Advertisement

American Journal of Clinical Dermatology

, Volume 12, Issue 3, pp 181–190 | Cite as

Honey and Wound Healing

An Overview
  • David S. Lee
  • Sammy Sinno
  • Amor Khachemoune
Review Article Honey and Wound Healing

Abstract

Honey has been used to treat wounds throughout the ages. This practice was rooted primarily in tradition and folklore until the late 19th century, when investigators began to characterize its biologic and clinical effects. This overview explores both historic and current insights into honey in its role in wound care. We describe the proposed antimicrobial, immunomodulatory, and physiologic mechanisms of action, and review the clinical evidence of the efficacy of honey in a variety of acute and chronic wound types. We also address additional considerations of safety, quality, and the cost effectiveness of medical-grade honeys. In summary, there is biologic evidence to support the use of honey in modern wound care, and the clinical evidence to date also suggests a benefit. However, further large, well designed, clinical trials are needed to confirm its therapeutic effects.

Keywords

Pressure Ulcer Chronic Wound Pyoderma Gangrenosum Venous Ulcer Manuka Honey 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Sipos P, Gyõry H, Hagymási K, et al. Special wound healing methods used in ancient Egypt and the mythological background. World J Surg 2004 Feb; 28 (2): 211–6Google Scholar
  2. 2.
    The Qur’an. Surah 16: An-Nahl [The Bee]: 1–128; verses 68-69Google Scholar
  3. 3.
    Sahih Bukhari. Volume 7; Book 71: medicine. Hadith #588Google Scholar
  4. 4.
    Hippocrates. The genuine works of Hippocrates. Adams F, translator. London: Sydenham Society, 1849Google Scholar
  5. 5.
    Majno G. The healing hand: man and wound in the ancient world. Cambridge (MA): Harvard University Press, 1991Google Scholar
  6. 6.
    Shizhen L. Bencao Gangmu: compendium of materia medica. Beijing: Foreign Languages Press, 2003Google Scholar
  7. 7.
    Getz FM. Healing and society in medieval England: a Middle English translation of the pharmaceutical writings of Gilbertus Anglicus. Madison (WI): University of Wisconsin Press, 1991Google Scholar
  8. 8.
    Subrahmanyam M. Honey dressing for burns: an appraisal. Ann Burns Fire Disasters 1996 Mar; 9 (1): 33–5Google Scholar
  9. 9.
    Dustmann JH. Antibacterial effect of honey. Apiacta 1979; 14 (1): 7–11Google Scholar
  10. 10.
    Griffin LL, George SMC, Harland CC. The bee’s knees: a history of bee products in dermatology. Br J Dermatol 2009; 161 Suppl. 1: 71–2Google Scholar
  11. 11.
    Gundell M, Blattner V. Über die wirkung des honigs auf bakerien und infizierte wunden. Arcj Hyg 1934; 112: 319–32Google Scholar
  12. 12.
    Bulman MW. Honey as a surgical dressing. Middlesex Hosp J 1955; 55 (6): 188–9Google Scholar
  13. 13.
    Simon A, Traynor K, Santos K, et al. Medical honey for wound care: still the ‘latest resort’? Evid Based Complement Alternat Med 2009 Jun; 6 (2): 165–73Google Scholar
  14. 14.
    United States Food and Drug Administration, Office of Device Evaluation. 510(k) premarket notification, July 30, 2009 [online]. Available from URL: (http://www.accessdata.fda.gov/cdrh_docs/pdf8/K083334.pdf) [Accessed 2010 Apr 5]
  15. 15.
    United States Food and Drug Administration, Office of Device Evaluation. 510(k) premarket notification, June 19, 2008 [online]. Available from URL: (http://www.accessdata.fda.gov/cdrh_docs/pdf8/K081584.pdf [Accessed 2010 Apr 5]
  16. 16.
    United States Food and Drug Administration, Office of Device Evaluation. 510(k) premarket notification, April 23, 2008 [online]. Available from URL: (http://www.accessdata.fda.gov/cdrh_docs/pdf8/K080315.pdf [Accessed 2010 Apr 5]
  17. 17.
    United States Food and Drug Administration, Office of Device Evaluation. 510(k) premarket notification, November 7, 2007 [online]. Available from URL: (http://www.accessdata.fda.gov/cdrh_docs/pdf7/K072956.pdf [Accessed 2010 Apr 5]
  18. 18.
    United States Food and Drug Administration, Office of Device Evaluation. 510(k) premarket notification, July 25, 2007 [online]. Available from URL: (http://www.accessdata.fda.gov/cdrh_docs/pdf5/K053613.pdf [Accessed 2010 Apr 5]
  19. 19.
    United States Food and Drug Administration, Office of Device Evaluation. 510(k) premarket notification, July 12, 2007 [online]. Available from URL: (http://www.accessdata.fda.gov/cdrh_docs/pdf5/K053095.pdf [Accessed 2010 Apr 5]
  20. 20.
    White JR, Subers MH, Schepartz AI. The identification of inhibine, the antibacterial factor in honey, as hydrogen peroxide and its origin in a honey glucose-oxidase system. Biochim Biophys Acta 1963 May 7; 73: 57–70Google Scholar
  21. 21.
    Wilkinson JM, Cavanagh HM. Antibacterial activity of 13 honeys against Escherichia coli and Pseudomonas aeruginosa. J Med Food 2005; 8 (1): 100–3PubMedCrossRefGoogle Scholar
  22. 22.
    Henriques AF, Jenkins RE, Burton NF, et al. The intracellular effects of manuka honey on Staphylococcus aureus. Eur J Clin Microbiol Infect Dis 2010 Jan; 29 (1): 45–50Google Scholar
  23. 23.
    Alandejani T, Marsan J, Ferris W, et al. Effectiveness of honey on Staphylococcus aureus and Pseudomonas aeruginosa biofilms. Otolaryngol Head Neck Surg 2009 Jul; 141 (1): 114–8Google Scholar
  24. 24.
    Okhiria OA, Henriques AFM, Burton NF, et al. Honey modulates biofilms of Pseudomonas aeruginosa in a time and dose dependent manner. J Api Product Api Medical Sci 2009; 1 (1): 6–10Google Scholar
  25. 25.
    Tan HT, Rahman RA, Gan SH, et al. The antibacterial properties of Malaysian tualang honey against wound and enteric microorganisms in comparison to manuka honey. BMC Complement Altern Med 2009 Sep 15; 9: 34Google Scholar
  26. 26.
    Blaser G, Santos K, Bode U, et al. Effect of medical honey on wounds colonised or infected with MRSA. J Wound Care 2007 Sep; 16 (8): 325–8Google Scholar
  27. 27.
    George NM, Cutting KF. Antibacterial honey (Medihoney™): in-vitro activity against clinical isolates of MRSA, VRE, and other multiresistant Gramnegative organisms including Pseudomonas aeruginosa. Wounds 2007; 19 (9): 231–6Google Scholar
  28. 28.
    Zeina B, Othman O, al-Assad S. Effect of honey versus thyme on Rubella virus survival in vitro. J Altern Complement Med 1996 Fall; 2 (3): 345–8PubMedCrossRefGoogle Scholar
  29. 29.
    Al-Waili NS. Topical honey application vs. acyclovir for the treatment of recurrent herpes simplex lesions. Med Sci Monit 2004 Aug; 10 (8): MT94–8Google Scholar
  30. 30.
    Tonks AJ, Cooper RA, Jones KP, et al. Honey stimulates inflammatory cytokine production from monocytes. Cytokine 2003 Mar 7; 21 (5): 242–7Google Scholar
  31. 31.
    Tonks AJ, Dudley E, Porter NG, et al. A 5.8kDa component of Manuka honey stimulates immune cells via TLR4. J Leukoc Biol 2007 Nov; 82 (5): 1147–55Google Scholar
  32. 32.
    Timm M, Bartelt S, Hansen EW. Immunomodulatory effects of honey cannot be distinguished from endotoxin. Cytokine 2008 Apr; 42 (1): 113–20Google Scholar
  33. 33.
    Beretta G, Artali R, Caneva E, et al. Quinoline alkaloids in honey: further analytical (HPLC-DAD-ESI-MS, multidimensional diffusion-ordered NMR spectroscopy), theoretical and chemometric studies. J Pharm Biomed Anal 2009 Oct 15; 50 (3): 432–9Google Scholar
  34. 34.
    Tonks A, Cooper RA, Price AJ, et al. Stimulation of TNF-alpha release in monocytes by honey. Cytokine 2001 May 21; 14 (4): 240–2Google Scholar
  35. 35.
    van den Berg AJ, van den Worm E, van Ufford HC, et al. An in vitro examination of the antioxidant and anti-inflammatory properties of buckwheat honey. J Wound Care 2008 Apr; 17 (4): 172–4, 176-8Google Scholar
  36. 36.
    Du Toit DF, Page BJ. An in vitro evaluation of the cell toxicity of honey and silver dressings. J Wound Care 2009 Sep; 18 (9): 383–9Google Scholar
  37. 37.
    Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg 1998 Aug; 176 (2A Suppl.): 26S–38SGoogle Scholar
  38. 38.
    Church J. Honey as a source of the anti-stiffness factor [abstract]. Fed Proc Am Physiol Soc 1954; 13 (1): 26Google Scholar
  39. 39.
    Galiano RD, Mustoe TA. Wound care. In: Thorne CH, Beasley RW, Aston SJ, et al., editors. Grabb and Smith’s plastic surgery. 6th ed. Philadelphia (PA): Lippincott Williams & Wilkins, 2007: 23–32Google Scholar
  40. 40.
    Subrahmanyam M. Aprospective randomised clinical and histological study of superficial burn wound healing with honey and silver sulfadiazine. Burns 1998 Mar; 24 (2): 157–61Google Scholar
  41. 41.
    Subrahmanyam M, Shahapure AG, Nagne NS. Effects of topical application of honey on burn wound healing. Ann Burns Fire Disasters 2001; 14: 143–5Google Scholar
  42. 42.
    Majtan J, Kumar P, Majtan T, et al. Effect of honey and its major royal jelly protein 1 on cytokine and MMP-9 mRNA transcripts in human keratinocytes. Exp Dermatol. Epub 2009 Oct 21Google Scholar
  43. 43.
    Gethin GT, Cowman S, Conroy RM. The impact of Manuka honey dressings on the surface pH of chronic wounds. Int Wound J 2008; 5: 185–94PubMedCrossRefGoogle Scholar
  44. 44.
    Schneider LA, Korber A, Grabbe S, et al. Influence of pH on wound-healing: a new perspective for wound-therapy? Arch Dermatol Res 2007 Feb; 298 (9): 413–20Google Scholar
  45. 45.
    Jull A, Walker N, Parag V, et al., Honey as Adjuvant Leg Ulcer Therapy Trial Collaborators. Randomized clinical trial of honey-impregnated dressings for venous leg ulcers. Br J Surg 2008 Feb; 95 (2): 175–82Google Scholar
  46. 46.
    Seymour FI, West KS. Honey: its role in medicine. Med Times 1951 Feb; 79 (2): 104–8Google Scholar
  47. 47.
    Cavanagh D, Beazley J, Ostapowicz F. Radical operation for carcinoma of the vulva: a new approach to wound healing. J Obstet Gynaecol Br Commonw 1970 Nov; 77 (11): 1037–40Google Scholar
  48. 48.
    Hutton DJ. Treatment of pressure sores. Nurs Times 1966 Nov 18; 62 (46): 1533–4Google Scholar
  49. 49.
    Phillips CE. Honey for burns. Bee culture: the magazine of American beekeeping 1933; 61: 284 [online]. Available from URL: (http://www.beeculture.com/) [Accessed 2011 Feb 14]
  50. 50.
    Burlando F. The therapeutic effect of honey on burns [in Italian]. Minerva Dermatologica 1978; 113: 699–706Google Scholar
  51. 51.
    Somerfield SD. Honey and healing [letter]. J R Soc Med 1991 Mar; 84 (3): 179Google Scholar
  52. 52.
    Tovey FI. Honey and healing [letter]. J R Soc Med 1991 Jul; 84 (7): 447Google Scholar
  53. 53.
    Bourne IH. Honey and healing of leg ulcers. J R Soc Med 1991 Nov; 84 (11): 693–4Google Scholar
  54. 54.
    Subrahmanyam M. Honey impregnated gauze versus polyurethane film (OpSite) in the treatment of burns: a prospective randomised study. Br J Plast Surg 1993 Jun; 46 (4): 322–3Google Scholar
  55. 55.
    Subrahmanyam M. Honey dressing versus boiled potato peel in the treatment of burns: a prospective randomized study. Burns 1996 Sep; 22 (6): 491–3Google Scholar
  56. 56.
    Subrahmanyam M. Topical application of honey in treatment of burns. Br J Surg 1991 Apr; 78 (4): 497–8Google Scholar
  57. 57.
    Wijesinghe M, Weatherall M, Perrin K, et al. Honey in the treatment of burns: a systematic review andmeta-analysis of its efficacy. N Z Med J 2009 May 22; 122 (1295): 47–60Google Scholar
  58. 58.
    Cooper RA, Halas E, Molan PC. The efficacy of honey in inhibiting strains of Pseudomonas aeruginosa from infected burns. J Burn Care Rehabil 2002 Nov-Dec; 23 (6): 366–70PubMedCrossRefGoogle Scholar
  59. 59.
    Emsen IM. A different and safe method of split thickness skin graft fixation: medical honey application. Burns 2007 Sep; 33 (6): 782–7Google Scholar
  60. 60.
    Misirlioglu A, Eroglu S, Karacaoglan N, et al. Use of honey as an adjunct in the healing of split-thickness skin graft donor site. Dermatol Surg 2003 Feb; 29 (2): 168–72Google Scholar
  61. 61.
    Hamzaoglu I, Saribeyoglu K, Durak H, et al. Protective covering of surgical wounds with honey impedes tumor implantation. Arch Surg 2000; 135: 1414–7PubMedCrossRefGoogle Scholar
  62. 62.
    Vardi A, Barzilay Z, Linder N, et al. Local application of honey for treatment of neonatal postoperative wound infection. Acta Paediatr 1998 Apr; 87 (4): 429–32Google Scholar
  63. 63.
    Al-Waili NS, Saloom KY. Effects of topical honey on post-operative wound infections due to Gram positive and Gram negative bacteria following Caesarean sections and hysterectomies. Eur J Med Res 1999 Mar 26; 4 (3): 126–30Google Scholar
  64. 64.
    Weheida SM, Nagubib HH, El-Banna HM, et al. Comparing the effects of two dressing techniques on healing of low grade pressure ulcers. J Med Res Institute 1991; 12 (2): 259–78Google Scholar
  65. 65.
    Stotts NA, Rodeheaver GT, Thomas DR, et al. An instrument to measure healing in pressure ulcers: development and validation of the Pressure Ulcer Scale for Healing (PUSH). J Gerontol A Biol Sci Med Sci 2001 Dec; 56 (12): M795–9Google Scholar
  66. 66.
    YapucuGüneŝ U, Eŝer I. Effectiveness of a honey dressing for healing pressure ulcers. J Wound Ostomy Continence Nurs 2007 Mar-Apr; 34 (2): 184–90Google Scholar
  67. 67.
    Smith T, Legel K, Hanft JR. Topical Leptospermum honey (Medihoney) in recalcitrant venous leg wounds: a preliminary case series. Adv Skin Wound Care 2009 Feb; 22 (2): 68–71Google Scholar
  68. 68.
    Sare JL. Leg ulcer management with topical medical honey. Br J Community Nurs 2008 Sep; 13 (9): S22, S24, S26 passimGoogle Scholar
  69. 69.
    van der Weyden EA. Treatment of a venous leg ulcer with a honey alginate dressing. J Clin Nurs 2009 Feb; 18 (3): 466–74Google Scholar
  70. 70.
    Dunford CE, Hanano R. Acceptability to patients of a honey dressing for nonhealing venous leg ulcers. J Wound Care 2004 May; 13 (5): 193–7Google Scholar
  71. 71.
    Gethin G, Cowman S. Manuka honey vs. hydrogel: a prospective, open label, multicentre, randomised controlled trial to compare desloughing efficacy and healing outcomes in venous ulcers. J Clin Nurs 2009 Feb; 18 (3): 466–74Google Scholar
  72. 72.
    Eddy JJ, Gideonsen MD. Topical honey for diabetic foot ulcers. J Fam Pract 2005 Jun; 54 (6): 533–5Google Scholar
  73. 73.
    Remmen R, Coenen S, Seuntjens R, et al. Honey for refractory diabetic foot ulcers [letter]. J Fam Pract 2005 Oct; 54 (10): 863Google Scholar
  74. 74.
    Shukrimi A, Sulaiman AR, Halim AY, et al. A comparative study between honey and povidone iodine as dressing solution for Wagner type II diabetic foot ulcers. Med J Malaysia 2008 Mar; 63 (1): 44–6Google Scholar
  75. 75.
    Efem SE. Recent advances in the management of Fournier’s gangrene: preliminary sobservations. Surgery 1993 Feb; 113 (2): 200–4Google Scholar
  76. 76.
    Tahmaz L, Erdemir F, Kibar Y, et al. Fournier’s gangrene: report of thirtythree cases and a review of the literature. Int J Urol 2006 Jul; 13 (7): 960–7Google Scholar
  77. 77.
    Subrahmanyam M, Ugane SP. Honey dressing beneficial in treatment of Fournier’s gangrene. Ind J Surg 2004; 66: 75–7Google Scholar
  78. 78.
    Alese OB, Irabor DO. Pyoderma gangrenosum and ulcerative colitis in the tropics. Rev Soc Bras Med Trop 2008 Nov-Dec; 41 (6): 664–7Google Scholar
  79. 79.
    Subrahmanyam M. Honey as a surgical dressing for burns and ulcers. Ind J Surg 1993; 55 (9): 468–73Google Scholar
  80. 80.
    Mphande AN, Killowe C, Phalira S, et al. Effects of honey and sugar dressings on wound healing. J Wound Care 2007 Jul; 16 (7): 317–9Google Scholar
  81. 81.
    Robson V, Dodd S, Thomas S. Standardized antibacterial honey (Medihoney) with standard therapy in wound care: randomized clinical trial. J Adv Nurs 2009 Mar; 65 (3): 565–75Google Scholar
  82. 82.
    Schumacher HH. Use of medical honey in patients with chronic venous leg ulcers after split-skin grafting. J Wound Care 2004 Nov; 13 (10): 451–2Google Scholar
  83. 83.
    Moore OA, Smith LA, Campbell F, et al. Systematic review of the use of honey as a wound dressing. BMC Complement Altern Med 2001; 1: 2PubMedCrossRefGoogle Scholar
  84. 84.
    Bardy J, Slevin NJ, Mais KL, et al. A systematic review of honey uses and its potential value within oncology care. J Clin Nurs 2008 Oct; 17 (19): 2604–23Google Scholar
  85. 85.
    Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996 Feb; 17 (1): 1–12Google Scholar
  86. 86.
    Jull AB, Rodgers A, Walker N. Honey as a topical treatment for wounds. Cochrane Database Syst Rev 2008 Oct 8; (4): CD005083Google Scholar
  87. 87.
    British Columbia Cancer Agency. A randomized placebo-controlled trial of Manuka honey for oral mucositis due to radiation therapy for cancer [ClinicalTrials. gov identifier NCT00615420]. US National Institutes of Health, ClinicalTrials.gov [online]. Available from URL: (http://www.clinicaltrials.gov) [Accessed 2010 Mar 29]
  88. 88.
    Wyeth. A methodology study to assess cough counts in subjects with acute upper respiratory tract infections [ClinicalTrials.gov identifierNCT01062256]. US National Institutes of Health, ClinicalTrials.gov [online]. Available from URL: (http://www.clinicaltrials.gov) [Accessed 2010 Mar 29]
  89. 89.
    Penn State University; National Honey Board. Effect of honey and dextromethorphan on nocturnal cough and sleep quality for coughing children and their parents [ClinicalTrials.gov identifier NCT00127686]. US National Institutes of Health, ClinicalTrials.gov [online]. Available from URL: (http://www.clinicaltrials.gov) [Accessed 2010 Mar 29]
  90. 90.
    Wenham TN. Botulism: a rare complication of injecting drug use. Emerg Med J 2008 Jan; 25 (1): 55–6Google Scholar
  91. 91.
    Nevas M, Lindström M, Hautamäki K, et al. Prevalence and diversity of Clostridium botulinum types A, B, E and F in honey produced in the Nordic countries. Int J Food Microbiol 2005 Nov 25; 105 (2): 145–51Google Scholar
  92. 92.
    Nakano H, Okabe T, Hashimoto H, et al. Incidence of Clostridium botulinum in honey of various origins. Jpn J Med Sci Biol 1990 Oct; 43 (5): 183–95Google Scholar
  93. 93.
    Nevas M, Lindström M, Hörman A, et al. Contamination routes of Clostridium botulinum in the honey production environment. Environ Microbiol 2006 Jun; 8 (6): 1085–94Google Scholar
  94. 94.
    Molan PC, Allen KL. The effect of gamma-irradiation on the antibacterial activity of honey. J Pharm Pharmacol 1996 Nov; 48 (11): 1206–9Google Scholar
  95. 95.
    White R. The benefits of honey in wound management. Nurs Stand 2005 Nov 16-22; 20 (10): 57–64Google Scholar

Copyright information

© Adis Data Information BV 2011

Authors and Affiliations

  1. 1.Stritch School of MedicineLoyola University ChicagoMaywoodUSA
  2. 2.Veterans Affairs Medical CenterBrooklynUSA
  3. 3.Dermatology ServiceVeterans Affairs HospitalBrooklynUSA

Personalised recommendations