The sweet life: Honey making comeback for treatment of chronic wounds

Key Points

National report - It is sticky; it is sweet. And if patients who use Medihoney (Derma Sciences, Princeton, N.J.) to heal their wounds leave it open on the counter, it might attract bugs.

"There are references to honey in the medical literature for more than 4,000 years; however, around World War II, when antibiotics were discovered, the use of honey and other dressings diminished," says Diane Maydick Youngberg, M.S.N., R.N., A.C.N.S.-B.C., C.W.O.C.N., director of clinical affairs, Derma Sciences.

Looking to revive honey's wound-healing properties - notably, a low pH and high osmotic component - Derma Sciences developed three formulations using sterilized, medical-grade, plant-derived active Leptospermum honey imported from New Zealand. The Food and Drug Administration cleared Medihoney as a burn wound dressing in July 2007.

Sold as an active Leptospermum honey-impregnated calcium alginate, colloid or a wound filler (liquid in a tube), Medihoney has been shown in various studies to help heal especially stubborn wounds.

Authors of a study published in the August 2008 Journal of Clinical Nursing conducted a randomized, controlled clinical trial showing a significant improvement in healing rates of stalled venous leg ulcers after subjects applied honey. The 108 subjects in the trial had venous leg ulcers that did not heal with compression therapy.

During the study, half added a common advanced woundcare gel to compression therapy, and half added manuka honey (now marketed under the brand name Medihoney).

After four weeks, the mean reduction in size of the wounds was 34 percent in the honey group and 13 percent in the control group. After 12 weeks, there was a 44 percent complete healing rate in the honey group vs. 33 percent in the control group.

Case studies

Tracey C. Vlahovic, D.P.M., associate professor, Temple University School of Podiatric Medicine, Philadelphia, cites cases in which she prescribed the honey for patients.

Dr. Vlahovic says that despite clearance for treating multiple types of ulcerations, Leptospermum honey's unique characteristics make it useful in other scenarios, such as skin irritations and disease.

In the case of a 45-year-old female with an infected second toe, a physician had performed an incision and drainage. A culture yielded a culture that was positive for methicillin-resistant Staphylococcus aureus. The patient had no relief from IV antibiotics.

At the patient's first visit with Dr. Vlahovic, the podiatrist debrided the necrotic tissue and dressed the wound with Leptospermum honey-impregnated calcium alginate. The patient continued to use the product with dressing changes at home and finished the IV antibiotics. At six weeks, the skin had healed completely.

According to Dr. Vlahovic, a 60-year-old diabetic female had scraped her foot on a wood surface and thought she had removed the splinter. Dr. Vlahovic noted a small draining area on the dorso-lateral aspect of the left foot and expressed a small amount of purulence, but she could not feel or extrude any foreign body. She dressed the wound with honey, and the patient used the product for home woundcare between office visits.

During the patient's second visit, Dr. Vlahovic removed the dressing and extracted a large splinter from the wound. The patient continued to use the honey at home, and, at the third visit, the wound was closed without incident.

Dr. Vlahovic concluded that Medihoney is an effective, non-invasive and painless treatment for a variety of dermatological conditions.

Contraindications

The only contraindication to honey's use for wound healing is if a patient is allergic to honey or alginate, Ms. Maydick Youngberg tells Dermatology Times.

"People also need to be aware that because honey has high osmolarity, it tends to pull a lot of fluid out of the wound. So, dermatologists need to know up front that patients using it may initially notice an increased amount of drainage.

"If they have increased drainage, an absorbent cover dressing should be used, and the skin around the wound should be protected with a skin protectant to minimize the chance of maceration," she says.

"This is a great product to help debride wounds - it prepares the wound bed quite nicely for healing. It is a dressing that can be used all the way from onset through closure," Ms. Maydick Youngberg says.

Disclosures: Ms. Maydick Youngberg is director of clinical affairs, Derma Sciences. Dr. Vlahovic reports no relevant financial disclosures.