November/December 2024

November/December 2024 Issue

Wound Care: Harnessing the Healing Power of Honey
By Keith Loria
Today’s Geriatric Medicine
Vol. 17 No. 6 P. 8

A Natural Solution for Wound Care

Honey has been used for centuries in wound care due to potent antibacterial properties that contribute to its effectiveness, but during the past two decades, it’s been an officially approved treatment.

“A professor in New Zealand—Peter Molan—was the first person who looked at the effects of Manuka honey on wound healing and got involved with the biggest honey company in New Zealand to study how to put honey into wound dressings or a tube to treat serious nonhealing wounds,” says Edward J. Quilty, director and vice president of corporate development for wound care company Gentell Inc, who was first introduced to the use of honey in 2006 and was instrumental in the FDA clearance for its medical use four years later.

Bapi Gorain, an assistant professor in the department of pharmaceutical sciences and technology at the Birla Institute of Technology in Ranchi, India, who’s been studying the use of honey in wound care for almost a decade, notes there are several characteristics of honey that make it such an important solution.

“High sugar content in honey creates a hyperosmolar environment, and this osmotic effect draws water out of bacterial cells, leading to dehydration and inhibition of bacterial growth,” he says. “The acidic pH of honey (pH 3.2 – 4.5) inhibits the growth of many pathogens. Most bacteria cannot thrive in such an acidic environment.”

What’s more, glucose oxidase in honey produces hydrogen peroxide when diluted with wound exudates. Therefore, slow production and release of hydrogen peroxide from honey upon application at the wound environment acts as a disinfectant, killing invading bacteria at the wound surface without damaging surrounding tissues.

“Methylglyoxal, a compound with strong antibacterial properties in Manuka honey, interferes with bacterial growth and helps eradicate infections,” Gorain says.

Additionally, honey contains various phytochemicals (such as flavonoids and phenolic acids) that have antibacterial, anti-inflammatory, and antioxidant properties. These compounds can damage bacterial cell walls, inhibit biofilm formation, and neutralize free radicals, thereby promoting wound healing.

The Right Honey
There are different varieties of honey available in the market commonly used in wound care, but the most important is Manuka honey, according to David Navazio, president and CEO of Gentell.

Produced from the nectar of the Leptospermum scoparium bush in New Zealand and Australia, Manuka honey is renowned for its high methylglyoxal content, which provides strong antibacterial properties.

“Manuka honey is preferred in wound care for its ability to promote healing, reduce inflammation, and prevent infection in various types of wounds,” he says.

There’s also neem honey, obtained from the nectar of the neem tree, which is native to the Indian subcontinent. This honey is known for its antiseptic and antifungal properties, effective in treating wounds and skin infections.

“It helps in reducing inflammation, promoting tissue repair, and preventing bacterial growth, making it suitable for wounds that require a natural antibacterial solution,” Gorain says.

Tulsi honey is produced by bees that collect nectar from the tulsi plant and is revered for its medicinal properties in Ayurvedic medicine. This honey is rich in antioxidants and has antibacterial and anti-inflammatory properties, which make it beneficial for wound healing and skin health. Tulsi honey is particularly useful for soothing irritated skin, reducing infection risk, and supporting the healing of minor wounds and burns.

Other varieties valuable for wound care, Gorain adds, include acacia honey, which promotes healing by maintaining a moist wound environment and reducing inflammation; eucalyptus honey, which is highly effective for its ability to reduce inflammation, promote tissue regeneration, and inhibit bacterial infections, making it ideal for treating cuts, burns, and other minor skin injuries; and Tualang honey, often used for burns and chronic wounds due to its ability to create a moist healing environment and combat infection.

“These varieties of honey are preferred over others due to potential anti-inflammatory properties, antimicrobial activity, and promoting tissue regeneration by enhancing fibroblast proliferation and collagen synthesis,” Gorain says. “Their ability to maintain a moist wound environment and facilitate enzymatic activity supports the natural healing processes, accelerating recovery and improving wound outcomes.”

Honey vs Conventional Treatments
Honey and more conventional wound care treatments both have their strengths, but they differ in several critical ways with regard to healing time and infection prevention.

Quilty notes that various research has proved honey can promote faster healing than can conventional treatments as its antimicrobial, immunomodulatory, antioxidant and anti-inflammatory properties help reduce infection, leading to quicker wound recovery.

Additionally, honey creates a moist wound-healing environment and keeps the surrounding skin dry, which is optimal for faster tissue repair.

“By maintaining a moist wound environment, honey can facilitate new tissue development and reduce scarring,” Quilty says.

“Modern dressings and treatments are designed to optimize the healing environment effectively, as honey does in reducing inflammation and infection,” Gorain says. “Some advanced wound healing dressings, like hydrogels, hydrocolloids, foam, nanofiber, and polymeric films, can also maintain a moist environment and promote healing, but they might not have the antimicrobial, immunomodulatory, and antioxidant properties similar to honey.”

It’s because of the presence of sugar, proteins, vitamins, minerals, organic acids, enzymes, polyphenolic compounds, and flavonoids, that honey has anti-inflammatory, antimicrobial, immunomodulatory, and antioxidant effects. These medical benefits effectively help in wound healing and may have pain control potential.

“Conventional treatments often involve antibiotic ointments, creams, and gels that can prevent infection,” Gorain says. “However, antibiotic resistance, a condition where a specific antibiotic can no longer kill bacteria, is risky if these treatments are used improperly or excessively. Modern dressings, bandages, and advanced formulations are designed to keep the wound clean and protected from external contaminants.” They usually succeed in preventing infection, he says, if they’re appropriately used and changed regularly and the infected area is cleaned.

Effective Treatment
Honey has been shown to treat many different types of wounds, from chronic wounds such as diabetic ulcers or pressure sores; burn wounds as a result of its ability to reduce pain and infection risk and promotion of tissue regeneration; and surgical wounds, as it can reduce the incidence of wound infection and promote faster healing. It’s also helpful for infected wounds, minor cuts, and scrapes.

Recent Research
Recent clinical studies have continued to explore honey’s efficacy and benefits in wound care.

One important study is “MEDIHONEY Gel Versus Collagenase for Wound Debridement,” which compared the ability of two products, Active Leptospermum Honey and Collagenase, to remove nonviable tissue.

“The study evaluated the noninferiority of MEDIHONEY Gel compared to Collagenase, two FDA-approved treatments, with respect to the percent reduction of necrotic (including slough and eschar) tissue in the wound at the end of 14 days,” Gorain says.

Another study, by Nupur Kapoor and Rahul Yadav, published in 2021 in the National Journal of Maxillofacial Surgery, looked at the growing use of Manuka honey in wound care.

“The investigators conducted a randomized, controlled, single-blinded study of patients undergoing reconstructive surgery,” Gorain explains. “This project uses split-thickness skin graft and free tissue transfer donor sites as standard wound models to compare the effects of Manuka honey versus standard wound care therapies.”

A third study, “A Comparative Study Between Use of Topical Honey and Edinburgh University’s Solution of Lime (EUSOL) Dressing in Necrotizing Fascitis Wounds,” by Lajpat Rai et al was published in 2023 in Cureus. The prospective randomized trial was conducted on patients undergoing dressing after debridement of necrotizing fasciitis wounds over a six-month period. It compared the effectiveness of EUSOL and honey dressings in wound healing, with outcomes measured through granulation tissue appearance, allergic reactions, and hospital stay duration.

Potential Risks
Using honey for wound care has become increasingly popular due to its natural antimicrobial and healing properties. However, several potential risks and side effects are associated with its use, which need careful consideration.

“Firstly, the allergic reactions—individuals with allergies to pollen or bee products might experience immune reactions when honey is applied to wounds,” Gorain says. “Symptoms can include itching, redness, swelling, and, in severe cases, anaphylaxis.”

Secondly, nonmedical-grade honey, which can contain bacteria, fungi, and other contaminants, poses a risk of infection if applied to open wounds. Medical-grade honey is sterilized to eliminate these contaminants.

Thirdly, Gorain says, some patients may experience irritation and sensitivity—a stinging sensation upon application of honey to their wounds. “This sensation can be uncomfortable and may discourage continued use.”

Another potential risk is the osmotic effect, by which honey’s high sugar content creates a hyperosmolar environment that can draw fluids out of the wound. While this can help reduce wound exudate, it may also lead to dehydration of the wound tissue if not adequately managed.

As the research progresses, the medical community continues to uncover and validate myriad ways in which honey can revolutionize wound care, offering a natural, effective alternative to conventional treatments.

— A graduate of the University of Miami, Keith Loria is a D.C.-based award-winning journalist who has been writing for major publications for nearly 20 years on topics as diverse as health care, travel, and sports.