Honey Is Not a Sweet Solution for Venous Leg Ulcers

By Tony Cappasso,
AUCKLAND, New Zealand, Jan. 10 -- Adding honey to dressings covering venous leg ulcers did not speed up wound healing and was associated with more adverse events than standard care, researchers here found.
After 12 weeks of treatment, dressings impregnated with manuka honey were not significantly better at treating ulcers than standard compression dressings, Andrew Jull, M.D., of the University of Auckland, and colleagues reported online in the British Journal of Surgery.
Furthermore, they reported, "treatment with honey was probably more expensive and associated with adverse events (relative risk: 1.3, 95% confidence interval: 1.1 to 1.6, P=0.013)."
Chronic leg ulcers, most commonly caused by venous insufficiency, are typically treated with compression bandaging over one of a variety of dressings, including alginate, hydrofiber, hydrocolloid, foam, hydrogel, non-adherent, and iodine or silver, the researchers said.
"The current interest in alternative medicines has led to renewed interest in honey as a potential healing agent," they noted. "Some people have suggested using honey dressings as well as a compression bandage."
The authors report a resurgent interest in this ancient remedy in New Zealand, Australia, the U.K., and elsewhere. In vitro and animal studies support that honey has antibacterial properties, stimulates cytokines, and might possibly stimulate cell growth.
Given a lack of trial information on the subject, Dr. Jull and his colleagues recruited 368 adults suffering from venous leg ulcers in four centers around New Zealand. Patients with diabetes, peripheral vascular disease, and rheumatoid arthritis were excluded. They randomly assigned 181 patients to receive standard dressings and 187 patients to get calcium alginate dressings impregnated with honey.
All patients got compression bandaging as the standard background therapy.
"The range of compression bandaging reflected what was normally available in the study centers, with the choice determined by the participant or district nurse preference," the researchers noted.
According to the authors, after 12 weeks, 104 ulcers (55.6%) in the group treated with honey-laced bandages, and 90 (49.7%) in the traditional care group had healed (absolute increase of 5.9%, 95% CI: -4.3 to 15.7, P=0.258).
"In our trial the honey dressing did not significantly improve healing, time to healing, change in ulcer area, incidence of infection, or quality of life," the researchers wrote.
It was, however, associated with adverse events, especially pain (P=0.001).
"Pain is a known side effect of using honey; 35% of patients in the largest case series reported transient or continuous pain associated with honey. The pain is reportedly due to the acidity of the honey," the researchers said.
"Any further trials of honey in wounds should record detailed information on ulcer pain, including intensity and duration," he advised.
Other adverse events reported, whether treatment related or not, included deterioration of the ulcer (RR: 2.0, 95% CI: 1.0 to 4.4, P=0.061), new ulceration (RR: 1.0, 95% CI: 0.5 to 2.0, P=0.926), dermatitis, redness, increased exudates, and deterioration of surrounding skin.
Circumstances imposed some limitations on the study, the researchers acknowledged.
"The trial recruited fewer participants than anticipated, despite extending the recruitment period," they said.
And funding limitations restricted follow-up to 12 weeks, even though a longer period would have allowed researchers to assess delayed effects.
In addition, they noted, outcome assessment could not be blinded as honey stains wound margins and leaves a smell.
"However, re-analysis of the primary outcome using healing state determined from blinded review of ulcer photographs did not affect the study findings," they asserted.
"The current focus of venous ulcer management should remain on compression and other treatments that have demonstrated that they improve compression's ability to work or prevent ulcer recurrence," the researchers recommended.
The trial was principally funded by a grant from the Health Research Council of New Zealand. Comvita New Zealand provided a small additional grant and supplied the honey dressings.
One of the study's co-authors reported receiving funding from Comvita New Zealand.
Primary source: British Journal of SurgerySource reference:Jull A, et al "Randomized clinical trial of honey-impregnated dressings for venous leg ulcers" British Journal of Surgery 2008; 95: 175-182.