Review
Biological properties and therapeutic activities of honey in wound healing: A narrative review and meta-analysis

https://doi.org/10.1016/j.jtv.2015.12.002Get rights and content

Highlights

  • Different types of honey have different medicinal value and effects on wound healing.

  • Honey has anti-microbial, immunomodulatory, anti-oxidant and wound healing properties.

  • Honey increases wound contraction, re-epithelialization and reduces excessive scar formation.

  • Most of the clinical trials suggest the use of honey for management of various wound models.

  • Honey is a safe, cost-effective and beneficial dressing biomaterial for wound management.

Abstract

For thousands of years, honey has been used for medicinal applications. The beneficial effects of honey, particularly its anti-microbial activity represent it as a useful option for management of various wounds. Honey contains major amounts of carbohydrates, lipids, amino acids, proteins, vitamin and minerals that have important roles in wound healing with minimum trauma during redressing. Because bees have different nutritional behavior and collect the nourishments from different and various plants, the produced honeys have different compositions. Thus different types of honey have different medicinal value leading to different effects on wound healing. This review clarifies the mechanisms and therapeutic properties of honey on wound healing. The mechanisms of action of honey in wound healing are majorly due to its hydrogen peroxide, high osmolality, acidity, non-peroxide factors, nitric oxide and phenols. Laboratory studies and clinical trials have shown that honey promotes autolytic debridement, stimulates growth of wound tissues and stimulates anti-inflammatory activities thus accelerates the wound healing processes. Compared with topical agents such as hydrofiber silver or silver sulfadiazine, honey is more effective in elimination of microbial contamination, reduction of wound area, promotion of re-epithelialization. In addition, honey improves the outcome of the wound healing by reducing the incidence and excessive scar formation. Therefore, application of honey can be an effective and economical approach in managing large and complicated wounds.

Section snippets

History and background

Throughout history, honey has been well used for medicinal applications. Islamic traditions, ancient Egyptians, ancient Greek, Chinese and other countries and nations have used honey as a remedy for every illness [1]. In modern history and in World War I, honey was used for repair of battle wounds. For the first time in 1892, antimicrobial properties of honey were noted by Van Ketel. The role of honey in healing of infected wounds was first reported in Europe and USA in the mid-20th century [2]

Therapeutic properties of honey

Honey, due to its antimicrobial, anti-inflammatory and antioxidant activities, boosting effect on immune system, debridement action and stimulating role in wound regeneration, significantly contributes in wound healing processes (Fig. 1, Table 1). Bellow, these beneficial biological properties have been discussed in detail.

Clinical observations on the wound healing properties of honey

To systematically evaluate the role of honey on clinical patients, only the clinical studies published in PubMed were considered. From the PubMed indexed clinical studies, only those that their patients had a cutaneous ulcer/wound and treated with honey, were included in the present review. In the present study, the clinical trials have been combined and their findings were provided as meta-analysis where appropriate and other clinical studies have been summarized, narratively. Based on the

Conclusion

In the present review, we highlighted the key information regarding therapeutic properties of honey and its mechanism of action. Honey is the most ancient wound dressing biomaterial and the effectiveness of honey in the management of wounds has been confirmed by many studies. There is no allergic reaction and no significant side effects due to clinical application of honey. Honey has all of the beneficial criteria to be considered as an ideal dressing material applicable for various wounds. It

Conflict of interest

There are no conflicts of interest.

References (146)

  • G.R. Williams et al.

    Deformed wing virus in western honeybees (Apis mellifera) from atlantic Canada, the first description of an overtly-infected emerging queen

    J Invertebr Pathol

    (2009)
  • A.M. McDermott

    Defensins and other antimicrobial peptides at the ocular surface

    Ocul Surf

    (2004)
  • A. Barui et al.

    Assessment of molecular events during in vitro re-epithelialization under honey-alginate matrix ambience

    Mater Sci Eng C Mater Biol Appl

    (2013)
  • M.B. Witte et al.

    Role of nitric oxide in wound repair

    Am J Surg

    (2002)
  • M. Kassim et al.

    The inhibitory effects of Gelam honey and its extracts on nitric oxide and prostaglandin E(2) in inflammatory tissues

    Fitoterapia

    (2010)
  • A. Lowe et al.

    Electrospun nitric oxide releasing bandage with enhanced wound healing

    Acta Biomater

    (2015)
  • G. Han et al.

    Nitric oxide-releasing nanoparticles accelerate wound healing by promoting fibroblast migration and collagen deposition

    Am J Pathol

    (2012)
  • E.J. Brisbois et al.

    Optimized polymeric film-based nitric oxide delivery inhibits bacterial growth in a mouse burn wound model

    Acta Biomater

    (2014)
  • A. Raynaud et al.

    Honey-induced macrophage stimulation: AP-1 and NF-κB activation and cytokine production are unrelated to LPS content of honey

    Int Immunopharmacol

    (2013)
  • N.S. Al-Waili et al.

    Honey and microbial infections: a review supporting the use of honey for microbial control

    J Med Food

    (2011)
  • D.S. Lee et al.

    Honey and wound healing: an overview

    Am J Clin Dermatol

    (2011)
  • P.H. Kwakman et al.

    Antibacterial components of honey

    IUBMB Life

    (2012)
  • A. Oryan et al.

    Effects of topical application of honey on cutaneous wound healing in rabbits

    Zentralbl Veterinarmed A

    (1998)
  • S. Bittmann et al.

    Does honey have a role in paediatric wound management?

    Br J Nurs

    (2010)
  • O.A. Moore et al.

    Systematic review of the use of honey as a wound dressing

    BMC Complement Altern Med

    (2001)
  • R. Strohal

    The EWMA document: debridement

    J Wound Care

    (2013)
  • M. Rüttermann et al.

    Local treatment of chronic wounds: in patients with peripheral vascular disease, chronic venous insufficiency, and diabetes

    Dtsch Arztebl Int

    (2013)
  • C.E. Manyi-Loh et al.

    An overview of honey: therapeutic properties and contribution in nutrition and human health

    Afr J Microbiol Res

    (2011)
  • J. Wasiak et al.

    Dressings for superficial and partial thickness burns

    Cochrane Database Syst Rev

    (2008)
  • A. Oryan et al.

    Effects of 4-chloro-2,6-bis-(2-hydroxyl-benzyl)-phenol on healing of skin wounds and growth of bacteria

    J Vet Med A Physiol Pathol Clin Med

    (2007)
  • A. Oryan et al.

    Effects of aqueous extract of Aloe vera on experimental cutaneous wound healing in rat

    Vet Arch

    (2010)
  • M.R. Tabandeh et al.

    Silibinin regulates matrix metalloproteinase 3 (stromelysine1) gene expression, hexoseamines and collagen production during rat skin wound healing

    Phytother Res

    (2013)
  • J.J. Song et al.

    Use of honey in wound care: an update

    Adv Skin Wound Care

    (2011)
  • R. Yaghoobi et al.

    Evidence for clinical use of honey in wound healing as an anti-bacterial, anti-inflammatory anti-oxidant and anti-viral agent: a review

    Jundishapur J Nat Pharm Prod

    (2013)
  • K. Brudzynski et al.

    Powerful bacterial killing by buckwheat honeys is concentration-dependent, involves complete DNA degradation and requires hydrogen peroxide

    Front Microbiol

    (2012)
  • R.J. Fair et al.

    Antibiotics and bacterial resistance in the 21st century

    Perspect Med Chem

    (2014)
  • D.J. Tirado et al.

    Efficacy of medical grade honey against multidrug-resistant organisms of operational significance: part I

    J Trauma Acute Care Surg

    (2014)
  • R. Cooper et al.

    Are there feasible prospects for manuka honey as an alternative to conventional antimicrobials?

    Expert Rev Anti Infect Ther

    (2012)
  • L. Labban

    Honey as a promising treatment for diabetic foot ulcers (DFU)

    J Med Soc

    (2014)
  • P. McLoone et al.

    Honey: a realistic antimicrobial for disorders of the skin

    J Microbiol Immunol Infect

    (2015)
  • S.E. Blair et al.

    The unusual antibacterial activity of medical-grade Leptospermum honey: antibacterial spectrum, resistance and transcriptome analysis

    Eur J Clin Microbiol Infect Dis

    (2009)
  • A.L. Camplin et al.

    Manuka honey treatment of biofilms of Pseudomonas aeruginosa results in the emergence of isolates with increased honey resistance

    Ann Clin Microbiol Antimicrob

    (2014)
  • R.A. Cooper et al.

    Absence of bacterial resistance to medical-grade manuka honey

    Eur J Clin Microbiol Infect Dis

    (2010)
  • K. Brudzynski et al.

    Antibacterial compounds of Canadian honeys target bacterial cell wall inducing phenotype changes, growth inhibition and cell lysis that resemble action of β-lactam antibiotics

    PLoS One

    (2014)
  • J. Majtan et al.

    Anti-biofilm effects of honey against wound pathogens Proteus mirabilis and Enterobacter cloacae

    Phytother Res

    (2014)
  • J. Lu et al.

    Manuka-type honeys can eradicate biofilms produced by Staphylococcus aureus strains with different biofilm-forming abilities

    PeerJ

    (2014)
  • P. Merckoll et al.

    Bacteria, biofilm and honey: a study of the effects of honey on 'planktonic' and biofilm-embedded chronic wound bacteria

    Scand J Infect Dis

    (2009)
  • J. Atrott et al.

    Methylglyoxal in Manuka honey – correlation with antibacterial properties

    Czech J Food Sci

    (2009)
  • J. Majtan

    Methylglyoxal-a potential risk factor of manuka honey in healing of diabetic ulcers

    Evid Based Complement Altern Med

    (2011)
  • F. Katiraee et al.

    Antifungal activity of Iranian honeybees against Candida, Aspergillus species and Trichophyton Rubrum

    J Food Process Preserv

    (2014)
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