A pplication of honey in the treatment of skin woundsP.A.M. Overgaauw(1) J.Kirpensteijn(2)

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INTRODUCTIONDog and cat skin wounds are a commonoccurrence and are brought into vetpractices every day. When treating them,both vet and owner are quick to use medication forlocal application. It needs “something” to apply on awound and there are a number of ointments andcreams being marketed for this purpose. Theygenerally are redundant and usually evencounterproductive, as virtually every medication willretard the wound healing process. Recently, however,two medications were reported to be proven to helpthe wound healing process through local application,i.e. 65% glycerol [12,16] and honey. The last mentionedproduct is discussed in more detail below.

WOUND HEALINGFreshly incurred wounds are best cleansed with aphysiological salt solution, and then stitched up.Superficial wounds do not require antibiotics when

treated properly and where not toomuch tissue damage is evident. Onlyinfected, deep wounds require antibiotictreatment [10].

This involves the systematic administering, for aminimum of 5 to 7 days, of a broad-spectrum antibioticsuch as cephalosporines and amoxicillin withclavulanic acid, against the most common skin bacteria.Important in this context is an adequate concentrationof active antibiotics in the blood before the wound isoperated on. This is best achieved by intravenousadministration of the antibiotic just before the inductionof anaesthesia. There are no medical grounds for localapplication of antibiotics. Anecdotes do exist howeverof substances enhancing the wound healing process,such as honey, which has reportedly been used forcenturies for its favourable effect on the wound healingprocess. This is explained by the fact that honey hasa cleansing effect, absorbs oedema and odours,displays anti-microbial and infection inhibiting effects,and induces granulation, epithelialisation, tissuegeneration and wound area nurturing [4,8].

S U M M A R Y

This paper reviews the current knowledge about the use of honey as treatment of skin wounds. Mostexperience has been gained in human medicine, but first reports of use in animals are available. Honey hasafter application in wounds an antibacterial effect against several bacteria and shows reduced oedema anddischarge. Moreover it helps in generating granulation tissue and epithelia and has an odour neutralizingeffect. The need to use sterilized honey products free from pesticide and antibiotic residues is explained.

(1) Certified Veterinary Microbiology, Certified Parasitology, Molecaten 57, 3772 LJ Barneveld. E-mail: P.overgaauw@planet.nl(2) Specialist Surgery of Domestic Animals, Department of Companion Animal Medicine, Veterinary Faculty, Utrecht University, Yalelaan 8, 3508 TD Utrecht * Presented by NACAM (The Netherlands)

This paper originallyappeared in:

Tijdschrift voorDiergeneeskunde*

(2005)130, p 115-116

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ANTIBACTERIAL EFFECT OFHONEYHoney has an antibacterial effect against severalbacteria such as Pseudomonas, staphylococci,streptococci and E. coli. Even some antibiotics-resistantbacteria, such as MRSA (Methicilline ResistantStaphylococcus Aureous) and VRE (VancomycineResistant Enterococci) are reportedly sensitive [2,3,9].A concentration of 10% v/v is sufficient for fullinhibition of wound bacteria [5]. The antibacterial effectis caused among other things by hyper-osmosis, low3.6 pH, and the presence of a thermo unstablesubstance named inhibine, hydrogen peroxide andenzymes such as catalysis. Hydrogen peroxide isgenerated along with glucose acid from honey as a

result of an enzyme reaction of the enzyme glucoseoxides (created by the bee) with the glucose. Thisreaction occurs after the honey has been diluted inthe wound. The gradually released hydrogen peroxidehas an adverse affect on bacteria but not on the normalcells, thus creating no cellular damage. The assumptionis that also other antibacterial substances occuroriginating from various flowers [17]. Studies show thatbacteria display a different sensitivity to monofloralhoney from differing species of plants [1,17].

OTHER EFFECTS OF HONEY

Animal experimental research has shown that honeyreduces the number of infecting cells infiltrating thewound. Clinical studies showed moreover reducedoedema and discharge. The hyperosmolarity of honeyand stimulation of body enzymes induces autolysins ofnecrotic tissue in a wound, achieving discharge ofdebris. Honey helps in the generation of granulation tissue andepithelia because hydrogen peroxide stimulatesangiogenesis and growth of fibroblasts. Also, low pHvalues and enhanced angiogenesis help releaseoxygen, stimulating tissue regeneration.The odour neutralizing effect is achieved becausebacteria in the wound are being inhibited, thus alsoinhibiting debris volumes. Also, once the honey hasbeen applied the bacteria will utilize the sugars itcontains. This generates the odourless milk acid [5].

HUMAN AND ANIMALCLINICAL RESEARCHFor skin burns very good results were found withhoney treatment compared to treatment with a silver-sulfadiazin [13] and polyurethane pack [14]. The sterileantibacterial wound ointment with a honey basis (50%v/v)* available in the Netherlands was used in a multi-centre case-report study of 139 nursing homes and GPpractice patients suffering from ulcers, decubitus,abrasions and burns [15]. On several wounds differentwound treatment products were used (e.g.Betadinezalf®, Duoderm®, silver-sulfadiazin) and theireffects compared for the same patient. Depending onthe type of wound, a 14-47% faster healing process hasbeen reported. However, no statistical processing ofthe results was made. The specific wound ointmentwith a honey basis* also showed an anti mycosis effectagainst Candida albicans. Now, the producer has thefirst dog and cat case-studies available.

Application of honey in the treatment of skin wounds

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NEED FOR AND USE OFSTERILE HONEYIt is evidently an attractive option to use a naturalproduct for treatment of patients, however oneimportant aspect must be stated before problems arisefor man and animals. Only a very few studies state thatsterile honey was used [14]. This aspect is often notstated, or the honey is presumed to be sterile [13]. Thishowever is a major misconception. Honey may containBacillus sp. and Clostridium traces and thus causebotulism [6,11]. The use of natural honey on necroticwounds is therefore in such cases counter indicated.Also, honey may contain pesticides as well as antibioticresidues such as tetracyclines used on bees. The recommendation therefore is to use only honeyfor medical purposes that originates from specificpathogen free (SPF) non-medicated bees living in areaswhere no pesticides are in use. Also radiated honeyproduces a sterile product without any change inproperties [7,11]. In the Netherlands, a sterile honeyointment for human use is available in tubes of 20 and50 g *. The ointment may be used in combination withwound dressings and the product information sheetstates that application once a day is sufficient.Scientific research into the wound healing effect ofhoney in (domesticated) animals has not beenperformed and this will need to be done in the futureto obtain independent proof that honey ointment is auseful addition to the existing treatments of (infected)wounds in veterinary practices (figures 1 and 2).

* Mesitran®; Klinion® series of the Firm Medeco BV(www.medeco.nl).

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P.A.M. OVERGAAUW J. KIRPENSTEIJN EJCAP - Vol. 16 - Issue 1 - April 2006

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