While honey is typically considered to be a sweetener or a food additive, it has in fact been used for medicinal purposes in the treatment of wounds since before recorded history.

Since the dawn of modern medicine, science struggled to explain its medicinal properties, but research suggests that there may be something to this ancient remedy – and that it may be something that today’s health professionals should study further as a tool that may prove a useful addition to their methods for treating wounds.

Flower nectar, which consists of 90% water and sucrose, is gathered by bees and then transformed into a viscous substance of only 15-20% water honey.

Honey in its pre-processed state is densely packed with nutrients, containing 22 amino acids, 30 bioactive plant compounds, and 31 minerals, as well as fructose and glucose.

The processing of honey for commercial consumption greatly reduces its efficacy, but in its raw state honey possesses many characteristics that are of interest from a medical perspective.

As a solution, honey exhibits high bioactivity. It is supersaturated with sugars that give it high osmolality, interacting strongly with water molecules, which in turn prevents the growth of microorganisms. Similarly, when brought into contact with wound exudates, honey undergoes a glucose oxidase enzyme reaction, which in turn produces hydrogen peroxide.

This provides further antibacterial protection which does not damage the surrounding tissues.

Additionally, some varieties of honey, such as that made from the pollen of Leptospermum scoparium flowers sprouting from Manuka trees, contain high quantities of antibacterial phytochemicals. Honey’s high acidity likewise acts as a catalyst for the release of oxygen from hemoglobin and inhibits harmful proteases.

The sugar in honey assists wound healing by sending the body’s moisture to cleanse the wound while depriving bacteria of it, slowing the latter’s growth. And lastly, some research suggests that honey stimulates the body’s immune system, which helps to ward off infections.

Specific uses for honey in wound treatment

Honey is most often used medicinally as a topical agent for preventing infection, particularly in cases where more conventional antibiotic and antiseptic treatments have proven unsuccessful. It also offers an alternative to harsher antiseptics or products that contain silver and can be used at any stage of treatment.

It has been used in treating burns (honey also possesses anti-inflammatory properties), diabetic foot ulcers, infected wounds, leg ulcers, malignant ulcers, pilonidal sinuses, pressure ulcers, sickle cell ulcers, skin grafts, tropical ulcers, and venous ulcers. Some reports have suggested that honey can also obviate the need for plastic surgery in some cases by stimulating epithelium growth.

Honey is most typically applied as an ointment, impregnated into gauze, or is combined with calcium alginate or hydrocolloids. It assists wound healing by acting as an antibacterial and an antioxidant, reducing inflammation, pain, and swelling.

The use of honey also minimizes the unpleasant odors that can emanate from wounds by virtue of its antimicrobial qualities and by offering an alternative food source for bacteria (glucose), diverting it from the amino acids in the wound itself.

Treatments in which honey has proven useful include wound bed preparation and exudate management, and is useful in preventing the formation of bioburden and biofilms, and can prevent cross-contamination, maceration, and malodor.
Honey has also proven beneficial in wound debridement, as the spreading of honey-based dressings on a wound can assist in the removal of damaged tissues without causing pain to the patient, and often without causing damage to the surrounding healthy cells.

Honey used in dressings

Not all types of honey and the same, and each possesses varying levels of potency depending on its specific bioactivity. The aforementioned Manuka honey, which is native to New Zealand, is most commonly used in wound care.

Its antibacterial properties are much more highly concentrated than in other forms of honey, such as methylglyoxal. The demand for Manuka honey far exceeds the supply, and some honey that is sold as Manuka is in fact fraudulent.

This has led to the need for the government of New Zealand to test batches of Manuka honey before it is exported to ensure that it is authentic. These tests verify its DNA, as well as its antibacterial activity – particularly the compounds dihydroxyacetone, leptospira, and methylglyoxal – and each batch, is then rated for its potency.

Manuka honey that qualifies as medical-grade is sterilized using gamma radiation, which avoids the loss of any of its medicinal qualities.

The existing evidence for honey’s value in wound treatment

Much research remains to be done on the efficacy of honey in treating wounds, but the data so far is promising. A review of the existing studies into honey’s value that was published in 2013 indicated that the use of honey produced results that are almost equal to, or in some cases even superior to, those obtained through more conventional treatments of acute wounds and superficial partial-thickness burns.

The review concluded that sufficient evidence already exists to demonstrate honey’s usefulness in those cases, but that more research was needed to determine whether this extended to other areas of clinical practice as well.

Additionally, a review of 16 randomized controlled trials of the use of honey in wound care that was published in 2011 by Dr. Peter Molan of the University of Waikato, expanding on a previous review of the same topic that he conducted in 2006, indicated that while insufficient high-quality evidence exists to conclusively prove honey’s effectiveness, this is no different than the situation regarding several other treatment methods which are commonly used to treat wounds.

Dr. Molan speculates in his review that many healthcare professionals regard honey disdainfully as an “alternative” treatment unworthy of further study and that this is the real reason why it is often regarded as less effective than other methods.

Further study of honey in wound treatment is required –and warranted by the preliminary evidence – to see if this particular bit of our ancient ancestors’ wisdom can be a guide for our own future medical practices.