Is Honey a Sweet Wound Treatment?

Gayle Nicholas Scott, PharmD

Disclosures

August 28, 2012

Question

Is honey effective as a wound dressing?

Response from Gayle Nicholas Scott, PharmD
Assistant Professor, Eastern Virginia Medical School, Norfolk, Virginia; Clinical Pharmacist, Chesapeake Regional Medical Center, Chesapeake, Virginia

The honeybee, Apis mellifera -- literally, "honey-bearing bee" in Latin -- produces several products that are used medicinally, including beeswax, royal jelly, bee pollen, bee venom, and honey. Although more commonly classified as a food, honey is the best-studied medicinal bee product. Historical prescriptions for medicinal honey span more than 4 millennia and describe using honey both orally and topically.[1] The antimicrobial properties of honey were documented in 1894, and its value in wound management was noted in the US and European literature about 50 years later.[2] The enthusiasm for honey dwindled with the availability of antibiotics, relegating honey to a folk remedy for decades.

Scientific advances have improved understanding of the mechanisms of wound healing and biological effects of honey. Physiologic response to a wound includes inflammatory, proliferative, and remodeling phases. Honey seems to have beneficial effects on wound healing during each phase. During the inflammatory phase, honey may limit infection through activity against many common bacteria, including Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa, as well as methicillin-resistant S aureus and vancomycin-resistant Enterococcus. However, prophylactic use of antibiotics is not associated with faster wound healing, so the antimicrobial effect of honey may not entirely explain its efficacy in wound healing.[3]

The effect of honey may depend upon its ability to upregulate production of cytokines, such as tumor necrosis factor and interleukins, that result in removal of wound debris and formation of new blood vessels.[4] Unlike some other wound dressings, honey is not cytotoxic to keratinocytes and fibroblasts that aid in wound healing.[5] Honey may promote tissue granulation and epithelialization and reduce wound healing time.[6]

With the rise of antibiotic resistance and wound care as a medical specialty, interest in honey for wound care has resurged. Honey has been studied for both acute wounds (eg, burns and surgical and traumatic wounds) and chronic wounds (eg, surgical infections, pressure ulcers, and lower-extremity ulcers). Characteristic of many studies of wound care, studies of honey have generally been of poor quality, with lack of blinding and small sample sizes. A Cochrane meta-analysis of 19 studies found that honey shortened healing times of partial-thickness burns by an average of 5 days compared with conventional dressings, but found no faster healing of chronic venous leg ulcers when used in conjunction with compression stockings. The reviewers cited insufficient data to evaluate the effects of honey on other acute and chronic wounds.[6] Other systematic reviews have reached similar conclusions.[7,8]

Honey wound dressings are approved by the US Food and Drug Administration (FDA) as a medical device, which does not undergo the same scrutiny for safety and effectiveness as drugs.[9] Honeys vary by floral source, and a specific type, manuka honey, is approved for marketing as Medihoney™ in wound dressings. Manuka honey is produced by honeybees that frequent the flowers of Leptospermum, known as the tea tree, manuka, and by other names; these trees are native to Australia and New Zealand. Leptospermum or manuka honey is the best studied, but other honeys have also been used for wound care, making it difficult to determine whether the effects described are universal to honey or particular to the type of honey used.[2]

Medical-grade honey in FDA-approved dressings is not the same product as honey on the grocery store shelf. Medical-grade honey has been filtered and gamma-irradiated to kill such pathogens as Clostridium botulinum. Heating honey kills bacteria but also decreases its activity.[10]

In summary, multiple studies using various honeys for acute and chronic wounds have reported improved healing, but interpretation of the available research is limited by poor study design. A large randomized controlled trial with blinding and sufficient follow-up time is needed to determine the place of honey in wound care. Warn patients that medical-grade honey is probably safer for wounds than food-grade honey, which might contain pathogens. Adverse effects of topical honey are generally mild; skin reactions and pain have been reported.[11]

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