Honey for Wound Healing

Editor’s Note from Michael Salewski: Sometimes what’s old becomes new again. In a time where there are so many antibiotic-resistant bacteria, alternative solutions to wound care are often needed.

All civilizations on the globe have relied on natural therapeutic agents to meet their primary health care needs at some point in time. Honey is one of the oldest topical wound healing herbals and has been used for thousands of years. The use of honey as a wound dressing extends some 4,500 years into the past. The use of honey for wound healing is based on historical and anecdotal evidence. Honey and honey poultices applied directly to the skin were commonly used to relieve pain, promote wound healing and treat sores, boils, cuts, abrasions, insect bites, burns and skin disorders. 

The ancient Greeks and the Egyptians were among the first to actually record the beneficial effects of honey for wound care. The ancient Egyptians were among the earliest recorded beekeepers and regularly used honey as a primary wound treatment. Honey has even been found in Egyptian tombs to help preserve body parts. Ancient papyrus documents have recorded that honey was used as an integral part of the “Three Healing Gestures” that included cleaning the wound, applying a salve made from honey, lint, (vegetable fiber) and grease (animal fat), and bandaging the wound. These three steps of ancient wound care are very similar to how wounds are still treated today.

Despite the long history of honey being used for medical conditions, it largely fell out of favor in conventional medical practice during the era of modern antibiotics in the 1970s. Due to the development of antibiotic-resistant wound infections, the use of honey for wound care has undergone a renaissance in the last few years. Veterinary conditions that can be treated with topical herbal medications include: abscesses, infected wounds, bite wounds, degloving injuries, surgical wound infection and dehiscence, burns, non-healing or slow healing skin grafts, infected amputation sites, endocrine skin disorders, snake bite vasculitis, venous chemical slough, gangrene, atopic dermatitis, otitis, stomatitis-gingivitis, chronic rhinitis-sinusitis, non-healing corneal ulcers, seborrhea and pododermatitis.Union.

There have been numerous in vivo and in vitro studies evaluating the antimicrobial and wound-healing properties of honey. Recent investigation and research on honey shows that it contains antibacterial compounds that are effective against many common antibiotic-resistant bacteria. In addition it has been shown to inhibit the growth of a wide range of fungi, protozoa and viruses, and may have application in the treatment of specific cancers.

Not all honeys have equal medicinal value. The anti-microbial activity of honey has been shown to vary in quality according to its floral source. Historical records show that when honey was prescribed for a medical condition, the type and location of the honey was nearly always specified. Doctors throughout history knew that honey obtained from specific floral sources produced better clinical results than honey from other plants or regions. 

Modern laboratory testing of many different types of honeys using bacterial cultures to evaluate their antimicrobial effects have shown this clinical observation to be true. Honey is composed of 17 percent water and 82 percent sugar (primarily glucose and fructose), proteins, enzymes, vitamins, minerals and a variety of floral phytochemicals. All honey has high osmolarity, low pH, low water content and produces hydrogen peroxide that is responsible for its antibacterial properties. Most honeys, when diluted enzymatically, release hydrogen peroxide. However not all honeys exhibit equal hydrogen peroxide activity and so vary in their antimicrobial potency. There are also certain types of honey that contain floral phytochemical factors that are responsible for strong non-peroxide antimicrobial effects. These honeys maintain their antimicrobial properties even when diluted by large amounts of wound exudate. 

The Leptospermum spp (manuka and jellybush) honeys from New Zealand and Australian are in this group and are currently under intense scrutiny for use as wound healing “medical grade honeys.” All medical honey is assigned an antibacterial rating based on their potency, which can vary by a hundred fold. The collection, processing and packaging of honey can also affect the quality of honey and is strictly controlled for honey used for therapeutic purposes. The successful use of honey for wound healing requires that an adequate amount be used and it must be kept in close contact with the wound bed. The severity, location and level of wound exudate are the primary determining factors for choosing the appropriate type of honey product or dressing to use for a particular wound or condition.

Most commercial honey dressings contain 20 ml (25-30 grams) of honey per slow release 10X10 cm dressing. If too little honey is used, it will be quickly diluted by exudate to the point where it becomes ineffective. The frequency of dressing changes also depends on the amount of exudation present. The higher the level of exudation, the greater the dilution of honey and the more frequently the dressing changes. Wounds with low or mild exudation may only require dressings changes every 3-5 days, moderate exudation typically require once daily dressing changes. Wounds with heavy exudation may initially require twice daily dressing changes and should be closely monitored.

Medical honey for wound healing comes in a variety of forms: pure-form honey, tube honey, honey ointment, a variety of honey-impregnated fibre dressing and honey impregnated calcium alginate dressings. Honey has many beneficial properties including analgesia, anti-inflammatory, antibacterial, antiviral, antifungal, antioxidant, immunostimulant, debridement and deodorizing actions. Honey also has the ability to nourish and moisten the skin and decrease scarring. For these reasons, honey should not be looked at as a generic substance. 

From a medical perspective choosing the right type of honey that has been appropriately produced, tested, processed and packaged is critical for optimal treatment outcome. Topical honey has been shown to be safe and effective and can be combined with conventional medications and therapies in the clinic and at home to decrease pain and promote overall quality of life.

Today the use of honey for wound healing is being investigated around the world and incorporated into modern therapeutic wound and skin care products. Medical grade honey based wound care products are now being sold and used in New Zealand, Australia, Canada, United States, Hong Kong and the European Union.

By Signe Beebe, DVM, CVA, CVHC, CVT, Contributor to Animals & Pets on Allthingshealing.com