ABSTRACT: Is Honey Effective for the Treatment of Burns?
Poster Presentation By: Amy and Mike Kiley
Honey has been used for millennia in medical traditions dating back to Ancient Egyptian civilizations.7 Mentions of honey are found in the Edwin Smith Papyrus which is believed to be the oldest documented scientific observation in medicine.2 Traditionally, honey has been used for the treatment of cough, ulcers, insomnia, wounds, sunburns, gastrointestinal infections, and burns.2 The beneficial properties of honey are typically attributed to the physical characteristics of honey and the antimicrobial activity of honey. Four mechanisms for the antimicrobial properties of honey have been proposed. The first property is the high sugar content of honey that draws moisture from the surrounding environment, thus dehydrating microbes and reducing bacterial growth. Secondly, the application of honey to tissue results in the production of hydrogen peroxide from glucose oxidase. The third property is the acidic pH of honey, which is typically between 3.2 and 4.5, and reduces microbial growth. Lastly, honey has shown to have anti-inflammatory properties which aid in T and B cell proliferation.4 In addition to the antimicrobial properties of honey, the viscosity of honey may also aid in the healing of burns and wounds by creating a protective barrier over the wound to prevent contamination from the environment, encourage healing by creating a moist environment to encourage epithelialization, and prevent adhesion of wound dressings to the burn. Some side effects expected with honey may include a stinging sensation when applied, nausea and vomiting if ingested. If honey is ingested it may interact with anticoagulant medications, phenytoin and other medications that are metabolized by CYP3A4. Honey should also be avoided in infants less than 1 year of age. The purpose of this review poster is to determine if honey is a safe and effective treatment of mild, superficial burns.
A prospective randomized clinical and histological study led by M. Subrahmanyam et al. randomly allocated patients with superficial thermal burns to measure epithelialization (skin growth) of patients treated with honey and compare them against patients treated with silver sulfadiazine. Group 1 (n = 25) patients received pure, unprocessed, undiluted honey. Honey was spread over the wound and covered with dry gauze and bandaged. The dressing was changed every other day. Group 2 (n = 25) patients received gauze that was filled with silver sulfadiazine and the dressing was changed daily. Both groups received wound evaluation every other day during the dressing changes to record type of granulation tissue, discharge and foul smell. The times taken for healing of the wounds were recorded for both groups and a bacterial culture and sensitivity determination was done in addition. The author found that Group 1 patients on the 7th day had satisfactory epithelialization occur in 84% of patients and 100% by the 21st day. Group 2 patients on the 7th day had satisfactory epithelialization occur in 72% of patients and had 84% of patients by the 21st day. Authors concluded that patients who received honey treatment observed a quicker wound healing time when compared to patients who received Silver Sulfadiazine.7
Aziz et al. led a systematic review of randomized control trials in humans comparing silver sulfadiazine to honey for the treatment of burn wounds. The literature search resulted in 4151 articles, and after applying the inclusion and exclusion criteria, 10 articles were analyzed and data was extracted from these by two investigators independently. According to a pooled effect based on a random-effect model (I2 of 93%), honey showed a statistically significant reduction in healing time that silver for superficial burn wounds (Mean Difference -4.62; 95% CI -7.37 to -1.88). As for the number of wounds rendered sterile, the pooled data showed a statistically significant effect favoring the use of honey over silver (RR 9.08; 95% CI 1.69 to 48.81). The authors concluded that although the data consistently favored the use of honey for the treatment of burn wounds, there lacks sufficient high-quality evidence to support the use of honey in clinical practice. 2
Clinical studies have shown that honey may be safe and effective in the treatment of mild superficial and partial thickness burns.2,3,9,5 A systematic review found honey to be clinically superior in anti-inflammatory and anti-infectious outcomes and the time for healing was significantly shorter with honey. However, currently available studies and trials on the effectiveness of honey for the treatment of burns are not of the highest quality.3 Further randomized controlled studies need to be conducted with larger population sizes to obtain a greater external validity and more substantial evidence. Current evidence should be presented to patients by pharmacists to provide informed decision making with patients and the use of alternative medicines.
- Aziz, Zoriah, and Bassam Abdul Rasool Hassan. “The Effects of Honey Compared to Silver Sulfadiazine for the Treatment of Burns: A Systematic Review of Randomized Controlled Trials.” Burns., vol. 43, no. 1, 2017, pp. 50–57.
- Eteraf-Oskouei, Tahereh, and Moslem Najafi. “Traditional and modern uses of natural honey in human diseases: a review.” Iranian journal of basic medical sciences vol. 16,6 (2013): 731-42.
- Moore, O A et al. “Systematic review of the use of honey as a wound dressing.” BMC complementary and alternative medicine vol. 1 (2001): 2. doi:10.1186/1472-6882-1-2
- Natural Medicines Comprehensive Database. https://naturalmedicines-therapeuticresearch-com./databases/food,-herbs-supplements/professional.aspx?productid=738#effectiveness
- Subrahmanyam, M. “Topical application of honey in treatment of burns.” The British journal of surgery vol. 78,4 (1991): 497-8. doi:10.1002/bjs.1800780435
- Subrahmanyam, M. “Topical application of honey for burn wound treatment – an overview.” Annals of burns and fire disasters vol. 20,3 (2007): 137-9.
- Subrahmanyam, M. “A prospective randomised clinical and histological study of superficial burn wound healing with honey and silver sulfadiazine.” Burns : journal of the International Society for Burn Injuries vol. 24,2 (1998): 157-61. doi:10.1016/s0305-4179(97)00113-7
- van Middendorp, Joost J et al. “The Edwin Smith papyrus: a clinical reappraisal of the oldest known document on spinal injuries.” European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society vol. 19,11 (2010): 1815-23. doi:10.1007/s00586-010-1523-6
- Zbuchea, A. “Up-to-date use of honey for burns treatment.” Annals of burns and fire disasters vol. 27,1 (2014): 22-30.