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Use of Honey in Wound Care: Overview, Benefits, and Effectiveness

Humans have used honey for consumption and wound treatment for thousands of years.  A plethora of current-day treatment options exist for wound care, and the application of honey in wound dressings is now standard. But what is the scientific basis supporting the use of honey, and how is it better than conventional dressing? What is so special about honey?

This article will aim to cover the inherent complexities of the clinical use of medical-grade honey and help you evaluate the paucity of the strength-of-evidence ratings to support the use of time-honored remedies like honey for wound healing.

What is Honey?

Honey is a sweet, amber, and viscous liquid made and stored by honey bees. A pound of honey is the processed and concentrated nectar of two million flowers.

 

Foraging bees collect flower nectar with high sugar content to convert it into honey through regurgitation and enzymatic activity. While there’s about 90% water in flower nectar in its original form, the final product – honey – is a viscous liquid containing about 15-20% water, fructose, glucose, 22 amino acids, 30 bioactive plant compounds, and 31 minerals, including zinc and magnesium. It also contains glucose oxidase, perhaps the most important antimicrobial component of honey, that produces hydrogen peroxide and gluconic acid when water is added to it.

 

Different types of honey can be found globally, named according to their geographic origin or the specific flower that serves as the prime source of nectar. Some of the examples are Clover honey, Manuka honey, and Jamun Honey.  Both Manuka and Jamun honey originates from single-flora flowering shrubs of the family Myrtaceae. Manuka is derived from the flowers of Leptospermum scoparium and Jamun from Syzygium cumini flowers. They are also the most popular type of honey for medical use. Continents apart, Manuka and Jamun honey has been successfully used for treating wounds. 

 

The honey used in today’s wound care treatments is medical-grade honey, which is raw honey treated with gamma irradiation, filtered, and tested.  Medical honey is not heated or pasteurized. Therefore, it contains many of the original compounds present in raw honey. The risk of contamination by Clostridium botulinum spores is, however, eliminated through the gamma irradiation process. 

Using Honey for Wound Healing

The topical application of medical-grade honey can impact the wound healing environment positively. Honey is acidic and has a pH of around 3.5-4.5. Therefore, it can be naturally used for topical acidification of wounds to promote healing by increasing the release of oxygen from hemoglobin. Honey seems to be an effective wound treatment for three main reasons: it is antibacterial, anti-inflammatory, and has antioxidant properties. 

Inflammation and bacteria delay can inhibit wound healing. However, the demonstrated antibacterial properties of honey against bacteria like Staphylococcus aureus can aid the healing process of wounds. The presence of bacteria feeding and metabolizing various amino acids in the wound is also the cause of malodor in wounds. 

Using honey as the wound dressing decreases the odor in two ways – through an antimicrobial effect and by providing a preferential food source for bacteria, glucose.  Unlike the metabolites of amino acids, glucose does not produce odorous amines and sulfurs as byproducts of metabolism that lead to the putrid odor.

Manuka or Leptospermum honey is the most widely used variety of honey in wound care.  Manuka honey is associated with high antibacterial activity not found in the same concentration as other types of honey. 

Methylglyoxal is an antibacterial present in high levels in Manuka honey. It is formed when the dihydroxyacetone found in the Leptospermum nectar is converted into methylglyoxal over time.  However, as Manuka honey is only produced in one area of the world, it is quite expensive, and the potential for adulteration does exist. The amount of Manuka honey sold in the world is ten times more than what is produced. To prevent adulteration, the government of New Zealand, in 2018, introduced strict testing standards for Manuka honey. One required test is the presence of DNA from Leptospermum scoparium pollen found in the honey.

Unfortunately, Manuka adulteration creates the possibility that the potential benefits of honey could be lost. Still, honey dressings seem to offer a treatment option that allows for moist wound healing and provides added antimicrobial and anti-inflammatory effects.  The rigorously tested products and those with a higher percentage of actual honey are likely to be more effective.  Such products are also more likely to contain all the beneficial properties of raw honey as it was first used in ancient times.

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Form of Honey for Wound Dressing

Various product names exist for wound dressings containing medical-grade manuka honey.  These include Activon Manuka Honey, Medihoney, Therahoney, Manukahd, to name a few.  Each comes in different forms and formulations and should provide the benefits that honey offers to wound healing.

 

However, even though honey offers an alternative to harsher antiseptics or silver-containing products like silver sulfadiazine, honey products are contraindicated in the presence of a bee allergy. The form of honey selected for treatment can also prove to be challenging to apply in some types of wounds.  

 

A research paper says that honey has almost equal or slightly superior effects when compared with conventional dressings for acute wounds and superficial partial-thickness burns. However, “more randomized controlled trials with significant statistical power comparing different kinds of honey are required in order to create a strong body of evidence towards definite recommendations for medical use”. It will also require several randomized controlled trials to demonstrate what characteristic or component of honey is the active ingredient promoting wound healing. 

 

In any case, honey dressings do seem to offer a treatment option that allows for moist wound healing and can provide added antimicrobial and anti-inflammatory effects.  The rigorously tested products and those with a higher percentage of actual honey are likely to be more effective.  And are likely to contain all the beneficial properties of raw honey as it was first used thousands of years ago.

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Author: Dr. Japa Volchok, DO

Dr. Volchok is the Vice President of Operations at Vohra Wound Physicians. Trained as a vascular and general surgeon he joined Vohra in 2009. Dr. Volchok is currently responsible for Vohra’s telemedicine program, legal and regulatory matters, and physician recruitment. He completed an executive management program at the Harvard Business School.

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