Manuka Honey for Managing Chronic Wounds

Introduction

Manuka honey is a natural compound that may be effective for wound management. Its quality to stop inflammation and stimulate injuries’ healing attracts attention and increases its value. While the medical efficiency of manuka honey is understudied, there are research papers that confirm that honey is indeed helpful. It has a rich chemical composition, and there is evidence that some of them have at least antibacterial, anti-inflammatory, and healing activities. To understand how honey may help in wound management, they should be evaluated, and data about the honey’s chemical composition and efficiency should be brought together. After that, conclusions about their efficiency may be made, including precise information about the wound management process.

Search Strategy

To find how manuka honey can help in chronic wound management, articles, where this topic is researched, should be found and explored. For the current research, eight articles were used: all of them were discovered via PubMed service or directly from Google Scholar. Papers that explore the manuka honey’s chemical composition and the activity of each compound, such as polyphenols and leptin, were selected in the first place. The reason is that those articles are the most information-rich considering the current research: they answer the question about the honey’s efficiency and show where it is effective and where it is not. Those articles where manuka honey was described but without connection with its wound healing functions were rejected. The overall scheme of how the source articles were found is presented in the table below.

Table 1: The search strategy used

The aim of the chosen search strategy is the finding articles where manuka honey healing activity was researched. While eight articles are enough to understand that manuka honey is effective against chronic wounds and describes its mechanism of action, two papers among them were evaluated more closely. One of them is a thorough review of manuka honey’s chemical constitution, and the activity of each compound or compound group is described there. It makes this article a valuable evaluation of manuka honey’s wound-healing activity. The second article describes a clinical assessment of a honey-based product used to heal chronic wounds in patients: it shows that the product is indeed efficient and describes the outcomes of its usage. While it is not a randomized clinical trial, it is still helpful to evaluate honey’s efficiency in chronic wound management.

Table of Evidence

Difficulties in Chronic Wounds Management

Chronic wounds are consequences of various external and internal injuries, which the host’s immune system cannot address. They are characterized by stability, making it very hard to heal them without external help; examples are ulcers, abscesses, blisters, burn wounds, and outer infections. Bacterial infections, entering the wounds, create biofilms that make them defend from the host’s immune system (Abd El-Malek, Yousef, and El-Assar, 2017). The wound, thus, cannot be healed by itself, as the macrophages cannot reach the bacteria and kill them, and before that, entering the growth factors that cause the healing is impossible. In addition, chronic wounds may be caused by chronic diseases which negatively influence the metabolism and immune system, such as obesity (Rafter et al., 2017). Thus, chronic wounds are difficult to manage and usually cannot be healed without external medical help. Due to its specific chemical composition, Manuka honey may be highly effective in providing this help.

Chemical Composition of Manuka Honey

Manuka honey consists of various compounds: most of them are members of the flavonoid and phenolic acid groups. Such a composition is typical for products of plant origin: examples of flavonoids present in the honey are chrysin and pinocembrin (Alvarez-Suarez et al., 2014). Those chemicals are helpful in slowing inflammation due to their antioxidant activity. In addition, due to a large number of organic acids, manuka honey has a relatively small pH, sometimes as low as 3.9 (Sell et al., 2012). Finally, as honey contains various compounds, it is characterized by high osmotic pressure (Johnston et al., 2018). Both increase the honey’s biological activity: the high osmotic pressure leads to the adsorbing effect, and low pH stimulates the growth factor activity. All mentioned functions are helpful in solving the issues of chronic wounds.

The honey contains several specific compounds, which are proven to be efficient against infectious microorganisms and help in wound healing. One of them is defensin-1, a bee protein that destroys bacterial cell membranes (Alvarez-Suarez et al., 2014; Johnston et al., 2018). Methylglyoxal and leptospirosis are other compounds with distinct strong antibacterial action specific to manuka honey (Kwiecińska-Piróg et al., 2020). The honey also contains hydrogen peroxide, typical for honey in general: it is a strong oxidant that is lethal for bacteria. However, its amount in manuka honey is relatively small, and its strong antibacterial action mostly follows from other specific compounds (Alvarez-Suarez et al., 2014; Jenkins, Roberts, and Brown, 2015; Kwiecińska-Piróg et al., 2020). To summarize, manuka honey is characterized by a great diversity of various substances, a large proportion of which are unique and have strong biological activity.

How Manuka Honey Helps in Wound Management

Due to the mentioned biological activity, manuka honey shows great efficiency against pathogens typical for chronic wounds: bacteria, viruses, and even fungi. For example, it inhibits the growth and development of antibiotic-resistant Staphylococcus and Pseudomonas bacteria, even in small amounts, and eradicates them completely in large (Alvarez-Suarez et al., 2014; Johnston et al., 2018). It kills them by lysing the cells of Pseudomonas and blocking the cell division of Staphylococcus while having no side effects typical for antibiotics (Jenkins, Roberts, and Brown, 2015). Manuka honey suppresses the metabolic activity of another bacterium, P. mirabilis, which is typical for wound biofilms, in all concentrations, starting from 2% (Kwiecińska-Piróg et al., 2020). Thus, honey kills and suppresses all studied types of bacteria, typical for chronic wounds, which makes it worthwhile to solve problems with them.

Along with being helpful against all types of infectious bacteria, it also shows antiviral activity, which is less studied than antibacterial activity. For example, it has been demonstrated that manuka honey decreases the concentration of the chickenpox virus (Carter et al., 2016). In the case of fungi, such as Candida albicans, the effect is not thus impressive, but the honey inhibits its growth (Carter et al., 2016). In that way, manuka honey is beneficial in cleaning chronic wounds from pathogens.

In addition, manuka honey quickens wound healing, cleaning, and pain relief. Its phenolic and flavonoid compounds result in the high antioxidative effect of honey. They lower the inflammation and stimulate the removal of the exudate, which is typical for chronic wounds (Abd El-Malek, Yousef, and El-Assar, 2017). After the wound becomes clear, it pains less and starts to heal much quicker as the access of growth factors, macrophages, and other body defense and restoring substances becomes open. Its low pH, between 4 and 5, stimulates the growth factor activity, further stimulating wound healing (Sell et al., 2012). The clinical evaluation of the drug Algivon, containing manuka honey and designed to help in wound healing, shows stable pain relief in most patients who previously suffered from pain (Rafter et al., 2017). Due to the large osmotic pressure, honey is a strong adsorbent and efficiently clears the wound of pus and other impurities (Johnston et al., 2018). This substance is an indispensable helper for wound healing in all stages: cleaning, pain relief, and restoration.

To summarize, manuka honey is a potent, biologically active substance that has a proven effect on wound treatment. It kills bacteria, slows the development of viral and fungal infections, and cleans chronic wounds from exudate and pus (Abd El-Malek, Yousef and El-Assar, 2017; Carter et al., 2016; Jenkins, Roberts and Brown, 2015; Johnston et al., 2018). In addition, it stimulates wound healing by creating a low-pH area in the wound and promoting growth factor activity (Alvarez-Suarez et al., 2014; Carter et al., 2016; Sell et al., 2012). Its antioxidants slow inflammation and decrease pain, making manuka honey extremely useful against ulcers, abscesses, and burns. Lastly, honey is shown to cause no allergic reactions and, thus, it is safe to use (Alvarez-Suarez et al., 2014). The question of the manuka honey efficiency is, therefore, answered positively: the substance is highly effective and may be used for pain relief, wound cleaning, removing the infection, and quickening the restoration process.

Critical Appraisal

The Composition and Biological Activity of Honey: A Focus on Manuka Honey (Alvarez-Suarez et al., 2014)

This article is a general review that explores the constitution of honey and how each of the compounds present in it may help with wound management. It is helpful as it provides a table with a full list of known substances present in the honey. It, too, shows the chemical structure for several of them: methyl syringe, leptin, methylglyoxal, and defensin-1. The two latter are the most active antibacterial compounds present in manuka honey. The substance’s qualities, such as the low pH and high osmotic activity, are mentioned as well. Then, each aspect of the honey’s action is analyzed: it is started with the antimicrobial activity. The extensive list of bacteria species sensitive to honey is present, enabling us to make conclusions about its activity. After that, other aspects of the substance’s biological activity are described: antioxidant activity, stimulating wound healing, anti-cancer effect, and the release of cytotoxic hydrogen peroxide.

Overall, the article is a good review, which shows all aspects of manuka honey, actual for the current research. It starts from the chemical composition and then shows how it conditions the honey’s activity. The active usage of lists, tables, and chemical formulae is an advantage of the paper: it is easy to comprehend, which is essential for the review. Finally, the list of used literature includes 66 papers, showing that the review is well-supported by evidence.

A Clinical Evaluation of Algivon® Plus Manuka Honey Dressings for Chronic Wounds (Rafter et al., 2017)

This clinical evaluation is designed to check the efficiency of the manuka honey-based wound dressing drug Algivon. Twenty-two patients with forty-five chronic wounds in total were recruited for the research. More than 200 assessments were conducted in total: part of them in the clinic and part in the community. At the end of the 49th day, almost 30 out of 45 wounds were healed, and most of the patients were relieved from pain. In addition, most of the wounds were cleaned and had less bad odor than before the assessment. Thus, the experiment shows the efficiency of honey-based drugs in chronic wound management.

The weak place of the evaluation is that it researches only one group of patients: there is not the control group. It makes the research biased, as researchers cannot compare the obtained results with the control and decide whether they are statistically significant. While it shows that Algivon helps people suffering from chronic wounds to release pain, heal wounds, and improve their general condition, it is unsure whether it is a real effect or just a placebo. Researchers understand that, writing about study biases in the Limitation section. Overall, however, the paper is good and well-supported, showing the actual effect of the honey.

Conclusion

Therefore, manuka honey can actually help in wound management: it kills bacteria, stimulates wound healing, and simultaneously lowers the inflammation. The honey contains a large number of antibacterial compounds, which are extremely helpful in case of chronic wound healing. Its high osmotic pressure helps in wound cleaning, adsorbing pus and exudate, and is destructive to microorganisms. The low pH is harmful to bacteria, too, and, in addition, stimulates the growth factor activity and, thus, wound healing. High antioxidant activity reduces inflammation and promotes healing as well. Overall, manuka honey has an extensive perspective for its usage as a strong antibacterial and wound-healing substance.

Reference List

Abd El-Malek, F.F., Yousef, A.S. and El-Assar, S.A. (2017). ‘Hydrogel film loaded with new formula from manuka honey for treatment of chronic wound infections.’ Journal of Global Antimicrobial Resistance, [online] 11, pp.171–176. doi:10.1016/j.jgar.2017.08.007.

Alvarez-Suarez, J., Gasparrini, M., Forbes-Hernández, T., Mazzoni, L. and Giampieri, F. (2014). ‘The Composition and Biological Activity of Honey: A Focus on Manuka Honey.’ Foods, [online] 3(3), pp.420–432. doi:10.3390/foods3030420.

Carter, D.A., Blair, S.E., Cokcetin, N.N., Bouzo, D., Brooks, P., Schothauer, R. and Harry, E.J. (2016). ‘Therapeutic Manuka Honey: No Longer So Alternative.’ Frontiers in Microbiology, [online] 7. doi:10.3389/fmicb.2016.00569.

Jenkins, R., Roberts, A. and Brown, H.L. (2015). ‘On the antibacterial effects of manuka honey: mechanistic insights.’ Research and Reports in Biology, p.215. doi:10.2147/rrb.s75754.

Johnston, M., McBride, M., Dahiya, D., Owusu-Apenten, R. and Singh Nigam, P. (2018). ‘Antibacterial activity of Manuka honey and its components: An overview.’ AIMS Microbiology, [online] 4(4), pp.655–664. doi:10.3934/microbiol.2018.4.655.

Kwiecińska-Piróg, J., Przekwas, J., Majkut, M., Skowron, K. and Gospodarek-Komkowska, E. (2020). ‘Biofilm Formation Reducing Properties of Manuka Honey and Propolis in Proteus mirabilis Rods Isolated from Chronic Wounds.’ Microorganisms, 8(11), p.1823. doi:10.3390/microorganisms8111823.

Rafter, L., Reynolds, T., Collier, M., Rafter, M. and West, M. (2017). ‘A clinical evaluation of Algivon® Plus manuka honey dressings for chronic wounds.’ Wounds UK, 13(4).

Sell, S.A., Wolfe, P.S., Spence, A.J., Rodriguez, I.A., McCool, J.M., Petrella, R.L., Garg, K., Ericksen, J.J. and Bowlin, G.L. (2012). ‘A Preliminary Study on the Potential of Manuka Honey and Platelet-Rich Plasma in Wound Healing.’ International Journal of Biomaterials, [online] 2012, p.313781. doi:10.1155/2012/313781.