is cholesterol. Steroids are also anti-inflammatory, antiseptic and

pain-relieving, in the wound healing process (Aris Wijaya, 2013)\

Burns will have a bad impact if not treated. Burns that are not controlled for a long time

will cause complications. These complications result in increased mortality and morbidity so

that alternative therapies are needed using traditional medicinal plants, one of which is aloe

vera gel. The formulation of the problem is as follows "How is the Application of Aloe Vera

Gel to the Burn Healing Process (Combustion)"?

The purpose of this study was to determine the substance content and function in aloe

vera gel (Aloe Vera) and the average speed of the burn wound healing process using aloe

vera gel (Aloe Vera)

2. METHOD

The type of research used is a literature study, the preparation of literature reviews of

scientific writing journals uses a database in research journals in the online database. This


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study uses secondary data obtained from the results of research that has been carried out by

previous researchers.

2.1. Data Sources and Searches

Journals and articles relevant to the topic were searched through online databases such as

PubMed, garuda, science direct, Wiley, and ProQuest Using a database of various references

on the internet with research journals related to the application of aloe vera gel (Aloe Vera) in

the process of healing burns (Combustion) published in 2010-2020.

2.2. Study Selection

How to select an article that is involved in the study based on inclusion and exclusion

criteria. It can be broken down from PICOTS question (Patient/Population,

Intervention/Interest, Comparation (if any), Outcome(s), Time, and Study design). The

strategy used to find articles using PICOS a. Population/problem Burn sufferers. b.

Intervention Provision of herbal ingredients aloe vera gel (aloe vera) c. Comparison Not

comparing journal articles. d. Outcome 1. Knowing the substance content and function in

aloe vera gel (Aloe Vera). 2. Knowing the average speed of the burn wound healing process

using aloe vera gel (Aloe Vera). e. Experimental design study. C. Research Path A research

flow protocol to determine the selection of journals that have been found and adapted to the

objectives of the literature study. Based on the search results, the researchers found journals

that matched the keywords: "Aloe Vera, Aloe Vera, Aloe vera leaf extract, Healing

acceleration, Burn injury, Burn care, Burns wound healing, Therapy, Topical, Wound,

Wounds, Burns, Degrees I and II Mortality rate, Proliferative phase, Wound healing, Wound

care, Cream, Gel Formulation, Flavonoids, Tannins, Saponins, Polyphenols, Steroids".

Researchers found several journals that match these keywords

3. RESULT

The Effectiveness of Aloe Vera Gel Compared with 1% Silver Sulfadiazine Cream is a

Burn Bandage for Second Degree Burns in 2013 (Muhammad Naveed Shahzad, Naheed

Ahmed, 2013).

The results of this study were given in the form of a dosage form using aloe vera gel

(Aloe Vera) for the burn wound healing process (Combustion) which was facilitated by the

doctor. The treatment was given for 11 ± 4. 18 days. This study used an intervention group of

25 patients who were divided into 2 equal groups randomly, one group was wrapped with

aloe vera gel, and the other group was 1% silver sulfadiazine silver cream (SSD). experienced


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burns on superficial & partial second-degree burns and the control group were silver

sulfadiazine silver 1% (SSD) cream. This research was conducted in the burn unit/plastic

surgery department of Nisar Multan Hospital, Pakitan during the period July 2008 to

December 2010, the aloe vera gel used in this study was (aloe tone jelr). This product consists

of 98% pure gel from the inner leaves of the plant, as a soaked bandage for wound dressing

performed twice a day until healing is complete. among 25 patients treated with aloe vera

dressing, 24 patients recovered completely while 1 patient was incomplete. in the SSD group,

of the 25 patients, 19 patients recovered completely and 6 had hypertrophic scar formation or

contracture development. This difference was statistically significant. Aloe vera contains

saponins which are soapy substances that makeup about 3% of the gel and have cleansing and

antiseptic properties. The sampling used was consecutive sampling, and this study was a true-

experimental type.

Aloe Vera Gel and Silver Sulfadiazine Accelerate Burn Healing in 2014(Fikri & Adriani,

2014)



treatment nurse who was given on the 15th day as many as 3 samples (37.5%). This study

used an intervention group of 8 white rats/musculus mice that had burns on shallow partial-

thickness burns (degree 2A) to be performed on muscle mice. and the control group using

0.9% NaCl.This research was conducted at Semen Gresik Hospital Jl. R. A. Kartini No 280,

which will be held from 1 to 30 May 2011. The aloe vera gel used in this study was a topical

wound agent. A good burn or aloe vera gel is directly applied to white rats/musculus mice.

The content in aloe vera is saponin which functions as an antiseptic. The sampling used

was simple random sampling, and this research was a pure experimental post-test type.

The Effectiveness of Aloe Vera (Aloe Vera) and Betel Leaf (Piper Betle Linn) Against

Second Degree Burn Healing in White Rats (Ratus Nerve Gicus Wistar Strain) at

Sidomulyo Rat Farm, Kediri in 2016(Kristyaningsih, 2016).



treatment group nurse who was given 10 days. by using the intervention group as many as 6

male white rats and given 3 spare rats. who suffered burns from second-degree burns to be

performed on male white rats. and the control group using 0.9% NaCl solution. This research


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was conducted at the Sidomulyo rat farm, Kediri. male white rats were given burns with an

area of 1x1 cm2 using an iron plate that had been heated with boiling water for 5 minutes

then attached to the rat's back for 30 seconds (epidermal area) after which the rats were given

aloe vera gel treatment which was used in this study. is directly applied to male white rats.

The content in aloe vera is saponin which functions as an anti-bacterial where this saponin

will destroy the bacterial wall so that the bacteria will undergo lysis and in the end will

reduce the risk of infection in the wound. The sampling used was simple random sampling,

and this research was true-experimental post-test only with control group design.

Based on the results in the journal article 1(Shahzad & Ahmed, 2010) second-degree

burn using aloe vera, is the content of saponins, saponins which are soapy substances make

up about 3% of the gel and have cleansing and anti-septic properties. Based on the results of

journal article 2(Fikri & Adriani, 2014), the content of aloe vera type Aloe vera barbandesis

Mill contains 72 substances needed by the body and the content of saponins contained in this

aloe vera gel. Based on the results in journal article 3 (Kristyaningsih, 2016) second degree

burns using aloe vera). One of the ingredients of aloe vera that can help accelerate wound

healing is saponins, saponins will work as antibacterial where these saponins will damage the

bacterial wall thus the bacteria will undergo lysis and will ultimately reduce the risk of

infection in the wound.

Based on the results of journal article 1 (Shahzad & Ahmed, 2010), it is known that of

the 50 patients, 26 were male and 24 female (age range 15-65 years). In the Aloe vera group,

epithelialization started on day 5, and in all patients, healing was complete on day 40 (Mean

= 11 4.18), whereas in the SSD group healing was prolonged (Mean = 24.24 11.16).

Based on the results of journal article 2 (Zahid Fikri, Kurnia Adriani, 2014), it is known

that the results showed the aloe vera gel group obtained F count 1.231 and significant 0.505,

after the one way ANOVA SPSS test was carried out. The average healing time is 15 days,

the fastest recovery is on the 13th day which is 1 sample and the longest recovery is on the

17th day as much as 1 sample.

Based on the results of journal article 3(Kristyaningsih, 2016) it is known that the

average healing in the treatment group using aloe vera contained 6 white rats (T1, T2, T3, T4,

T5, T6) experiencing wound drying on day 3. Burns healing in group II contained T1 and T5

which healed on the 9th day, T2 which healed on the 11th day, T3 and T6 which healed on

the 12th day, and T4 which healed on the 10th day.


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4. DISCUSSION

All journal articles as samples of this research are the results of experimental research. 2

journals using True-experimental and 1 journal using Pure Experiments after the test. with 1

journal design using post-test only with control group design. The population used in the

study was clinical trial phases 1 and 2 (animals and humans) who experienced first and

second-degree burns (shallow). The total number of humans and animals used as samples in

phase 1 clinical trial journals was 25 patients with superficial and partial burns, and the phase

2 clinical trial journals ranged from 8-6 white rats/musculus mice and male white rats.

The sample selection method was following experimental research standards, namely

consecutive sampling (Muhammad Naveed Shahzad, Naheed Ahmed, 2013). while 2 journals

use simple random sampling that uses experiments(Fikri & Adriani, 2014), (Kristyaningsih,

2016) and this number was chosen by the researcher in this literature review study. The

samples were taken from burns I and II degree (shallow), this is very important so that the

results of the study can be generalized to the population and suppress common occurrences in

the study. The population used in these 3 research journals were humans/patients and animals

with burns. The total number of respondents used by consecutive sampling journals was 50

humans/patients and 2 journals only on animals. The inclusion and exclusion criteria of the

sample varied, based on the specific objectives of each study, of course, the research had

been carefully considered so that the sample criteria did not affect the results of the study.

The number of samples in journal article 1(Shahzad & Ahmed, 2010), the intervention

group was 25 patients, while the control group was only 25 patients. the number of samples

in journal 2(Fikri & Adriani, 2014) for the intervention group was 8 animals, while for the

control group 8 animals. and the number of samples in journal 3 (Kristyaningsih, 2016)

amounted to a sample of the intervention group of 6 animals and given 3 animals as a reserve.

while for the control group, 6 animals and 3 animals were given as a reserve. method of

giving intervention in 3 research journals. of the 3 research journals analyzed, all research

interventions were administered by doctors and nurses in the period of administration of

research interventions which varied widely, ranging from 18 days and 15 days to 10 days.

The measured parameters or independent variables in the 3 journal articles from this

research include the substance content and function of aloe vera (Aloe vera), and the average

speed of the burn healing process (Combustion).


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4.1 Knowing the content and functional substances in aloe vera gel

Based on the results of journal article 1 (Shahzad & Ahmed, 2010), These are the

ingredients and functional substances in aloe vera gel (second-degree burns) using aloe vera,

containing saponins, saponins which are soap ingredients that makeup about 3% of the gel

and have cleansing and antiseptic properties. Aloe vera gel not only increases the collagen

content of the wound but also changes the collagen composition and increases the degree of

collagen cross-linking. Due to this, it accelerated wound contraction and increased the

breaking strength of the resulting scar tissue among 25 patients treated with aloe vera

dressing, 24 patients recovered completely while 1 patient was incomplete.

Based on the results of journal article 2 (Fikri & Adriani, 2014), saponins which function

as anti-septic, aloecin B which accelerates wound healing, and anthraquinone and quinone

which have an analgesic effect.

Based on the results of journal article 3 (Kristyaningsih, 2016), saponins will work as

anti-bacterial where these saponins will damage the bacterial wall so that the bacteria will

experience lysis and will ultimately reduce the risk of infection in the wound. This substance

(saponin) will stimulate TGF-β activity at fibroblast receptors, withincreased TGF-β activity

it will also increase fibroblast migration and proliferation.

Based on the two journal articles that were tested on musculus mice and male white rats

aged between 3-4 months with a bodyweight of 250-300 grams, the content and functional

substance in aloe vera gel is a saponin that functions as an anti-septic, aloecin. B which

accelerates wound healing is to kill germs and prevent the growth of microorganisms that can

arise in the wound so that the wound does not experience severe infection and anthraquinone

and quinone which have analgesic effects, saponins will work as anti-bacterial where these

saponins will damage the bacterial wall so that the bacteria will undergo lysis and will

ultimately reduce the risk of infection in the wound. While the journal articles that were

tested on humans the content and functional substances in aloe vera gel contain saponins,

saponins which are soap ingredients that makeup about 3% of the gel and have cleansing and

antiseptic properties.

Based on the three journal articles, it can be concluded that the similarities obtained are

the content and functional substances in aloe vera gel, namely saponins, while the difference

is that the first journal contains a salicylic acid in aloe vera gel which has anti-inflammatory


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properties, while the article contains salicylic acid. the second journal is water which reaches

99.5% and the third journal article is mineral content which helps the wound healing process.

4.2. Knowing the average speed of the burn wound healing process using aloe vera gel

(Aloe Vera).

Based on the results of journal article 1, it is known that the average speed of the burn

wound healing process using aloe vera gel (Aloe Vera) is that in the Aloe vera group,

epithelialization begins on the 5th day, and in all patients, healing was completed on day 40

(Mean = 11 4.18) while in the SSD group healing was prolonged (mean = 24.24 11.16).

Based on the results of journal article 2, after the one-way ANOVA SPSS test was

carried out. the average healing time is 15 days, the fastest healing is on the 13th day which is

1 sample and the longest healing is on the 17th day as much as 1 sample, according to this

theory aloe vera gel is indeed effective in accelerating the healing of shallow partial-thickness

burns. this can be seen in the average day of wound healing which is faster when compared to

the control group. In addition, the fastest healing process was also shorter than the control

group.

Based on the results of journal article 3, in the aloe vera gel group, healing had occurred

on day 13, while in the control group it only occurred on day 17. Treatment using aloe vera

(Aloe vera) there were 33.33% recovered on the 9th day, there were 16.67% recovered on the

10th day, there were 16.67% recovered on the 11th day, and there were 33.33% recovered on

the 12th day. The average value of burn healing days in white rats treated with aloe vera was

10 days. The average healing in the treatment group using aloe vera contained 6 white rats

(T1, T2, T3, T4, T5, T6) T1 and T5 which recovered on the 9th day, T2 recovered on the

11th day, T3 and T6 recovered on the 12th day, and T4 recovered on the 10th day. Based on

the results of observations in the treatment group with aloe vera, the results were different,

there were T1 and T5 who recovered on the 9th day, T2 recovered on day 11, T3 and T6

recovered on day 12, and T4 recovered on day 10. This is because some samples of white rats

often bite the gauze bandage so that some samples are detached and also white rats often bite

their injured body parts. In the group using aloe vera, there were 3 white rats (T2, T3, T6)

that often bit the gauze bandage so that the bandage came off and bit its own injured body.

Based on the results of journal articles in humans (Shahzad & Ahmed, 2010)), the

average speed of the burn wound healing process using aloe vera gel (Aloe Vera) was and in

all patients healing was completed on the 40th day (Mean = 11 4.18). Meanwhile, based on


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the results of journal articles on animals(Fikri & Adriani, 2014), musculus mice the average

speed of the burn wound healing process using aloe vera gel (Aloe Vera) is 15 days, the

fastest recovering on day 13 is 1 sample and the longest healed on day 17 as much as 1

sample. and based on the results of journal articles on animals (Kristyaningsih, 2016), male

white rats the average value of burn healing days in white rats treated with aloe vera is 10

days.

Based on the three journal articles, it can be concluded that the equation obtained is the

average speed of the burn wound healing process using aloe vera gel (Aloe Vera), which can

accelerate the healing of burns more effectively using aloe vera gel (Aloe Vera), while the

difference is that in the first journal the average healing process in humans/patients recovered

on the 40th day, while the second journal article was that the animals recovered on the 15th

day, and the third journal article on animals recovered on the 15th day. 10 days.

This study was supported by a study by (Thamlikitkul) using Aloe freshmucilage in 38

patients and found accelerated healing. according to (Visuthikoso) reported a study on 27

patients with partial-thickness burns who were well treated with gauze bandages saturated

with Aloe vera gel. they observed a significantly reduced wound healing time in patients

treated with aloe vera (11.19 days vs. 11.89 days). according to (Akhtar) also observed a

significantly reduced wound healing time in patients treated with aloe vera for 18.9 days. a

better rate of epithelialization is also appreciated in the one Iran study, the time required for

partial-thickness burns to heal was 15.9 2 days. however, one clinical report 35 suggests that

aloe vera can interfere with the healing of severe wounds. according to (Schmidt) evaluated

the time interval required for wound healing using a standard wound management protocol

with and without aloe vera gel in a randomized controlled trial. All patients experienced

wound healing complications. only 21 people completed the study. That is, the healing time

in the conventional treatment group (53 days) was significantly shorter (P < 0.003) than in

the aloe vera gel group (83 days)

5. CONCLUSION

Based on journal articles that were tested on humans, the content and functional substances in

aloe vera (aloe vera) and journal articles that were tested on animals were saponins, these

substances (saponins) will stimulate TGF-β activity at fibroblast receptors, with increased


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TGF activity. -β it will also increase the migration and proliferation of fibroblasts (Robbin,

2007).

Based on journal articles that were tested on humans, the average healing time for all patients

was completed on the 40th day, and the journal articles tested on animals showed that the

average healing time was 15 days and 1 journal was wound healing that was recovered on

day 10.

6. REFERENCES

Aris Wijaya, R. (2013). Formulasi Krim Ekstrak Lidah Buaya (Aloe Vera) Sebagai Alternatif

Penyembuh Luka Bakar. In Skripsi.

Atikah Fatmawati, Henry Sudiyanto, M. N. F. (2020). Upaya Peningkatan Pengetahuan

Masyarakat Tentang Pertolongan Pertama Pada Luka Bakar Melalui Pendekatan Focus

Group Discussion Di Kelompok Dasa Wisma Perumahan Graha Majapahit Kabupaten

Mojokerto. Jurnal Kreativitas Pengabdian Kepada Masyarakat (Pkm), 3, 430–436.

Fikri, Z., & Adriani, K. (2014). Gel Lidah Buaya dan Silver Sulfadiazin Mempercepat

Penyembuhan Luka Bakar. Journals of Ners Community, 5(1), 93–100.

Kristyaningsih, P. (2016). Efektivitas Lidah Buaya (Aloe Vera) Dan Daunsirih (Piper Betle

Linn) Terhadap Kesembuhan Luka Bakar Derajat Ii Pada Tikus Putih (Rattus

Norvegicus Strain Wistar) Di Peternakan Tikus Sidomulyo Kediri. Jurnal Ilmu

Kesehatan, 5(1), 114. https://doi.org/10.32831/jik.v5i1.122

Nugraha, A., & Rahayu, U. (2015). Pengaruh Pemberian Aloe Vera Pada Pasien Luka Bakar

“Studi Literatur. Jurnal Medika Cendikia, 2(2), 72–81.

Shahzad, M. N., & Ahmed, N. (2010). 2013 Silver vs Aloe gel in burns. J Pak Med Assoc,

63(2), 225–230.

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