By Michael W Simpson
I am a scientist with over 40 years of experience in cell biology, biochemistry, infectious diseases, and cardiovascular disease. As a part of that background, I also had further education in immunology, microbiology, and evolutionary biology.
Speaking of honey, when I was in the ICU being treated for a nasty case of cellulitis recently, the wound treatment included dressings that were soaked in "medical grade" honey. The physicians and nurses insisted that it was really good for wound healing — of course, I gave them the old Skeptical Raptor side-eye. I had to "do my own research" about it and find out if there was any science involved.
Well, there was a lot of science around honey being used for wound treatment, so that meant it wasn't pseudoscientific woo, but there might be some science around it. I want to warn the reader that it's not necessarily definitive that honey is effective for wound treatment, but the science seems to be building a consensus that it's useful.
Why does honey work in wound treatment?
Let me first start by saying that there are no magical properties in honey. Taking a dose of honey every day is not going to keep infections away. Taking a bath in honey is not going to boost your immune system. That's not how it works.
In a review article published in 2021 in Open Life Sciences, the author wrote:
Their data showed that honey resulted in rapid epithelialization and wound contraction in wound healing, and reduced pain, inflammation, and debridement, ensuring control of infection and reducing the time of wound healing, and was cost-effective.
It appears that honey helped do two things that are important in wound healing — rapid regrowth of epithelial cells and wound contraction. This can help the wound resist infection and reduce the time for healing.
Dr. Tashkandi proposed a mechanism for its action that appears to be biologically plausible:
Natural honey is a viscous fluid; its jelly consistency creates a surface layer over the wound that inhibits the entrance of bacteria and protects the wound from dehydration. Its high sugar content creates a higher osmotic gradient that pulls fluid up through the subdermal tissue and offers an additional glucose source for flourishing cellular components in the wounded area. The water activity of honey is less than 0.91 aw, which prevents and controls the growth of bacteria on the wound surface and causes fluid flow that flushes slough, debris, and necrotic tissue as well as microorganisms out of the wound. Apart from this, the low water activity of honey helps transport oxygen and nutrients from the deep tissue into the wound area. In addition, the low pH of honey increases tissue oxygenation, while free radicals, which lead to tissue damage, are removed by flavonoids and aromatic acids.
In other words, honey doesn't contain any magical chemicals that promote wound healing, it just blocks bacteria from entering the wound, the osmolality of honey forces fluid flow through the wound, and reduces tissue damage.
Although it's good to have a biologically plausible mechanism for honey and wound healing, we need to see if there is robust evidence that supports its use in medicine.
For this section, I'm going to focus on systematic reviews and meta-analyses (which are at the pinnacle of biomedical research) that examined the effectiveness of honey in wound treatment. Unfortunately, some of them were published in "complementary medicine" journals which sometimes publish articles that support outright pseudoscience. Their research seemed fine, nevertheless, I prefer research published in mainstream journals.
- A 2015 review in the journal Wounds concluded that "there is good evidence for honey also having bioactivities that stimulate the immune response (thus promoting the growth of tissues for wound repair), suppress inflammation, and bring about rapid autolytic debridement. There is clinical evidence for these actions, and research is providing scientific explanations for them." I do not think that honey has magical properties that have a direct effect on the immune response, but as I wrote above, it provides an environment that allows the immune system to do its job better.
- A 2014 review in the American Journal of Therapeutics concluded that "a large number of in vitro and limited clinical studies have confirmed the broad-spectrum antimicrobial (antibacterial, antifungal, antiviral, and antimycobacterial) properties of honey, which may be attributed to the acidity (low pH), osmotic effect, high sugar concentration, presence of bacteriostatic and bactericidal factors (hydrogen peroxide, antioxidants, lysozyme, polyphenols, phenolic acids, flavonoids, methylglyoxal, and bee peptides), and increase in cytokine release, and to immune-modulating and anti-inflammatory properties of honey; the antimicrobial action involves several mechanisms." However, the author stated that there were not enough clinical studies that showed a direct effect of honey's anti-microbial activity.
- A 2017 systematic review in the journal Burns showed that honey was statistically better in healing time and keeping the wound sterile in burn patients.
The best systematic review I could find on honey's effectiveness in treating wounds was a Cochrane Database of Systematic Reviews published in 2017. The review, which looked at several antiseptics found the following results for honey:
- There is moderate certainty evidence that, on average, burns treated with honey are probably more likely to heal over time compared with topical antibiotics, hazard ratio (HR) = 2.45.
- They found high certainty evidence that treating burns with honey, on average, reduced mean times (about -5.3 days) to healing in comparison with non-antibacterial treatments.
- There is moderate certainty evidence that honey probably also increases the likelihood of wounds healing over time compared to unconventional anti-bacterial treatments, HR = 2.86.
There is some research that does not support the use of honey:
The use of honey in wound treatment does not appear to be pseudoscientific woo that is being pushed by alternative medicine, even though that's probably where it started. Of course, this supports the old adage that "alternative medicine that has been shown to work is just called medicine."
Although honey may not be effective in some cases, like leg, pressure, or diabetic ulcers, good evidence seems to indicate that it is more effective than standard treatments.
My personal anecdote is that I have no clue if it worked for me because I didn't have a control point. My cellulitis seemed to respond to the honey, but then again, maybe I just have a good immune system or the antibiotics did their thing.
Anyway, based on what I've read, it appears that honey is an effective method of wound treatment. But I'd like to see more clinical evidence published in journals that aren't focused on alternative medicine before I stand up and proclaim honey as a miracle healing substance for wounds. For now, I think that it is probably useful in many cases.
- Aziz Z, Abdul Rasool Hassan B. The effects of honey compared to silver sulfadiazine for the treatment of burns: A systematic review of randomized controlled trials. Burns. 2017 Feb;43(1):50-57. doi: 10.1016/j.burns.2016.07.004. Epub 2016 Aug 28. PMID: 27576926.
- Israili ZH. Antimicrobial properties of honey. Am J Ther. 2014 Jul-Aug;21(4):304-23. doi: 10.1097/MJT.0b013e318293b09b. PMID: 23782759.
- Molan P, Rhodes T. Honey: A Biologic Wound Dressing. Wounds. 2015 Jun;27(6):141-51. PMID: 26061489.
- Norman G, Christie J, Liu Z, Westby MJ, Jefferies JM, Hudson T, Edwards J, Mohapatra DP, Hassan IA, Dumville JC. Antiseptics for burns. Cochrane Database Syst Rev. 2017 Jul 12;7(7):CD011821. doi: 10.1002/14651858.CD011821.pub2. PMID: 28700086; PMCID: PMC6483239.
- Norman G, Dumville JC, Moore ZE, Tanner J, Christie J, Goto S. Antibiotics and antiseptics for pressure ulcers. Cochrane Database Syst Rev. 2016 Apr 4;4(4):CD011586. doi: 10.1002/14651858.CD011586.pub2. PMID: 27040598; PMCID: PMC6486293.
- O'Meara S, Al-Kurdi D, Ologun Y, Ovington LG, Martyn-St James M, Richardson R. Antibiotics and antiseptics for venous leg ulcers. Cochrane Database Syst Rev. 2014 Jan 10;(1):CD003557. doi: 10.1002/14651858.CD003557.pub5. PMID: 24408354.
- Tashkandi H. Honey in wound healing: An updated review. Open Life Sci. 2021 Oct 6;16(1):1091-1100. doi: 10.1515/biol-2021-0084. PMID: 34708153; PMCID: PMC8496555.