Honey and Wound Healing

Honey is one of the oldest wound-healing agents in human history. From ancient Egyptian medical papyri to modern wound repair science, this natural product has never been forgotten. Over the past two decades, the work of researchers such as Molan, JULL, and NORDIN has systematically revealed the mechanisms by which honey promotes wound healing, bringing this economical, safe, and effective adjunctive treatment back into clinical practice.

I. Physicochemical properties and active components

The ability of honey to promote wound healing stems first from its unique physicochemical characteristics: high viscosity, high osmolarity, and acidity. Molan et al. (2001) showed that at a pH of approximately 3.7, honey provides an optimal microenvironment for fibroblast migration, proliferation, and collagen formation. The hyperosmolar environment promotes the migration of lymphocytes to the wound site, helps expel bacteria and tissue debris, and maintains a moist condition that enables protease-mediated autolytic debridement (Molan P C, 2002).

In terms of chemical composition, honey contains multiple active components. Among them, apalbumin, a royal jelly protein with a molecular weight of 5.8 kDa, activates monocytes/macrophages around the wound, prompting them to release cytokines involved in tissue repair (Molan et al., 2022). In addition, unknown components in honey induce keratinocytes to release cytokines such as TNF-α, IL-1β, TGF-β, and MMP-9, promoting epithelial cell generation. Organic acids and various oxidases are important substances for the antibacterial and regenerative effects of honey (Li Shixiang, 2000). Sugars, hydrogen peroxide, methylglyoxal, and defensin-1 act synergistically to inhibit multidrug‑resistant bacteria, alleviate wound infection, and convert bacterial metabolites into odorless compounds (Viuda-Martos M et al., 2008; Molan P C, 1999). Hydrogen peroxide also participates in debridement, promotes fibroblast proliferation, and activates the NF‑κB pathway to reduce inflammatory responses (Alcaraz A et al., 2002; Lusby P et al., 2002).

II. Mechanisms of action

The antibacterial, anti‑inflammatory, and healing‑promoting effects of honey on wounds can be summarised in two main categories (Zhu Hongjuan et al., 2011). The first relies on its physicochemical actions through high viscosity, high osmolarity, and acidity. The second involves antibacterial, anti‑inflammatory, and immunomodulatory effects mediated by hydrogen peroxide and non‑peroxide substances. Specifically, honey provides wound nutrition, controls infection, removes necrotic tissue, and modulates wound‑healing‑related cytokines (Li Shixiang, 2000). It also induces leukocytes to release cytokines, initiating the tissue repair cascade (HIXON KR et al., 2019), and promotes the proliferation of B lymphocytes and T lymphocytes as well as the activity of phagocytic cells. A moist honey dressing allows epithelium to form over the wound surface rather than under a scab and prevents the dressing from adhering to the wound, facilitating atraumatic changes (Lusby P et al., 2002).

III. Clinical efficacy

Numerous clinical studies have confirmed that honey is significantly effective for various wound types, including burns, pressure injuries, diabetic foot ulcers, chronic wounds, and postoperative infections.

In burn wounds, JULL et al. (2015) showed that healing time with honey treatment was 4 to 5 days shorter than with conventional dressings. Wang Peng (2020) noted that honey possesses more antibacterial properties than silver, and that honey dressings lead to shorter healing times for burn wounds. For pressure injuries, TERESE L et al. (2015) found that honey‑containing dressings shortened wound healing time in critically ill children, with no allergic reactions or secondary bacterial infections. Meng Jianmin et al. (2018), in a clinical analysis of 100 patients with pressure ulcers, reported that honey significantly shortened wound healing time compared with conventional ointments.

In the treatment of diabetic foot ulcers, a clinical trial by Guo Chunlan et al. (2013) demonstrated that honey dressings were superior to functional dressings and conventional dressings in eliminating infection and necrotic tissue and in promoting healing. Furthermore, at certain concentrations honey can inhibit bacterial biofilm formation in chronic wounds (WANG DANYANG et al., 2021). NORDIN et al. (2018) confirmed that honey extracts promote the viability and proliferation of dermal fibroblasts. ATALAY K et al. (2019) reported that a mixture of chestnut honey and royal jelly promotes corneal healing in rats. For postoperative infected wounds, honey achieves faster healing and fewer side effects than antiseptic solutions.

IV. Clinical advantages and considerations

In summary, honey effectively promotes autolytic debridement, stimulates tissue growth, accelerates healing, reduces pain, inhibits oedema and exudate production, and reduces the formation of hypertrophic scars (Han Fei et al., 2016). Honey dressings are economical, safe, and effective, especially for chronic wounds that respond poorly to conventional treatments. However, honey used clinically must be of medical grade and sterilised. Different types of honey vary in composition and biological properties; clinicians should understand the specific properties of the chosen honey before use to better exploit its effects through comparative analysis.

The wound‑healing ability of honey does not result from a single component but from the synergistic action of its physicochemical properties and multiple active ingredients. From antimicrobial activity, autolytic debridement, and promotion of granulation tissue formation to accelerated epithelialisation, honey participates in multiple stages of wound repair. Against the backdrop of increasing antibiotic resistance, the modern application of this ancient remedy deserves further attention and research.

References

1. Alcaraz A, Kelly J. Treatment of an infected venous leg ulcer with honey dressings[J]. British Journal of Nursing, 2002, 11(13): 859-860.
2. ATALAY K, CABUK KS, KIRGIZ A, et al. Treatment of corneal alkali burn with chestnut honey, royal jelly, and chestnut honey-royal jelly mixture[J]. Beyoglu Eye J, 2019,4(3): 196.
3. Guo Chunlan, Fu Xiangyang. Effect evaluation of honey dressing in local treatment of diabetic foot ulcers[J]. Western Medicine, 2013,25(7):977-980.
4. Han Fei, Xing Renhui, Chen Linqi, et al. Research progress on antibacterial resistance of traditional Chinese medicine[J]. China Journal of Chinese Materia Medica, 2016,41(5):813-817.
5. HIXON KR, KLEIN RC, EBERLIN CT, et al. A critical review and perspective of honey in tissue engineering and clinical wound healing[J]. Adv Wound Care, 2019, 8(8): 403-415.
6. JULL AB, CULLUM N, DUMVILLE JC, et al. Honey as a topical treatment for wounds[J]. Cochrane Database Syst Rev, 2015, 3(3):CD005083.
7. Li Shixiang. Chemical composition and trace elements of honey[J]. Apiculture of China, 2000, 51(6):38-39.
8. Lusby P E, Coombes A, Wilkinson J M. Honey: a potent agent for wound healing?[J]. Journal of Wound, Ostomy & Continence Nursing, 2002,29(6):295-300.
9. Meng Jianmin, Wang Lizhou. Observation on the efficacy of moist exposed burn ointment combined with honey in the treatment of pressure ulcers[C]// Proceedings of the 15th National Conference on Burn, Wound and Ulcer, 2018.
10. Molan P C. Potential of honey in the treatment of wounds and burns[J]. American Journal of Clinical Dermatology, 2001, 2(1): 13-19.
11. Molan P C. Re-introducing Honey in the Management of Wounds and Ulcers - theory and practice[J]. Ostomy/Wound Management,2002,48(11):28-40.
12. Molan P C. The role of honey in the management of wounds[J]. Journal of Wound Care, 1999,8(8):415-418.
13. NORDIN A, OMAR N, SAINIK NQAV, et al. Low dose stingless bee honey increases viability of human dermal fibroblasts that could potentially promote wound healing[J]. Wound Med, 2018, 23: 22-27.
14. TERESE L, OSCAR A, MOLINA P, et al. A systematic review and meta-analysis of dressings used for wound healing: the efficiency of honey compared to silver on burns[J]. Contemporary Nurse, 2015, 51(2-3):121-34.
15. Viuda-Martos M, Ruiz-Navajas Y, Fernandez-Lopez J, et al. Functional properties of honey, propolis, and royal jelly[J]. Journal of Food Science, 2008,73(9): 117-124.
16. WANG DANYANG, LIU YONGHUI, ZHAO WEI. The Adjuvant Effects on Vaccine and the Immunomodulatory Mechanisms of Polysaccharides From Traditional Chinese Medicine[J]. Frontiers in Molecular Biosciences, 2021, 8:655570.
17. Wang Peng. Honey can treat chronic wounds[J]. Apiculture of China, 2020,71(05):43.
18. Zhu Hongjuan, Zhao Pinpin, Cheng Ni, Wang Bini, Deng Jianjun. Research progress on honey in the treatment of burns and scalds[J]. Apiculture of China, 2011, 62(4):31-33.