Topical Application of Honey for Burn Wound Treatment – an Overview

Honey as a medicine

The medicinal properties of honey have been known over the years. The Indian medicine system Ayurveda describes honey as the nectar of life and recommends its use in the treatment of various ailments such as diarrhoea, ulcers, etc.4 Honey is used as a nutritious food, recommended to be taken along with lemon juice and hot water early in the morning.3 It was used as a component of beauty creams and for embalming the dead in Egypt.

Honey has been used as an adjuvant for accelerating wound healing in ulcers, infected wounds, and burns. It has also been used for storing skin grafts. In 1933 Philips6 mentioned the use of honey in burns and described it as the best natural dressing. In 1937 Voigtlander7 used honey to treat scalds and stressed the relief of pain and honey’s soothing action.

Studies in animal models have demonstrated that honey leads to faster healing and reduced inflammation than controls in infection-free superficial burns and full-thickness wounds and in wounds experimentally infected with Staphylococcus aureus.8 There are case reports describing burn wounds not responding to conventional treatment which healed when honey dressings were used.9 A retrospective study of 156 burn patients treated in a hospital over a 5-yr period (1988 to 1992) found that 13 patients treated with honey had a similar outcome to those treated with silver sulphadiazine.

Prospective randomized controlled clinical trials have proved that honey treatment leads to significantly more rapid healing of superficial and partial-thickness burns than that achieved with silver sulphadiazine, polyurethane film, amniotic membrane, and potato peel.2,1120 However, in full-thickness burns, early tangential excision and skin grafting were found to be superior to honey dressing.

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In superficial and partial-thickness burns, honey treatment of burns has resulted in an effective control of infection that is much better than that achieved with current standard treatment, silver sulphadiazine, and other substances.2123 Thermal injury is an oxidative injury. There is increased free radical activity at the site, resulting in increased lipid peroxidation, which is responsible for scarring and contractures. In burns the early application of honey mops up the free radicals and reduces such scarring and contractures. This may also explain the reduced depigmentation after honey treatment compared to silver sulphadiazine and other methods of treatment. Decreased pain during dressing changes, decreased inflammation, and the promotion of healthy granulation have been shown to be further benefits of honey. Wound swabs taken before and after honey treatment and conventional treatment have shown significantly reduced rates of infection, indicating that honey sterilizes wounds and promotes early granulation.

The components and features of honey that are relevant to wound healing are as follows: viscosity, water content, sugars (primarily glucose and fructose), antioxidants, a wide range of amino acids, vitamins and minerals, glucose oxidase, which produces hydrogen peroxide, and gluconic acid, which gives honey an acidic pH of 3.2 to 4.5. Hydrogen peroxide is produced only when honey is diluted, as glucose oxidase is inhibited in undiluted honey – this provides most of the antibacterial activity of diluted honey (in undiluted honey the high osmolarity prevents bacterial growth) and improves local nutrition, because of levulose and fructose.

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This results in early wound healing and decreased hospital stay, thus contributing to honey treatment’s cost-effectiveness. Honey is cheap, non-toxic, and non-allergenic, it does not stick to the wound, and it provides a moist environment conducive to rapid burn healing.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3188068/

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