ABSTRACT: Is Honey Effective for the Treatment of Burns?
Poster Presentation By: Amy and Mike Kiley
Background
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.
Clinical Evidence
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
Conclusions
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.
References
- 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.
Responses
Hello Amy and Mike – what are the two main things you learned from preparing and developing this topic?
Hi Dr. Shane-McWhorter,
I found the history behind Honey to be fascinating. I had no idea that ancient civilizations we’re using honey to heal skin ailments 5,000 years ago. I also found it interesting that many studies found honey to be non-inferior and in some cases superior to silver sulfadiazine. I would say after doing this poster topic I have an additional remedy I could recommend to patients with mild and superficial burns.
Hi Dr. Shane-McWhorter,
The first main thing that I learned from preparing on this topic was the antimicrobial properties of honey. I was shocked to find that honey has been found to be effective against such a wide range of bacteria.
The second thing I learned was about the current guidelines for the treatment of burns. I am actually quite surprised that silver sulfadiazine is preferred, and honey is not mentioned in the guidelines. I looked into possible reasons why this might be and it looks like there is just little financial interest in completing clinical trials for FDA approval of honey for the treatment of burns. I would be very interested to chat with a provider who works in the Burn Unit to see what they’ve encountered and what their thoughts on honey would be.
Interesting topic. You mention that honey is effective for MRSA – are burn patients more susceptible to MRSA? What type of statistical evaluation was done in the first study (p values)? Who would you say are good candidates for use of honey to treat burns? How many subjects were included in the second study (systematic review)?
Hi Dr. Shane-McWhoter,
As for the susceptibility of MRSA in burn patients, the guidelines do recommend treating burns with antibiotics and in severe cases to consider MRSA. Similar to many skin wounds, with burns there is a concern of possible MRSA infection. Burn wounds are also more susceptible to infection due to the epithelial damage.
I believe that the best candidate for the use of honey on burns would be patients with a first degree burn (not extending past the epidermis) that is less than 3 inches in diameter. I definitely think honey should be studied more in clinical trials. The current evidence suggests that honey may be more beneficial for burns that the current standard of care. However, there is a need for more testing before this could be implemented into actual practice. Though, unlike silver sulfadiazine which is manufactured by a pharmaceutical company, honey is a relatively cheap and commonly available material. This limits the funding available to test honey in clinical trials.
In the second study, there were 160 subjects included in the review.
Amy & Mike – what made you choose this topic? Have you used honey for burns or do you know someone who has? If so, how well did it work for you/them? I enjoyed learning about the uses of honey and its mechanism of action. Great poster!
Hi Brittney,
Thank you for your question. Amy and I came to this topic through deep literature searches on herbal supplements and uncommon uses. We came across honey and its use in burns and it seemed like a great fit after reading a few abstracts. Who knew honey had so many uses? Neither Amy nor I have used honey on our own burns as this topic was the first time we found that it could be used to treat burn wounds. I do not know anyone personally that has used honey on burns but I imagine they would find it to be useful, given it was not a severe burn and was limited to a diameter size of less than 3 inches.
Thanks for stopping by and give such positive feedback!
Hey Brittney!
Thanks for the positive feedback on our poster! Initially, I wanted to try and find an herbal supplement linked to the history of witchcraft or supernatural superstition. However, many of these supplements have already been addressed and I wanted to find something that has shown to be effective or possibly effective. We looked at quite a few different herbal supplements, and finally landed on honey due to the sheer number of possibly effective uses of honey!
Very interesting! I have heard of local honey being used to treat seasonal allergies but have never heard of it being used to treat burns. My husband recently took up the hobby of beekeeping this year and we have been harvesting honey the past month, so the only thing I can think of when treating burns with honey is how sticky and messy it would be (since that is the current status of my kitchen). 🙂
Hi Cassie,
Thanks for the comment and for stopping by! We and various authors of the studies we looked at agree, this is a sticky mess but that is also appealing for holding some dry sterile gauze onto the burn site. The nice thing about honey is it is nonirritating and you can simply wash it off the sight of injury when you’re done! We found it especially interesting that many studies showed that burns treated with honey 🍯 had a faster healing time than those who used silver sulfadiazine cream which is the standard treatment for mild burns. Although this area of study is still needing additional research to give more evidence.
Hi Amy and Mike, very interesting topic. I am surprised that honey was actually better than silver sulfadiazine for mild to moderate burns. In the Aziz et al. study it was reported that there was a difference between the groups (-4.62). What is the units associated with the difference? days? It wasn’t clear to me.
Hi Dr. Malone,
The units used was days and it was based on the time to burn healing. This is one of the limitation of this study since there was no universal metric used in each study to determine the definition of a healed burn.
I was also interested to see that honey may be better than silver sulfadiazine! My boyfriend got some second-degree burns on his hand a couple years ago. It cost an arm and a leg to take him to instacare and all we got from it was a tube of silver sulfadiazine! Haha perhaps honey would have been a much less expensive alternative.
Hi Amy and Mike,
I have seen many people in my home country use it for the same reasons but I never trusted it. It’s good to have studies on it that prove they may be right. Well done guys I liked it!
Hey Amy and Mike! I just recently got a really bad muffler burn and actually came across this as a treatment last week (I didn’t trust it but its nice to see studies that support it haha). I was wondering if you guys came across any data in regards to scars after burns and if there was one treatment that was superior over the other?
Great question Brenae,
So we actually did see in some studies that honey had a reduction in scaring as well when compared to silver sulfadiazine. After a burn or thermal injury to the skin cells release a lot of free radicals which damage lipid cell walls and are believed to be responsible for the burn scarring. Honey acts as an antioxidant and “mops” up the free radicals and stops them from continuing to wreaking havoc to the area and thereby reduces the scarring.
I will attach the article I used for a lot of our background information in this poster as it goes over this as well. You can see it under the subtitle “Honey as a medicine” and look into the 5th paragraph. It is a really interesting topic.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3188068/ Topical Application of Honey for Burn Wound Treatment – an Overview
Awesome! thanks so much!
Here’s a question I guarantee you never thought of; in your research, did you find any reports of using different types of honey? That would be an interesting trial to run.
Hi Tyler,
This is actually something that comes up quite often in the literature. Differences in honey stem from the type of flower that the bee extracts the honey from. The most commonly studied honey is Manuka honey, which as its name implies, is honey made from bee extracting nectar from the Manuka plant.
However, as noted in the MOA, many of the burn healing properties of honey are attributed to the physical characteristics of honey, such as its thick consistency, which is typical of all honey. While Manuka honey has demonstrated to have more effective antimicrobial activity, other types of honey may also be beneficial for the treatment of superficial mild burns.
We also looked into sterilized versus unsterilized honey for the treatment of burns and there seems to be no difference in effectiveness, since the high sugar content of honey sufficiently acts as an antimicrobial.
I’m curious about the actual application. Is the honey thinned with water or another emulsion? It just seems that it would be too thick in some aspects.
Hi Soren,
Actually, the thickness of the honey contributes to the burn wound healing process by creating a protective and moist barrier to encourage epithelial growth. Adding water was actually found to decrease the effectiveness of honey. The honey is applied as you would a cream or gel, and can be cover with a dressing. The thickness of honey also helps to prevent the adhesion of the dressing to the actual burn wound.
Hi Amy and Mike
Nice work on this poster! Honey has been around for a long time! It was interesting to learn how it has been studied in burn wound management. I know that we use MedaHoney at the hospital (It goes by some other trade name.) for some wounds, especially those that have had a chronic time frame associated with them. I had no idea honey had/has been used for dry eyes? I bet those folks have had blurry vision! Your poster showed good balance and was packed with a variety of information! Thank you!
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