Honey: Uses

Clinical Use

BURNS

Honey-dressed wounds had a more rapid reduction in local inflammation, better infection control and more rapid healing than for standard treatment with silver sulfadiazine (SSD) in a randomised clinical trial. Of the 25 patients with wounds, 84% treated with honey achieved satisfactory epithelialisation by day 7 and 100% by day 21 compared with 72% and 84% respectively with SSD. Histological evidence confirmed honey’s superiority, with 80% of wounds showing significant reparative activity and decreased inflammation by day 7 compared with 52% with SSD.

WOUND HEALING

Honey applications have been used to treat various types of wounds, such as leg ulcers and bed sores. Honey has also been used to enhance postoperative wound healing and partial-thickness wounds such as split-thickness skin graft donor sites.

One study involving 59 patients with wounds or ulcers not responding to conventional treatment were treated with topical unprocessed honey. Of these, 58 cases were reported as showing remarkable recovery, with all sterile wounds remaining sterile until healed and infected wounds becoming sterile within 1 week. The one case that did not respond involved a malignant ulcer. Clinically, honey promoted rapid debridement of wounds, epithelialisation and reduced oedema surrounding the ulcers. Vardi et al (1998) found that 5-10 mL of unprocessed honey applied twice daily to infants not responding to at least 2 weeks of conventional treatment was able to produce a marked clinical improvement within 5 days and complete wound closure after 21 days.

A non-randomised, prospective open study compared the effects of honey-impregnated gauze, paraffin gauze, hydrocolloid dressings and saline-soaked gauzes in 88 patients who underwent skin grafting. Honey gauzes produced a faster epithelialisation and reduced the sensation of pain compared with paraffin and saline-soaked gauzes. This effect was the same as that observed for hydrocolloid dressings.

A honey-medicated dressing was tested for ease of use and efficacy in a study involving 60 patients with chronic, complicated surgical or acute traumatic wounds. In 59 patients, the preparation was considered easy to use and helpful in cleaning wounds.

A RCT of 101 haemodialysis patients compared thrice-weekly application of Medihoney with mupirocin for the healing of catheter exit sites. This study found the honey to be safe, effective and more affordable than mupirocin for this group.

FOURNIER’S GANGRENE

In 1996, the effects of topical unprocessed honey, together with traditional treatment in a rare condition known as Fournier’s gangrene (FG) were investigated. FG is an extensive fulminant infection of the genitals, perineum or the abdominal wall and is generally regarded as a difficult-to-manage infectious disease. The major gross pathological findings are oedema and necrosis of the subcutaneous tissues when the male genitalia are involved, necessitating aggressive treatment. In this study, 38 patients admitted with the diagnosis of FG were treated with broad-spectrum triple antimicrobial therapy, broad debridement, exhaustive cleaning and application of unprocessed honey dressings daily for 2 weeks. Rapid changes to wound healing rate occurred after 10 days’ honey use — advancing necrosis ceased, wounds became sterile, odour was reduced and fluid was absorbed from wounds. Honey also enhanced the growth and multiplication of epithelial cells from the wound edges and reduced the need for scrotal plastic surgery. As a result of the impressive results obtained, these researchers highly recommend honey dressings in gangrenous wounds, suggesting that it significantly improved patient outcomes.

Other Uses

ALLERGIC RHINOCONJUNCTIVITIS

Honey does not reduce symptoms of allergic rhinoconjunctivitis, according to results from a randomised study of 35 volunteers. The study compared the effects of unpasteurised unfiltered honey with filtered and pasteurised honey and corn syrup with synthetic honey flavouring and found that an oral dose of 1 tablespoon daily of either honey produced the same results as placebo.

HEUCOBACTER PYLORI INFECTION

Honey inhibits H. pylori in test tube studies, although no controlled studies are available to clarify its effectiveness in humans.

PERIODONTAL DISEASE

In vitro tests show that honey can inhibit the growth of oral bacteria. As a follow-up investigation, 10 volunteers were asked to swish 5 mL of honey around their mouths for 4 minutes then swallow. At 10 minutes after honey use, oral bacterial counts were significantly decreased.

ECZEMA

Topically applied honey is sometimes used to enhance skin healing and prevent infection in eczema. Although controlled trials are not available, the clinical evidence generally supporting efficacy in wound healing provides a theoretical basis for its use in this condition.

COLON CANCER

Preliminary animal studies on experimentally induced colon cancer show the potential for reduced disease development, but further study is necessary to validate this for clinical use.

DYSBIOSIS

Honey may assist in inhibiting the growth of the pathogenic bacteria Clostridium perfringens and Eubacterium aerofaciens, while not affecting, or possibly promoting, the growth of beneficial Bifidobactenum spp. (B. longum, B. adolescentis, B. breve, B. bifidum and B. infantis).

Dosage Range

Honey is applied topically (see ‘Tips on how best to use honey in practice’ below).

Toxicity

Not applicable — used externally.

Adverse Reactions

A mild transient stinging may occur when applied to open wounds. If this is too uncomfortable, honey can be washed away with warm water.

Allergic reactions have also been reported, but these are considered rare.

Significant Interactions

None known

Contraindications and Precautions

DIABETICS

Honey contains a large concentration of glucose. If applied to large open wounds, it may theoretically elevate blood sugar levels — monitor blood sugar levels.

Pregnancy Use

Safety has not been scientifically established, but historical use suggests that it is safe.

Practice Points / Patient Counselling

• Topical application of honey has been used to enhance wound healing and infection control.

• Honey has a deodorising and debriding effect on wounds, accelerates epithelialisation and reduces inflammation and pain.

• Effects are generally seen within 7 days of use.

• Not all honeys have significant antibacterial properties; however, research has identified the New Zealand Leptospermum (manuka honey) and Australian jelly bush honey as having potent activity.

• The honey to be used as a topical wound-healing agent or dermatological treatment should ideally be sterile and tested for clinical activity.

Answers to Patients’ Frequently Asked Questions

What will honey do for me?

If you apply a honey preparation that has tested positive for antibacterial activity, it will enhance wound healing, reduce pain and inflammation, and reduce the risk of wound infection.

When will it start to work?

Studies have found that by the 7th day of use, most wounds show considerable improvement and healing.

Are there any safety issues?

Using sterile honey preparations is recommended.

Tips on how best to use honey in practice*

• Ensure that there is an even coverage of the wound surface.

• Cavities may be filled by pouring in slightly warmed honey.

• Spreading honey on a dressing pad or gauze rather than on the wound directly will be more comfortable for the patient.

• The amount of honey needed depends on the amount of fluid leaking from the wound — if honey becomes diluted, it will be less effective; typically, 20 mL of honey is used on a 10 cm x 10 cm dressing.

• Cover with absorbent secondary dressings to prevent honey oozing out from the dressing. Change the dressings more frequently if the honey is being diluted — otherwise change every day or two.

*Adapted from www.worldwidewounds.com and www.manukahoney.co.uk.