Return to
Module 6: Wound Dressing Selection
Topic Progress:

Topic Three: Honey Dressings

Honey has been used in wound care since ancient times, and although it has been used for centuries in wound care, there has been a recent resurgence of interest, with it now being integrated into modern medical practice. There is a wide variety and range of products available which can used to treat many types of wounds, including traumatic wounds, surgical incision sites, burns, sloughy wounds, and pressure ulcers. It is now realised that honey is a biologic wound dressing with multiple bioactivities that work in harmony to expedite the healing process (Molan & Rhodes, 2015).

Honey has broad-spectrum antibacterial activity, but not all honeys have the same potency or action (Grothier & Cooper, 2011; Molan & Rhodes, 2015). There are two types of antibacterial activity with most kinds of honey, this is down to the action of hydrogen peroxide. However, much of this is inactivated by the enzyme catalase, which can be found in blood, serum, and wound tissues (Molan & Rhodes, 2015). In manuka honey, this is due to methylglyoxal, which is not inactivated. It can stand being diluted and still maintain its antibacterial activity (Grothier & Cooper, 2011; Molan & Rhodes, 2015).

Honey has been shown to be effective against 60 species of bacteria, including aerobes, anaerobes, gram-positive organisms, gram-negative organisms and resistant strains of Staphylococcus pyogenes and Staphylococcus aureus (Benbow, 2005; Grothier & Cooper, 2011).

Mode of Action

Some honeys produce hydrogen peroxide on dilution. Conversely, manuka honey does not create detectable levels and is known as a non-peroxide honey (Wound Care Today 2016). The physical properties of honey positively impact the wound healing process. Honey is acidic with a pH of around 3.2 – 4.5, 5 (Molan & Rhodes, 2015). This promotes healing by increasing the release of oxygen from haemoglobin and also has an effect on protease activity, slowing the negative effects they can have on a wound. Honey has a high osmolarity due to its elevated sugar content. The osmotic effect of the sugar draws out water from the wound bed. As long as the circulation of blood underneath the wound is sufficient to replace the fluid lost from the cells, there shouldn’t be any risk of harm or dehydration to the wound tissue (Molan & Rhodes, 2015).

The osmotic effect of honey has been thought to encourage lymphatic flow to devitalised tissue, an action beneficial to the healing process (Seckam & Cooper, 2013). This mode of action also reduces the wound’s bacterial load, in turn promoting autolytic debridement.

Honey dressings have the following properties:

  • Broad-spectrum antibacterial action
  • Deodorising action
  • Promotes wound debridement
  • Maintains moist wound environment
  • Anti-inflammatory action and potential pain relief
  • Stimulation of wound healing

(Wound Care Today, 2016)

Disadvantages

  • May be a need for frequent dressing changes as a result of its dilution of exudate
  • Possibility of honey allergy
  • Can cause pain at the wound site (sometimes described as a drawing sensation)

(Colbourn, Hampton, & Tadej, 2009)

Advantages

  • Maintains a moist wound management
  • Control and reduce odour from wounds
  • Can be used on a variety of wounds
  • Can be effective on infected wounds
  • Antibacterial
  • Variety of dressings available
  • Can be used under compression

(Vuolo, 2009; Wound Care Today, 2016)

Indications for use

There are a wide variety of wounds where honey may be beneficial. For example:

  • Burns
  • Pressure ulcers
  • Venous and arterial leg ulcers
  • Pilonidal sinuses
  • Fungating wounds
  • Surgical wounds
  • Superficial wounds
  • Donor sites
  • Infected wounds that are unresponsive to conventional treatment

(Betts & Molan, 2001; Wound Source, 2017)

Contraindications

Honey dressings should be avoided in patients with a history of sensitivity or allergy to honey and or bee venom.

Honey dressings, particularly manuka, have been shown to improve the healing process in clinical studies with patients with diabetes (Molan & Rhodes, 2015). A study published in the diabetic foot journal in 2009 suggested that honey dressings do not impact on glycaemic control in patients with diabetes (Kirby et al., 2009). However, further studies need to be undertaken to explore this area further.

Honey is commercially available in sheet or gel form, which should be covered with an appropriate secondary dressing, depending on the exudate level. It is also available in impregnated foam dressings, which can be applied directly to the wound and do not require a secondary dressing.

The currently available literature would generally support the continued use and evaluation of honey in the wound care setting, although more clinical trials are required to demonstrate significant clinical outcome differences compared to first-line dressings.

For further information, visit: NICE