Honey as a Dressing for Wounds, Burns, and Ulcers (Part 1).

Honey - A Healing Power.

Most people think of honey as the sweet, sticky stuff you put on toast or drop into hot tea, but in recent years, researchers have been exploring its potential in other ways.

Honey as a Dressing for Wounds, Burns, and Ulcers: A Brief Review of Clinical Reports and Experimental Studies.

Summary.

The use of honey as a wound dressing material, an ancient remedy that has been rediscovered, is becoming of increasing interest as more reports of its effectiveness are published.

Some of these include:

• To lessen the ill effects of radiation therapy in patients with cancer of the head and neck.
• To improve oral health.
• To preserve food.
• To boost antioxidants.
• To enhance athletic performance.

The clinical observations recorded are that infection is rapidly cleared, inflammation, swelling and pain are quickly reduced, odour is reduced, sloughing of necrotic tissue is induced, granulation and epithelialisation are hastened, and healing occurs rapidly with minimal scarring.

The antimicrobial properties of honey prevent microbial growth in the moist healing environment created.

Today, the general public is showing more of an interest in honey, both in the kitchen and outside of the kitchen. This includes the use of honey as a folk remedy for ailments such as cuts and scraps. This is due in part to the current trend with natural remedies and foods and a throwback to ancient times when honey was used as a wonder healer, laxative, cough and sore-throat balm and a salve for sore eyes, among other things.

Unlike other topical antiseptics, honey causes no tissue damage: in animal studies it has been demonstrated histologically that it actually promotes the healing process. It has a direct nutrient effect as well as drawing lymph out to the cells by osmosis.

The stimulation of healing may also be due to the acidity of honey. The osmosis creates a solution of honey in contact with the wound surface which prevents the dressing sticking, so there is no pain or tissue damage when dressings are changed.

At the University of Illinois, honey has been the focus of several studies. One study showed that honey, when mixed with ground turkey, slows the oxidation process that gives it that leftover taste after a few days. They also found that honey has the same level of antioxidants as some fruits and vegetables. Antioxidants are thought to thwart the process by which fats in food react with oxygen and cause the development of free radicals that damage the body. The body fights this oxidation process up to a certain point, but if it gets out of control, it can eventually lead to things such as cardiovascular disease, cancer and aging. The way to protect against that is to use an antioxidant. Research has shown that darker honeys are typically better, but that does not mean lighter honeys are not protective.

There is much anecdotal evidence to support its use, and randomised controlled clinical trials that have shown that honey is more effective than silver sulfadiazine and polyurethane film dressings for the treatment of burns.

Introduction.

In 1989 an editorial in the Journal of the Royal Society of Medicine expressed the opinion: "The therapeutic potential of uncontaminated, pure honey is grossly underutilized. It is widely available in most communities and although the mechanism of action of several of its properties remains obscure and needs further investigation, the time has now come for conventional medicine to lift the blinds off this 'traditional remedy' and give it its due recognition."

Another study is looking at how honey consumption might benefit athletes. For carbohydrate consumption, honey gel packs are just as good as PowerGel as a low to moderate source of carbohydrates. Another interesting find for athletes: Honey was just as good as a gel form of dextrose called glucose at improving endurance cycling performance. Additional research showed that ingesting powdered honey with a protein supplement after intense weight lifting promotes an anabolic or muscle-building response equivalent to taking a protein supplement in combination with maltodextrin, another form of carbohydrate.

Mostly this was in reference to reports of the use of honey as a wound dressing. The ancient usage of honey as a wound dressing has been reviewed , but there have been only some very brief reviews, with little clinical detail, of the literature reporting modern usage of this rediscovered therapy for wounds.

Because of the increasing interest in the use of alternative therapies, especially as the development of antibiotic resistance in bacteria is becoming a major problem , and because of the increase in reported usage of honey as a wound dressing in recent times, it was considered timely to review the clinical and experimental findings that have been published on this subject.

Honey was also found to be beneficial in maintaining blood-sugar levels.

Pertinent to this are reports of honey being effective on wounds not responding to conventional therapy.

In honey, there is little water available to promote the growth of bacteria and yeast. Also, honey's natural acidity inhibits some pathogens, and it has tiny amounts of hydrogen peroxide as well as other substances that seem to contribute to its antibacterial effect, according to the National Honey Board.

In many of the reports the effectiveness of honey as a dressing on infected wounds is attributed in part to its antibacterial properties. But the large volume of published literature from in vitro studies that has established that honey has significant antibacterial activity will not be included in this review as it has been comprehensively reviewed elsewhere.

Manuka honey in New Zealand has been used to destroy bacteria found in stomach ulcers as well as tough strains of bacteria that infect wounds and burns, according to the honey board... [read more]

However, it is noted here for the interest of the reader that honeys with median levels of antibacterial activity have been found to completely inhibit the major wound-infecting species of bacteria at concentrations of 1.8% - 11% , and a collection of strains of strains of MRSA at concentrations of 1% - 4%.

More on honey and wounds.

The fact that honey can help wounds to heal is something that was known to the Ancient Egyptians several thousand years ago. And in the last two world wars poultices with honey were used to assist the healing process in soldiers' wounds. However, the rise of the new antibiotics replaced this household remedy. 'In hospitals today we are faced with germs which are resistant to almost all the current anti-biotics,' Dr. Arne Simon explains. 'As a result, the medical use of honey is becoming attractive again for the treatment of wounds.' Dr. Simon works on the cancer ward of the Bonn University Children's Clinic. As far as the treatment of wounds is concerned, his young patients form part of a high-risk group: the medication used to treat cancer known as cytostatics not only slows down the reproduction of malignant cells, but also impairs the healing process of wounds. 'Normally a skin injury heals in a week, with our children it often takes a month or more,' he says.

Two more randomised trials with 1000 additional patients confirm results of a systematic review, that honey is an effective treatment for burn wounds.

A systematic review examined seven randomised trials of the use of honey as a dressing for burns or wounds. The conclusion was that honey was effective. A correspondent from India has sent two further randomised trials, one missed by the original search (probably because the journal was not in MEDLINE) and the other published subsequently. Bandolier would be grateful if correspondents sent information on any other studies.

Study 1.

Subjects were 900 patients with partial-thickness burns in less than 40% body surface area. Inclusion criteria were partial-thickness burns judged by appearance, presence of blisters of desquemated skin, capillary return, and sensitivity.

Moreover, children with leukaemia have a weakened immune system. If a germ enters their bloodstream via a wound, the result may be a fatal case of blood poisoning. For several years now Bonn paediatricians have been pioneering the use in Germany of medihoney in treating wounds. Medihoney bears the CE seal for medical products; its quality is regularly tested. The success is astonishing: 'Dead tissue is rejected faster, and the wounds heals more rapidly,' Kai Sofka, wound specialist at the University Children's Clinic, emphasises. 'What is more, changing dressings is less painful, since the poultices are easier to remove without damaging the newly formed layers of skin.' Some wounds often smell unpleasant - an enormous strain on the patient. Yet honey helps here too by reducing the smell. 'Even wounds which consistently refused to heal for years can, in our experience, be brought under control with medihoney - and this frequently happens within a few weeks,' Kai Sofka says. In the meantime two dozen hospitals in Germany are using honey in their treatment of wounds. Despite all the success there have hitherto been very few reliable clinical studies of its effectiveness.

Randomisation after initial treatment was to a honey dressing (n=450) or a conventional dressing (n=450). For the honey dressing 15-30 mL of pure, unprocessed honey was applied to the surface of the burn, covered with sterile gauze and bandaged. Honey was applied on alternate days until the wound healed. For the conventional dressing wounds were covered with vaseline impregnated gauze, OpSite or Soframycin (90 patients each). In 90 more patients the wounds were exposed with sterile linen changed at frequent intervals, and in 90 more patients sterile gauze was applied and the wound bandaged.

The study was not blinded, and there appeared to be no withdrawals or dropouts.

Results.

The honey and control groups were well matched at baseline.

Wound healing in honey-treated patients occurred in 10 days in 275/450, and in 15 days in 350/450. The mean time for wound healing was 9 days. In conventionally-treated patients wounds healed in 12-28 days, with a mean time to wound healing of 13.5 days.

In conjunction with colleagues from Düsseldorf, Homburg and Berlin, the Bonn medical staff now want to remedy this. With the Woundpecker Data Bank, which they have developed themselves, they will be recording and evalu-ating over 100 courses of disease over the next few months. The next step planned is comparative studies with other therapeutic methods such as the very expensive cationic silver dressings. 'These too are an effective anti-bacterial method,' says Dr. Arne Simon. 'However, it is not yet clear whether the silver released from some dressings may lead to side-effects among children.' Effective bacteria killer It has already been proved that medihoney even puts paid to multi-resistant germs such as MRSA. In this respect medihoney is neck and neck in the race to beat the antibiotic mupirocin, currently the local MRSA antibiotic of choice. This is shown by a study recently published by researchers in Australia. In one point medihoney was even superior to its rival: the bacteria did not develop any resistance to the natural product during the course of treatment. It is also known today why honey has an antiseptic effect: when producing honey, bees add an enzyme called glucose-oxidase. This enzyme ensures that small amounts of hydrogen peroxide, an effective antiseptic, are constantly being formed from the sugar in the honey. The advantage over the hydrogen peroxide from the chemist's is that small concentrations are sufficient to kill the germs, as it is constantly being produced.

Infected wounds occurred in 25/450 (5.5%) of patients treated with honey, and 52/450 (12%) of those with conventional treatment.

Minor scars occurred in 18/450 (6.2%) with honey and 87/450 (20%) with conventional treatment.

Study 2.

Subjects were 100 patients with burns involving less than 40% of body surface area treated with six hours of the burn.

Randomisation after initial treatment was to honey dressing (n=50) or to silver sulphadiazine impregnated dressing (n=50). Dressings were replaced every two days until healing. Bacterial cultures were made from swabs on admission and weekly or until the wounds healed.

The study was not blinded, and there appeared to be no withdrawals or dropouts.

Results.

The honey and control groups were well matched at baseline.

Healing was faster with honey, with a mean time of 15 days as against 17 days with silver sulphadiazine

As a rule much larger quantities of hydrogen peroxide would have to be used, as hydrogen peroxide loses its potency over time. However, in large concentrations it not only damages the bacteria, but also the skin cells. Furthermore, medihoney consists of two different types of honey: one which forms a comparatively large amount of hydrogen peroxide, and another known as 'lepto-spermum honey'.

In the honey group, 44/50 patients had positive swab cultures on admission. After one week of honey treatment, 40/44 (90%) were sterile. In the silver sulphadiazine group, 42/50 had positive swabs on admission, and all showed persistent infection after one week.

Hospital stay averaged 22 days with honey treatment and 32 days with silver sulphadiazine. Slit-thickness grafting was needed in one patient treated with honey and 11 with silver sulphadiazine.

Comment.

These two trials add a remarkable further 1,000 patients to those in the systematic review . The two trials were very positive for use of honey for burn wounds compared with conventional treatment.