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Healing Wounds: What’s the Buzz about Sweet and Sticky Dressings?

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Humans have eaten honey for over 8,000 years and used honey almost as long to treat wounds.  A plethora of current-day treatment options exist for wound care, and wound dressings containing honey are now standard. Do they work? Why use them?  What is so special about honey?

 

Honey, the sweet, amber, viscous liquid made and stored by bees.  A pound of honey is the processed and concentrated nectar of two million flowers. It is broken down by the honeybee in a unique structure known as the bee crop the flower nectar changes from a liquid of 90% water and sucrose into its final form a viscous material containing 15-20% water.  Raw honey, unpasteurized, contains fructose, glucose, 22 amino acids, 30 bioactive plant compounds, and 31 mineral, including zinc and magnesium.  Glucose oxidase is also present and produces hydrogen peroxide and gluconic acid when water is incorporated or added into honey.  Commercial processing of honey for food and other uses involves heating and filtering, which destroys many of these compounds.  There are numerous varieties of honey commonly named based on geographic origin or some specific flower that makes up the bulk of the nectar source.  Clover honey, Manuka honey, Jamun honey, are just a few examples.  Both Munka and Jamun originate from single-flora flowering shrubs of the family Myrtaceae. Continents apart Manuka and Jamun honey have been successfully used for treating wounds.  Manuka derived from the Leptospermum scoparium flowers and Jamun from Syzygium cumini flowers.

The honey used in today’s wound care treatments is medical-grade honey.  The raw honey has been treated with gamma irradiation, filtered, and tested.  Medical has not been pasteurized and still contains many of the original compounds present in raw honey.  The risk of contamination by Clostridium botulinum spores has been eliminated.  A pH of 3.5-4.5, 0.5% gluconic acid, and hyperosmolar quality make honey an excellent antibacterial substance.  Of variable concentration is glucose oxidase.  When applied to a wound, glucose oxidase, in the presence of water, produces hydrogen peroxide and gluconic acid.  Hydrogen peroxide occurs at various degrees and in some honey varieties, does not occur too much extent at all.

 

Available in ointment form, impregnated into gauze, combined with hydrocolloids, or calcium alginate honey offers an alternative to the harsher antiseptics or silver-containing products.  Honey products are contraindicated in the presence of a bee allergy.  The form of honey selected for treatment can prove challenging to apply in some types of wounds.  Honey seems to be an effective wound treatment for three main reasons: it is antibacterial, it is anti-inflammatory, and it has antioxidant properties.  Inflammation and bacteria delay and inhibit wound healing.  The presence of bacteria feeding and metabolizing various amino acids in the wound is the cause of malodor in wounds.  Using honey as the wound dressing decreases the odor by both an antimicrobial effect and by providing a preferential found source for bacteria, glucose.  Unlike the metabolites of amino acids, glucose does not produce odorous amines and sulfurs as byproducts of metabolism. 

Manuka or Leptospermum honey is the most widely used variety of honey in wound care.  Manuka honey has an additional antibacterial activity not found in the same concentration in other honeys.  Methylglyoxal is an antibacterial present in high levels in Manuka as is.  It is formed when then dihydroxyacetone found in the Leptospermum nectar is converted into methylglyoxal over time.  Because Manuka honey is only produced in one area of the world, it is more expensive, and in-demand the potential for adulteration does exist.  Approximately ten times more, Manuka honey is sold worldwide than produced.  The government of New Zealand in 2018 introduced the testing standard for Manuka honey one required test is the presence of DNA from Leptospermum scoparium pollen found in the honey. 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. 

Additional research and time is needed to demonstrate the effectiveness of any single product and also to demonstrate what characteristic or component is the actual active ingredient.  Counterfeit honey is common, and Manuka adulteration creates the possibility that the potential benefits of honey could be lost and the benefits of a specific honey variety lost entirely.  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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