Topical Honey and Wounds

Honey on Sloughy Venous Ulcers

   Reference: 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. 2008;Aug 23. [Epub ahead of print]    Rationale: Expert opinion suggests honey may be effective as a wound desloughing and healing agent. Randomized controlled trials (RCTs) on chronic wounds remain to be conducted.    Objective: Conduct a prospective RCT to explore the effects of Manuka honey (MH) on VU desloughing and healing.    Methods: Adult patients with an ankle/brachial systolic blood pressure ratio (ABI) ≥ 0.8 recruited from vascular centers in the United Kingdom, acute care, and community leg ulcer clinics with a VU area Honey in Wound Care: A Cochrane Review    Reference: Jull AB, Rodgers A, Walker N. Honey as a topical treatment for wounds. Cochrane Database Syst Rev. 2008;(4):CD005083.    Rationale: Honey has been used since ancient times in wound care. Preclinical studies and some clinical trials suggest honey may accelerate healing.    Objective: Conduct a systematic review to determine whether honey accelerates acute and/or chronic wound healing.    Methods: The authors searched Cochrane, EMBASE, MEDLINE, and CINAHL databases for RCTs and quasi-experimental controlled studies using any source of honey on acute or chronic clinical wounds with primary outcomes of time to complete healing or proportion of participants with completely healed wounds. Secondary outcomes included length of hospital stay, change in wound size, cost of care, quality of life, and incidence of infections or adverse events. Manufacturers were contacted for unpublished trials. Combined analyses were performed if data were homogeneous. Treatment effects were deemed significant if P ≤ 0.05.    Results: Nineteen trials on 2554 patients were included in the analysis. Homogeneity was insufficient for a combined healing analysis of acute and chronic wound studies. Topical honey reduced healing time compared to conventional dressings for partial-thickness burns (2 studies; 496 honey patients; P Clinical Perspective    The RCT by Gethin et al suggests that honey matches or exceeds the recognized capacity of hydrogel for autolytic debridement of sloughy VUs, and facilitates healing for VUs independent of risk factors for delayed healing. The robust association between Margolis scores and 12-week percentage healed in both groups suggests research exploring predictive validity of Margolis score for 12-week VU healing. Simply put, larger VUs with longer duration take longer to heal.    Another hypothesis to explore is that the larger, longer duration of the VUs, the more difference MH makes.7 Gethin et al studied patients with more recalcitrant, larger, more slough-covered VU with mean duration 29–39 weeks compared to 16- to 20-week duration VUs studied by Jull et al6—the second VU study in the Jull et al Cochrane review summarized above. Variability in “usual care” control treatments may also explain lack of consistency of the reported favorable MH healing effect.6 The Cochrane reviewers conclude that a possible healing effect of MH as an adjuvant to compression cannot be ruled out inviting further RCTs on VUs and other chronic wounds. The overall effect of honey on adverse events remains to be clarified in future studies with more consistent reporting of both severity and frequency of adverse events.    The Cochrane review conclusion that honey is safe and may improve healing in burns and skin graft donor sites is useful information to support acute wound care decisions. Future RCTs are needed on chronic wounds comparing outcomes using topical honey from different sources.

References

1. Breasted JH. The Edwin Smith Papyrus, Published in Facsimile and Hieroglyphic Transliteration. Chicago, IL: University of Chicago Press; 1930. 2. Molan PC. The evidence supporting the use of honey as a wound dressing. Int J Low Extrem Wounds. 2006;5(1):40–54. 3. Cooper RA, Molan PC, Harding KG. The sensitivity to honey of Gram-positive cocci of clinical significance isolated from wounds. J Appl Microbiol. 2002;93(5):857–863. 4. Tonks AJ, Dudley E, Porter NG, et al. A 5.8-kDa component of manuka honey stimulates immune cells via TLR4. J Leukoc Biol. 2007;82(5):1147-1155. 5. Margolis DJ, Berlin JA, Strom BL. Which venous leg ulcers will heal with limb compression bandages? Am J Med. 2000;109(1):15–19. 6. Jull A, Walker N, Parag V, Molan P, Rodgers A. Honey as adjuvant leg ulcer therapy trial collaborators. Randomized clinical trial of honey-impregnated dressings for venous leg ulcers. Br J Surg. 2008;95(2):175–182. 7. Bolton LL. Leg ulcers and honey: a review of recent controlled trials. In: Cooper RA, Molan P, White RJ, eds. Honey: A Modern Wound Management Product. Shaftesbury, Dorset, UK: Wounds UK Books; 2008:16–29.