Wound is defined as the damage of skin layers which leads to disruption in normal anatomical structure and function of body. Beyond skin wound can also be deeper reaching to internal tissue or even muscles and nerves and even bone.
The damage of tissue results in physiological response from the body which leads to vessel contraction, bleeding and inflammation.
Wounds can be classified as:
- Acute wounds- wounds that got repair on their own without much care requirement. The course of healing is generally 5-10 days only.
- Chronic wounds- chronic wounds can’t get repair on its own and require extra care and special treatment. Various factors interfere with the normal healing process, such as necrosis (tissue death), excess level of cytokines (inflammatory agents release by body). Hence chronic wounds remain for long.
Wound healing is process which requires coordination between diverse immunological and biological system of body. It occurs in various phases with each phase following other and form a cascade of cell proliferation, tissue repair and regulation steps.
Different phases in wound healing process are:
- Coagulation and haemostasis – coagulation and haemostasis refers to stopping of blood flow and changing blood to gel like clot to prevent excess of blood loss from wound. It occurs just after the injury. The blood clot form later provides support for growth of other cells. This process require blood platelet factor (thrombin).
- Inflammation – it is the second phase of wound healing. It occurs due to activation of immune cells near the site of injury. It helps in preventing infection by creating a barrier of immune cells around wound. It involves activation of various immune cells, production of cytokines and oxygen free radicles to kill the approaching bacteria and other microbes.
- Proliferation of cell – this is the third phase of wound healing. It begins after 2 days of injury. It is the longest phase and goes on for many days. It involves many processes like release of growth factors,deposition of extracellular matrix, formation of new blood vessels, deposition of various proteins like collagen and epithelialization (formation of epithelial cell layer).
- Wound remodelling – this is the final phase of wound healing. It involves development of new tissue layers, final scar tissue formation. This stage is the indication that wound has healed successfully.
What is Manuka honey?
Manuka honey is made from the nectar obtained from pinkish white flowers of Manuka plant. Scientifically Manuka is known as Leptospermum scoparium.
This honey has lot of special properties which makes it most popular among the scientist and researchers. It is marketed as medicinal product in Australia and New Zealand (its native countries) and in rest of the world also.
Manuka honey specialty lies in its antibacterial, antiviral, anti-inflammatory, antioxidant properties. Its high phenolic content and presence of methoxyglyoxal along with high sugar content and low pH puts it under the category of medicinal agents.
4 Benefits of Manuka Honey In Wound Healing
Manuka honey heals wound very effectively. It has ability to heal all types of wounds from minor injury of body to most deep burns. It along with healing also reduces the scar left after healing.
Its anti-inflammatory and anti-oxidant properties help in rapid and easy wound healing. The antimicrobial activity of honey prevents further infection in wounds. It can be both taken orally and directly put on the wounds.
1.Manuka honey has anti-bacterial action
The physical properties of Manuka honey like low pH, high sugar content and high viscosity makes it a very potent antimicrobial and antibacterial agent. It also has hydrogen peroxide activity which is very effective in killing bacteria.
So even in very dilute form Manuka honey shows sufficient antimicrobial activity. Due its anti-microbial property Manuka honey prevents wound infection by various microbes. The Manuka honey dressing on wound prevents the dressing to get stick with the wound by providing sufficient moisture.
What does this mean?
The antibacterial property of manuka honey prevents microbes to grow on the wound and create biofilm which help in easy healing of wound.
2.Manuka honey has anti-inflammatory effect
Manuka honey has potent anti-inflammatory property; this has been proven by various studies. It not only kills the inflammation causing bacteria in wounds but act on inflammation directly. It reduces inflammation, reduces the swelling and exudates in the wound and improves its healing.
The pain at the nerve endings also got reduced due to its action. The amount of inflammatory cytokines which create halt in wound healing also get reduce. Honey also boost the immune system which results in early healing of wound with no or least scars left after treatment.
A study was conducted on mice to see the effect of manuka honey on induced inflammation in wounds. It was found that manuka honey reduce the inflammatory agents in wounds.
What does this mean?
Manuka honey reduces the inflammation of wounds which results in reduced redness and pain.
3. Manuka honey boosts antioxidant defense
Manuka honey contains many antioxidants in it which are involved in antioxidant action of Manuka honey. The presence of components like flavonoids, monophenolics, polyphenols, vitamin C and methylglyoxal adds to its antioxidant properties.
This prevents damage to cells by reducing the oxidative stress. The presence of oxygen free radicles and superoxide cause oxidative stress. But phenolic components in Manuka honey reduce the content of these free radicles.
What does this mean?
Phenolic and many antioxidant compounds in wound prevent tissue necrosis which enhance the process of wound healing.
4. Manuka honey has intrinsic wound healing properties
Manuka honey has all the wound healing properties which are ideally required in a wound healing dressing these are:
- Bactericidal effect
- Prevent oedema and exudates
- Enhanced tissue repair
- Relieve pain
- Easy to apply and comfortable for patient
- No side effects
- Easily available at low cost than standard treatment
These properties make Manuka honey best choice for topical administration on wounds. Manuka can be effective in all type of wounds from burn to ulcer to surgical wounds. It can even be used for postoperative care.
What does this mean?
Manuka honey has various properties that make it an excellent and non toxic wound healing agent.
3 Wound Types Manuka Honey Heals
Research proves that manuka honey benefits in healing various wounds and similar conditions.
1.Manuka honey heals burn wounds
A study conducted on 104 patients with minor burn injury to see the effect of honey on wound healing,found that honey healed around 87% wounds with in 15days as compared to only 10%by natural healing and low incidence of scar and early relief from pain was also observed.
Two more studies were conducted to compare the wound healing effect of honey and silver sulfadiazine for healing burn wounds. The result of the study shows that honey treats wound quicker with reduction in scar and infection and inflammation.
In many other studies conducted to compare the wound healing efficiency of Manuka honey with other wound dressings it has been observed that honey has better healing effect than polyurethane film , amniotic membrane and boiled potato peel .
What does this mean?
Manuka honey is very effective in treating burn wounds. Treatment of wound with Manuka honey leaves minimal scar and cost effective and less painful.
2. Manuka honey benefits in various ulcers
Manuka honey can treat all types of ulcers effectively without any major side effects many studies have been conducted to prove this:
Skin ulcers and wounds
A study conducted on rat model to test the effect of Manuka honey associated with pectin on chronic skin ulcers. The result of the study show improvement in cell proliferation and increased wound healing.
Tenci et.al conducted a study on rat model to test the effect of Manuka honey mini-capsules on the chronic skin ulcers shows significant cell proliferation in wounded area. An increase in wound healing was also seen along with reduction in infection.
Diabetic foot ulcers
A study was conducted on 172 patients with diabetic foot ulcer to study the role of honey in wound dressing. The result of the study shows a significant wound healing and decrease in score of ulcer.
Another study conducted on 258patients to test the effect of honey dressing in treatment of diabetic foot ulcer the result shows superiority of Manuka honey in treating foot ulcer than that of normal method of dressing.
A study published in International wound journal in 2012 shows effect of Manuka honey dressing on neuropathic diabetic ulcers on 63 patients. The result shows significant reduction in healing time and disinfection of ulcers as compared to conventional dressing.
Oral ulcers
A study was conducted to test the effects of Manuka honey mouth ulcers due to bacterial infection. The result of study shows a significant decrease in plaque scores and bleeding sites indicates healing of ulcers and injuries of mouth on treatment with Manuka honey.
It has found through a study that honey promotes oral wellness by treating dental diseases, mouth ulcers and dental plaque formation. It keeps normal microbiota of mouth under control.
Another study was conducted on 40 patients to test the effect of honey on radiation induces mucositis (oral ulcer due to anticancer therapy). The result of study show significant decrease in mucositis in patient treated with honey.
Gastric ulcers
A study was conducted to test the effect of Manuka honey on gastric ulcer in animal model. The result of study showed a significant decrease in gastric ulcer. A reduction in inflammation was also observed along with increase in antioxidant activity.
In another study conducted to test the effect of various doses of Manuka honey on gastric disease a significant reduction was found in inflammation and ulcers in the bowel by all the doses of honey.
Another study was conducted to test the effect of Manuka honey + sulfasalazine treatment on rat model with gastric ulcers. The result of the study shows significant reduction in ulcer and score and inflammation.
What does this mean?
Manuka honey's anti-inflammatory and anti-bacterial activity helps in healing ulcers of varied origin such as skin ulcers, diabetic foot ulcers and even gastric ulcers.
3. Manuka honey speeds up healing of surgical wounds
A study was conducted on a patient undergoing surgery and generated infection on surgical wound. The patient was treated with Manuka honey which resulted in effective healing of surgical wounds with no side effects. Manuka honey can also be used to treat recalcitrant (difficult to treat)surgical wounds.
Malhotra et.al conducted a study to test the role of Manuka honey on wound in eyelid surgery. In 55 patients one eyelid was treated with Vaseline and other with Vaseline + Manuka honey. The result show early healing, in eyelid treated with Manuka honey.
A study published in Clinical and Experimental Optometry journal in 2015 to see the effect of Manuka honey in treating post-operative oedema of cornea. The results of study were positive and a significant reduction in oedema level and thickness of cornea was observed. Also there was improvement in visibility.
What does this mean?
This means that surgical wounds can be easily treated by the Manuka honey with reduction in oedema level. Also Manuka honey can be used in post-operative care of a most sensitive organ like eye.
How To Use Manuka Honey In Wound Healing?
There is no dosage restriction to use Maunka honey. But at market level to maintain its safety and quality,a special method is used, that is to determine Unique Manuka Factor (UMF).
The UMF value is the measure of concentration of phenol with same antibacterial activity as Manuka honey.UMF is a registered trademark for Manuka honey marketing.It is used in New Zealand and Australia.
The UMF value of Manuka honey which is available in market ranges from 5 to 40 above that value Manuka honey has negative effect on health.
The UMF 18+ is considered best for wound care and antibacterial action of Manuka honey. If using for topical application it is advisable to use sterilised, medical grade honey. Conduct a patch test prior to application.
Small quantities of manuka honey can be applied topically on the dressing which is used to cover the affected area. This can be repeated twice a day. If worsening of symptoms is observed please discontinue the use of manuka honey for wound healing.
Manuka honey can be consumed orally say 1-2 tsp a day. Consult a health practitioner before using manuka honey for topical application in wounds.
Precautions
Although many studies are there to prove the positive effect of Manuka honey in wound healing but there are still a few studies which do not gave expected result but show side effects.
A study conducted to test the effect of methylglyoxal on wound healing, it has been found that methylglyoxal induce diabetes like symptoms in patient and delay the wound healing with several side effects.
Also in another study it has been found that methylglyoxal delay healing of diabetic ulcers and it is true that Manuka honey has high level of methylglyoxal in it.
Methylglyoxal content of Manuka honey is 100 times higher than other honey . The quantitative analysis of Manuka honey helps to estimate the methylglyoxal content to be around 38-761mg/kg .
But the study mentioned above shows only the effect of methylglyoxal and not the manuka honey as whole. So the study is not much effective to prove any side effect of manuka honey. But since, precaution is better than cure, hence here are some precautions mentioned to consider before using Manuka honey.
First perform a sensitivity assay by applying small amount of manuka honey on wound and observe its effects for 48 days. If no adverse effect seen than it is safe to use.
Diabetic patients must be more careful while using manuka honey. Prescription from doctor would ensure safety.
For infants it is advisable to avoid consumption of manuka honey as it can cause disease like botulism .
Manuka honey should be stored in glass or plastic bottle away from sunlight at room temperature.
Conclusion
Manuka honey is very effective for wound healing. Also the Manuka honey is easy available and cost effective so it can be a best option to be used as dressing for wounds.
However care should be taken regarding the methylglyoxal content, purity and sterilization of the honey prior to topical application for wound healing.