Honey: A Therapeutic Agent for Disorders of the Skin
Main Article Content
Problems with conventional treatments for a range of dermatological disorders have led scientists to search for new compounds of therapeutic value. Efforts have included the evaluation of natural products such as honey. Manuka honey, for example, has been scientifically recognised for its anti-microbial and wound healing properties and is now used clinically as a topical treatment for wound infections. In this review, scientific evidence for the effectiveness of honey in the treatment of wounds and other skin conditions is evaluated. A plethora of in vitro studies have revealed that honeys from all over the world have potent anti-microbial activity against skin relevant microbes. Moreover, a number of in vitro studies suggest that honey is able to modulate the skin immune system. Clinical research has shown honey to be efficacious in promoting the healing of partial thickness burn wounds while its effectiveness in the treatment of non-burn acute wounds and chronic wounds is conflicted. Published research investigating the efficacy of honey in the treatment of other types of skin disorders is limited. Nevertheless, positive effects have been reported, for example, kanuka honey from New Zealand was shown to have therapeutic value in the treatment of rosacea. Anti-carcinogenic effects of honey have also been observed in vitro and in a murine model of melanoma. It can be concluded that honey is a biologically active and clinically interesting substance but more research is necessary for a comprehensive understanding of its medicinal value in dermatology.
Authors who publish with this journal agree to the following terms:
- The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
- Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
- The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
- Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site;
- The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
- Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
- The Author represents and warrants that:
- the Work is the Author’s original work;
- the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
- the Work is not pending review or under consideration by another publisher;
- the Work has not previously been published;
- the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
- the Work contains no libel, invasion of privacy, or other unlawful matter.
- The Author agrees to indemnify and hold Publisher harmless from Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.
Revised 7/16/2018. Revision Description: Removed outdated link.
Molan PC. The antibacterial activity of honey: 1. The nature of the antibacterial activity. Bee World. 1992;73(1):5-28.
Barakhbah SASA. Honey in the Malay tradition. Malays J Med Sci. 2007;14(1):106.
Sepehr S. The most important medicinal uses of honey and its side effects in the book of the Canon by Avienna and in the modern medical literature: A comparative study. J ApiProd ApiMed Sci. 2010;2(1):43.
Deshpande SD KK. Indian honey as a medicine. J ApiProd ApiMed Sci. 2010;2(1):45.
Ediriweera ER, Premarathna NY. Medicinal and cosmetic uses of Bee's Honey - A review. Ayu. 2012;33(2):178-182.
Subrahmanyam M. Practical application of honey dressing. Malays J Med Sci. 2007;14(1):103.
Marwat SK, Khan MA, Rehman F, Khan K. Medicinal uses of honey (Quranic medicine) and its bee flora from Dera Ismail Khan District, KPK, Pakistan. Pak J Pharm Sci. 2013;26(2):307-314.
Meda A, Lamien CE, Millogo J, Romito M, Nacoulma OG. Therapeutic uses of honey and honeybee larvae in central Burkina Faso. J Ethnopharmacol. 2004;95(1):103-107.
WHO. WHO traditional medicine strategy 2014-2023. 2014. Accessed 15 Dec 2014, 2014.
Burlando B, Cornara L. Honey in dermatology and skin care: a review. J Cosmet Dermatol. 2013;12(4):306-313.
Irish J, Blair S, Carter DA. The antibacterial activity of honey derived from Australian flora. PLoS One. 2011;6(3):e18229.
Kwakman PH, Te Velde AA, de Boer L, Vandenbroucke-Grauls CM, Zaat SA. Two major medicinal honeys have different mechanisms of bactericidal activity. PLoS One. 2011;6(3):e17709.
Majtan J. Honey: an immunomodulator in wound healing. Wound Repair Regen. 2014;22(2):187-192.
Sherlock O, Dolan A, Athman R, et al. Comparison of the antimicrobial activity of Ulmo honey from Chile and Manuka honey against methicillin-resistant Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa. BMC Complement Altern Med. 2010;10:47.
Carnwath R, Graham EM, Reynolds K, Pollock PJ. The antimicrobial activity of honey against common equine wound bacterial isolates. Vet J. 2014;199(1):110-114.
McLoone P, Warnock M, Fyfe L. Honey: A realistic antimicrobial for disorders of the skin. J Microbiol Immunol Infect. 2016;49(2):161-167.
Schneider M, Coyle S, Warnock M, Gow I, Fyfe L. Anti-microbial activity and composition of manuka and portobello honey. Phytother Res. 2013;27(8):1162-1168.
Tan HT, Rahman RA, Gan SH, et al. The antibacterial properties of Malaysian tualang honey against wound and enteric microorganisms in comparison to manuka honey. BMC Complement Altern Med. 2009;9:34.
Cooper RA, Halas E, Molan PC. The efficacy of honey in inhibiting strains of Pseudomonas aeruginosa from infected burns. J Burn Care Rehabil. 2002;23(6):366-370.
Cooper R, Jenkins L, Hooper S. Inhibition of biofilms of Pseudomonas aeruginosa by Medihoney in vitro. J Wound Care. 2014;23(3):93-96, 98-100, 102 passim.
Kronda JM, Cooper RA, Maddocks SE. Manuka honey inhibits siderophore production in Pseudomonas aeruginosa. J Appl Microbiol. 2013;115(1):86-90.
Jenkins RE, Cooper R. Synergy between oxacillin and manuka honey sensitizes methicillin-resistant Staphylococcus aureus to oxacillin. J Antimicrob Chemother. 2012;67(6):1405-1407.
McLoone P, Warnock M, Fyfe L. Honey: an immunomodulatory agent for disorders of the skin. Food Agric Immunol. 2016;27(3):338-349.
Majtan J, Kumar P, Majtan T, Walls AF, Klaudiny J. Effect of honey and its major royal jelly protein 1 on cytokine and MMP-9 mRNA transcripts in human keratinocytes. Exp Dermatol. 2010;19(8):e73-79.
Tonks AJ, Cooper RA, Jones KP, Blair S, Parton J, Tonks A. Honey stimulates inflammatory cytokine production from monocytes. Cytokine. 2003;21(5):242-247.
Ahmad A, Khan RA, Mesaik MA. Anti inflammatory effect of natural honey on bovine thrombin-induced oxidative burst in phagocytes. Phytother Res. 2009;23(6):801-808.
Majtan J, Bohova J, Garcia-Villalba R, et al. Fir honeydew honey flavonoids inhibit TNF-alpha-induced MMP-9 expression in human keratinocytes: a new action of honey in wound healing. Arch Dermatol Res. 2013;305(7):619-627.
Ranzato E, Martinotti S, Burlando B. Epithelial mesenchymal transition traits in honey-driven keratinocyte wound healing: comparison among different honeys. Wound Repair Regen. 2012;20(5):778-785.
Barui A, Mandal N, Majumder S, et al. Assessment of molecular events during in vitro re-epithelialization under honey-alginate matrix ambience. Mater Sci Eng C Mater Biol Appl. 2013;33(6):3418-3425.
Rossiter K, Cooper AJ, Voegeli D, Lwaleed BA. Honey promotes angiogeneic activity in the rat aortic ring assay. J Wound Care. 2010;19(10):440, 442-446.
Diegelmann RF, Evans MC. Wound healing: an overview of acute, fibrotic and delayed healing. Front Biosci. 2004;9:283-289.
Bischofberger AS, Dart CM, Perkins NR, Kelly A, Jeffcott L, Dart AJ. The effect of short- and long-term treatment with manuka honey on second intention healing of contaminated and noncontaminated wounds on the distal aspect of the forelimbs in horses. Vet Surg. 2013;42(2):154-160.
Boekema BK, Pool L, Ulrich MM. The effect of a honey based gel and silver sulphadiazine on bacterial infections of in vitro burn wounds. Burns. 2013;39(4):754-759.
Gethin G, Cowman S. Manuka honey vs. hydrogel--a prospective, open label, multicentre, randomised controlled trial to compare desloughing efficacy and healing outcomes in venous ulcers. J Clin Nurs. 2009;18(3):466-474.
Gupta SS, Singh O, Bhagel PS, Moses S, Shukla S, Mathur RK. Honey dressing versus silver sulfadiazene dressing for wound healing in burn patients: a retrospective study. J Cutan Aesthet Surg. 2011;4(3):183-187.
Haidari M, Nazer MR, Ahmadinejad M, Almasi V, Khorramabadi MS, Pournia Y. Honey in the treatment of Fournier's gangrene as an adjuvant: a cross sectional study. J Pak Med Assoc. 2014;64(5):571-573.
Ingle R, Levin J, Polinder K. Wound healing with honey--a randomised controlled trial. S Afr Med J. 2006;96(9):831-835.
Jull A, Walker N, Parag V, Molan P, Rodgers A. Randomized clinical trial of honey-impregnated dressings for venous leg ulcers. Br J Surg. 2008;95(2):175-182.
Khoo YT, Halim AS, Singh KK, Mohamad NA. Wound contraction effects and antibacterial properties of Tualang honey on full-thickness burn wounds in rats in comparison to hydrofibre. BMC Complement Altern Med. 2010;10:48.
Maghsoudi H, Salehi F, Khosrowshahi MK, Baghaei M, Nasirzadeh M, Shams R. Comparison between topical honey and mafenide acetate in treatment of burn wounds. Ann Burns Fire Disasters. 2011;24(3):132-137.
Malik KI, Malik MA, Aslam A. Honey compared with silver sulphadiazine in the treatment of superficial partial-thickness burns. Int Wound J. 2010;7(5):413-417.
Mat Lazim N, Abdullah B, Salim R. The effect of Tualang honey in enhancing post tonsillectomy healing process. An open labelled prospective clinical trial. Int J Pediatr Otorhinolaryngol. 2013;77(4):457-461.
McIntosh CD, Thomson CE. Honey dressing versus paraffin tulle gras following toenail surgery. J Wound Care. 2006;15(3):133-136.
Nakajima Y, Nakano Y, Fuwano S, et al. Effects of three types of Japanese honey on full-thickness wound in mice. Evid Based Complement Alternat Med. 2013;2013:504537.
Sare JL. Leg ulcer management with topical medical honey. Br J Community Nurs. 2008;13(9):S22, S24, S26 passim.
Shukrimi A, Sulaiman AR, Halim AY, Azril A. A comparative study between honey and povidone iodine as dressing solution for Wagner type II diabetic foot ulcers. Med J Malaysia. 2008;63(1):44-46.
Subrahmanyam M. Honey impregnated gauze versus polyurethane film (OpSite) in the treatment of burns--a prospective randomised study. Br J Plast Surg. 1993;46(4):322-323.
Subrahmanyam M. Honey-impregnated gauze versus amniotic membrane in the treatment of burns. Burns. 1994;20(4):331-333.
Subrahmanyam M. Honey dressing versus boiled potato peel in the treatment of burns: a prospective randomized study. Burns. 1996;22(6):491-493.
Subrahmanyam M. A prospective randomised clinical and histological study of superficial burn wound healing with honey and silver sulfadiazine. Burns. 1998;24(2):157-161.
Subrahmanyam M. Early tangential excision and skin grafting of moderate burns is superior to honey dressing: a prospective randomised trial. Burns. 1999;25(8):729-731.
Tahmaz L, Erdemir F, Kibar Y, Cosar A, Yalcyn O. Fournier's gangrene: report of thirty-three cases and a review of the literature. Int J Urol. 2006;13(7):960-967.
Vijaya KK, Nishteswar K. Wound healing activity of honey: A pilot study. Ayu. 2012;33(3):374-377.
Gethin G, Cowman S. Case series of use of Manuka honey in leg ulceration. Int Wound J. 2005;2(1):10-15.
Zerm R. Topical honey for diabetic foot ulcers. Dtsch Arztebl Int. 2013;110(21):373.
Jull AB, Cullum N, Dumville JC, Westby MJ, Deshpande S, Walker N. Honey as a topical treatment for wounds. Cochrane Database Syst Rev. 2015;3:Cd005083.
Al-Jawad FH, Sahib AS, Al-Kaisy AA. Role of antioxidants in the treatment of burn lesions. Ann Burns Fire Disasters. 2008;21(4):186-191.
Henriques A, Jackson S, Cooper R, Burton N. Free radical production and quenching in honeys with wound healing potential. J Antimicrob Chemother. 2006;58(4):773-777.
Ansari MJ, Al-Ghamdi A, Usmani S, et al. Effect of jujube honey on Candida albicans growth and biofilm formation. Arch Med Res. 2013;44(5):352-360.
Brady NF, Molan PC, Harfoot CG. The Sensitivity of Dermatophytes to the Antimicrobial Activity of Manuka Honey and Other Honey. Pharm Pharmacol Commun. 1996;2(10):471-473.
Wu Q. Antimicrobial effect of manuka honey and kanuka honey alone and in combination with the bioactives against the growth of Propionibacterium acnes ATCC 6919. New Zealand, Massey University; 2011.
Ong PY. Recurrent MRSA skin infections in atopic dermatitis. J Allergy Clin Immunol. In practice. 2014;2(4):396-399.
Al-Waili NS. Therapeutic and prophylactic effects of crude honey on chronic seborrheic dermatitis and dandruff. Eur J Med Res. 2001;6(7):306-308.
Al-Waili NS. Topical application of natural honey, beeswax and olive oil mixture for atopic dermatitis or psoriasis: partially controlled, single-blinded study. Complement Ther Med. 2003;11(4):226-234.
Al-Waili NS. An alternative treatment for pityriasis versicolor, tinea cruris, tinea corporis and tinea faciei with topical application of honey, olive oil and beeswax mixture: an open pilot study. Complement Ther Med. 2004;12(1):45-47.
Al-Waili NS. Clinical and mycological benefits of topical application of honey, olive oil and beeswax in diaper dermatitis. Clin Microbiol Infect. 2005;11(2):160-163.
Al-Waili NS. Topical honey application vs. acyclovir for the treatment of recurrent herpes simplex lesions. Med Sci Monit. 2004;10(8):Mt94-98.
Ngatu NR, Saruta T, Hirota R, et al. Antifungal efficacy of Brazilian green propolis extracts and honey on Tinea capitis and Tinea versicolor. Eur J Integr Med. 2011;3(4):e281-e287.
Braithwaite I, Hunt A, Riley J, et al. Randomised controlled trial of topical kanuka honey for the treatment of rosacea. BMJ open. 2015;5(6):e007651.
Semprini A, Braithwaite I, Corin A, et al. Randomised controlled trial of topical kanuka honey for the treatment of acne. BMJ open. 2016;6(2):e009448.
Fingleton J, Helm C, Tofield C, Weatherall M, Beasley R. A randomised controlled trial of topical Kanuka honey for the treatment of eczema. JRSM open. 2014;5(1):2042533313509263.
Fingleton J, Sheahan D, Corin A, Weatherall M, Beasley R. A randomised controlled trial of topical Kanuka honey for the treatment of psoriasis. JRSM open. 2014;5(3):2042533313518913.
Fingleton J, Corin A, Sheahan D, et al. Randomised controlled trial of topical kanuka honey for the treatment of cold sores. Adv Integr Med. 2014;1(3):119-123.
Naidoo NM, P. Littler, R. Mok, G. Jameson, M. Round, G. A phase II randomized controlled trial of manuka honey as prophylaxis against radiation induced dermatitis in breast cancer patients. Eur J Cancer. 2011;47(Supplement 1):S367.
Nilforoushzadeh MA, Jaffary F, Moradi S, Derakhshan R, Haftbaradaran E. Effect of topical honey application along with intralesional injection of glucantime in the treatment of cutaneous leishmaniasis. BMC Complement Altern Med. 2007;7:13.
Fernandez-Cabezudo MJ, El-Kharrag R, Torab F, et al. Intravenous administration of manuka honey inhibits tumor growth and improves host survival when used in combination with chemotherapy in a melanoma mouse model. PLoS One. 2013;8(2):e55993.
Pichichero E, Cicconi R, Mattei M, Muzi MG, Canini A. Acacia honey and chrysin reduce proliferation of melanoma cells through alterations in cell cycle progression. Int J Oncol. 2010;37(4):973-981.
Ahmad I, Jimenez H, Yaacob NS, Yusuf N. Tualang honey protects keratinocytes from ultraviolet radiation-induced inflammation and DNA damage. Photochem Photobiol. 2012;88(5):1198-1204.
Pichichero E, Cicconi R, Mattei M, Canini A. Chrysin-induced apoptosis is mediated through p38 and Bax activation in B16-F1 and A375 melanoma cells. Int J Oncol. 2011;38(2):473-483.
Placzek WJ, Wei J, Kitada S, Zhai D, Reed JC, Pellecchia M. A survey of the anti-apoptotic Bcl-2 subfamily expression in cancer types provides a platform to predict the efficacy of Bcl-2 antagonists in cancer therapy. Cell Death Dis. 2010;1:e40.
Jiang X, Shapiro DJ. The immune system and inflammation in breast cancer. Mol Cell Endocrinol. 2014;382(1):673-682.
Erdei E, Torres SM. A new understanding in the epidemiology of melanoma. Expert Rev Anticancer Ther. 2010;10(11):1811-1823.
WHO. Antimicrobial resistance: global report on surveillance.: World Health Organisation;2014.
Baizhumanova A, Sakamoto J. Cancer in Kazakhstan: Present situation on Cancer. Annals of Cancer Research and Therapy. 2010;18(2):65-68.
Iwata K, Takamura N, Nakashima M, et al. Loss of heterozygosity on chromosome 9q22.3 in microdissected basal cell carcinomas around the Semipalatinsk Nuclear Testing Site, Kazakhstan. Hum Pathol.;35(4):460-464.
Benguedouar L, Lahouel M, Gangloff SC, et al. Ethanolic extract of Algerian Propolis and galangin decreased murine melanoma tumour progression. Anticancer Agents Med Chem. 2016.
Henshaw FR, Bolton T, Nube V, et al. Topical application of the bee hive protectant propolis is well tolerated and improves human diabetic foot ulcer healing in a prospective feasibility study. J Diabetes Complications. 2014;28(6):850-857.
Nina N, Quispe C, Jimenez-Aspee F, et al. Antibacterial Activity, Antioxidant Effect and Chemical Composition of Propolis from the Region del Maule, Central Chile. Molecules. 2015;20(10):18144-18167.
Akhmetova A ST, Kulsharova G, Nurgozhin T, Mikhalovsky S. Current State of Chronic Wound Care in Kazakhstan: Focus on Topical Treatments. Russian Open Medical Journal. 2015;4(1).
Kuncic MK, Jaklic D, Lapanje A, Gunde-Cimerman N. Antibacterial and antimycotic activities of Slovenian honeys. Br J Biomed Sci. 2012;69(4):154-158.
Shahzad A, Cohrs RJ. In vitro antiviral activity of honey against varicella zoster virus (VZV): A translational medicine study for potential remedy for shingles. Transl Biomed. 2012;3(2).
Canonico B, Candiracci M, Citterio B, et al. Honey flavonoids inhibit Candida albicans morphogenesis by affecting DNA behavior and mitochondrial function. Future Microbiol. 2014;9(4):445-456.
Jenkins R, Burton N, Cooper R. Proteomic and genomic analysis of methicillin-resistant Staphylococcus aureus (MRSA) exposed to manuka honey in vitro demonstrated down-regulation of virulence markers. J Antimicrob Chemother. 2014;69(3):603-615.
Lee JH, Park JH, Kim JA, et al. Low concentrations of honey reduce biofilm formation, quorum sensing, and virulence in Escherichia coli O157:H7. Biofouling. 2011;27(10):1095-1104.
Gannabathula S, Skinner MA, Rosendale D, et al. Arabinogalactan proteins contribute to the immunostimulatory properties of New Zealand honeys. Immunopharmacol Immunotoxicol. 2012;34(4):598-607.
Raynaud A, Ghezali L, Gloaguen V, Liagre B, Quero F, Petit JM. Honey-induced macrophage stimulation: AP-1 and NF-kappaB activation and cytokine production are unrelated to LPS content of honey. Int Immunopharmacol. 2013;17(3):874-879.
Timm M, Bartelt S, Hansen EW. Immunomodulatory effects of honey cannot be distinguished from endotoxin. Cytokine. 2008;42(1):113-120.
Tonks A, Cooper RA, Price AJ, Molan PC, Jones KP. Stimulation of TNF-alpha release in monocytes by honey. Cytokine. 2001;14(4):240-242.
Tonks AJ, Dudley E, Porter NG, et al. A 5.8-kDa component of manuka honey stimulates immune cells via TLR4. J Leukoc Biol. 2007;82(5):1147-1155.
Tomblin V, Ferguson LR, Han DY, Murray P, Schlothauer R. Potential pathway of anti-inflammatory effect by New Zealand honeys. Int J Gen Med. 2014;7:149-158.