Should You Consider Using Honey for Wound Care?

Barbara Zeiger
Editor, Ostomy Wound Management

Honey may be the oldest known wound dressing, but scientists only recently have been able to explain how the substance’s bioactivities and physical characteristics play a role in wound healing. Its low pH (3.2-4.5) increases the release of oxygen from hemoglobin and discourages proliferation of harmful proteases. Its high sugar content has a beneficial osmotic effect on the wound by drawing in moisture to hydrate and cleanse as well as antibacterial repercussions by drawing moisture away from bacterial cells, thus inhibiting their growth. Although there are several Cochrane reviews that withhold hearty endorsement of honey in wound care due to questionable aspects of the research, honey use is often considered to be “alternative” medicine. Should its use be considered for wound and skin care within 24 hours to up to 5 days. 

Types of Honey

Medicinal honey is not for-table-use honey. Different types of honey have different potency and nature of antibacterial activity depending on the amount of hydrogen peroxide and its effect on the honey’s osmolarity and acidity. However, the bacterial activity of the honey from manuka trees (and other plants of the genus Leptospermum) does not depend on hydrogen peroxide content; rather, honey’s healing characteristics are a result of methylgloxal—a small, easily diffused water-soluble molecule with antibacterial, immunostimulatory, and anti-inflammatory capabilities. Regardless of type, honey should be sterilized as part of the manufacturing process using gamma-radiation, rather than heat, before use to kill spores of Clostridium that may occur.

What Can Honey Do?

Honey can be used on any type of wound at any stage of healing. Research has shown honey to be capable of clearing infection, healing infected surgical wounds, and thwarting the progression of necrotizing fasciitis (eg, Fournier’s gangrene). It has been used when wounds did not respond to conventional antibiotic and antiseptic therapy and in wounds infected with antibiotic-resistant bacteria. It can deodorize and debride wounds, expediting, and restarting the healing process. 

Honey also has been reported to negate the need for plastic surgery by stimulating epithelium growth. It has been shown to reduce inflammation, edema, and exudate; it soothes wounds and burns and minimizes scarring. 

Honey also has shown benefits in skin grafts, infected donor sites and traumatic wounds, abscesses, pilonoidal sinuses, pressure ulcers, venous ulcers, diabetic ulcers, tropical ulcers (eg, Naga sores, which are large, open, sloughing wounds or abrasions, often infected with spirochetes and bacteria and present on the feet and legs), sickle cell ulcers, and malignant ulcers. It also is used to manage peristomal excoriation around ileostomies and colostomies to facilitate epithelialization. 

Numerous studies have touted honey’s comparative effectiveness, but the quality of the studies limits the ability to celebrate its success over its comparators—ie, it works but perhaps not any more efficaciously than the many dressings to which it has been compared (eg, polyurethane film, silver-impregnated dressings). Honey champions counter that honey maintains its minimum inhibitory concentration even in the presence of copious exudate; in resistance training studies, several species of bacteria tested did not develop a honey resistance and most importantly, the only adverse effect reported among patients is a stinging sensation, probably due to honey’s acidity.

How Can You Use Honey?

If you are considering incorporating honey into your wound and skin care armamentarium, you may want to explore these options.

Wound bed preparation. Honey’s bioactivity aligns closely with the concept of wound bed preparation, a carefully controlled series of events to facilitate or restart timely healing. Honey can be used to manage exudate, debride devitalized tissue, and address bioburden. The appropriate application of honey dressings offers a way forward in managing potential wound-related barriers to healing.

Exudate management. Honey can help reduce the amount of wound exudate through its anti-inflammatory ability to increase fluid movement into soft tissue, subsequently increasing surface exudate. Additional consequences of effective inflammation management include pain and edema reduction, as well as minimization of hypertrophic scarring. 

Debridement. Honey’s osmotic pull draws lymph from the deeper tissues and constantly bathes the wound bed; the proteases in the lymph fluid enhance honey’s debriding action. Plus, the constant cleansing may help remove healing-prohibitive matter. 

Malodor. Because honey provides bacteria an alternative source of energy with glucose, these noxious compounds are no longer produced and wound malodor is avoided.

Maceration. Honey’s osmotic activity has been shown to reduce the risk of maceration, protecting the periwound skin from overhydration.

Bioburden. Honey is effective in vitro against a range of multiresistant organisms, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococci, and other multiresistant gram-negative organisms including Pseudomonas aeruginosa. 

Biofilms. Recent in vitro evidence also has shown honey can prevent the formation of biofilm; specifically, manuka honey disrupted pseudomonal biofilms. 

Cross-contamination. Honey’s viscosity may provide a physical barrier that can prevent cross-contamination.

Although literature reviews comparing options may not be conclusive, consider honey as a viable option in fragile patients who require debridement—both as an antibacterial that is not known to cause resistance and as a soothing, nonallergic dressing that
appears to add to, rather than detract from, the quality of life.


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