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Honey: A Therapeutic Agent for Disorders of the Skin

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  • Olabisi Onabanjo University, College of Health Sciences, OOUTH, P.O.Box 657, Shagamu, Ogun, Nigeria.

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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.
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Honey:
A Therapeutic Agent for Disorders of the
Skin
Pauline McLoone1, Afolabi
Oluwadun2, Mary Warnock3, Lorna
Fyfe3
1Department of Biomedical Sciences,
School of Medicine, Nazarbayev
University, Astana, Kazakhstan;
2Department of Medical Microbiology and
Parasitology Olabisi Onabanjo University,
Sagamu, Ogun State, Nigeria; 3Dietetics,
Nutrition and Biological Sciences, Queen
Margaret University, Musselburgh, East
Lothian, Scotland, United Kingdom
Vol. 5, No. 1 (2016) | ISSN 2166-7403 (online)
DOI 10.5195/cajgh.2016.241 | http://cajgh.pitt.edu
MCLOONE
This work is licensed under a Creative Commons Attribution 4.0 United States License.
This journal is published by the University Library System of the University of Pittsburgh as part
of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press.
Central Asian Journal of Global Health
Volume 5, No. 1 (2016) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2016.241 | http://cajgh.pitt.edu
Abstract
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.
Keywords: dermatology, honey, skin cancer, wound healing
Honey:
A Therapeutic Agent for Disorders of the
Skin
Pauline McLoone1, Afolabi
Oluwadun2, Mary Warnock3, Lorna
Fyfe3
1Department of Biomedical Sciences, School
of Medicine, Nazarbayev University, Astana,
Kazakhstan; 2Department of Medical
Microbiology and Parasitology Olabisi
Onabanjo University, Sagamu, Ogun State,
Nigeria; 3Dietetics, Nutrition and Biological
Sciences, Queen Margaret University,
Musselburgh, East Lothian, Scotland, United
Kingdom
Commentary
Historically, honey has been recognised around
the world for its healing properties with records of its
therapeutic use dating back to 2000 B.C. The ancient
Greeks and Egyptians, for example, used honey to treat
skin wounds and burns by applying topically on the
skin.1 Honey has been reported to ameliorate a broad
array of diseases but the focus of this review is on the
therapeutic properties of honey in the treatment of
disorders of the skin.
Traditional medicine in numerous countries
around the world has described honey as efficacious in
the treatment of a range of skin disorders. In Malaysian
tradition, honey is used to treat furuncles, carbuncles,
diabetic wounds and burns. Persian traditional medicine
documented honey as effective in the treatment of
wounds, eczema, and inflammation.2,3 In Ayurvedic
medicine, a traditional medicine native to the Indian
CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH
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This journal is published by the University Library System of the University of Pittsburgh as part
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Central Asian Journal of Global Health
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subcontinent, honey is used to treat cuts and wounds,
eczema, dermatitis, burns, skin diseases and Fournier’s
gangrene.4-6 Similarly, Quranic medicine in Pakistan
recorded honey combined with cinnamon powder as a
treatment for pustules, eczema, ringworm and a variety
of other skin diseases and in Burkina Faso, Africa, it has
been reported that indigenous people use honey as a
skin cleansing agent and as a treatment for measles
rash.7,8 The uses of honey in traditional medicine are
still significant today, especially, when we consider the
fact that most of the population of developing countries
presently rely on indigenous medicine as their source of
primary health care.9 Honey has also been used
extensively as an ingredient in cosmetic skin care
products both in the past and present day.5,10
In clinical practice today, manuka honey
produced by honey bees (Apis mellifera) feeding on the
manuka tree (Leptospermum scoparium) in New
Zealand is used topically in the management of wound
infections.11 It has been approved for clinical use in
Australia, New Zealand, Europe, United States of
America, Canada and Hong Kong and products include
γ irradiated honey in gels, ointments and impregnated
dressings. Revamil honey is another medical grade
honey commonly used in clinical practice for wound
care.12 It is produced by manufacturers in the
Netherlands in collaboration with the University of
Wageningen and the Academic Medical Centre,
Amsterdam. The manufacturers have disclosed that the
honey is produced in greenhouses but further details
about the origin of the honey have not been revealed.
The skin healing ability of honey has been
attributed to its antimicrobial properties, its ability to
modulate the skin’s immune system and promote tissue
repair.13,14 This review explores clinical and scientific
research investigating the efficacy of honey in the
treatment of wounds and a variety of other skin
disorders. A principle aim was to use the scientific
literature to evaluate the potential efficacy of honey in
the treatment of a range of dermatological disorders.
Methods
The databases Pubmed, Medline and
ScienceDirect were used to carry out a comprehensive
search of the scientific literature on the effects of honey
in the treatment of skin disorders including wounds.
Some of the key search terms used in combination were
“honey” “antimicrobial activity” “skin immune system”
“skin disorders” “wound healing” “seborrheic
dermatitis” “atopic dermatitis” “psoriasis” “rosacea”
“acne” “pityriasis versicolor” “cutaneous leishmaniasis”
“skin cancer” Kazakhstan” and “Central Asia”.
Relevant in vitro and in vivo studies were selected and
we also searched the reference list of included papers to
ensure that no important papers were omitted. Texts in
English, published between 1990 and 2016 were
included.
Results
The Efficacy of Honey in the Treatment of
Skin Wounds
The ability of honey to aid the healing of skin
wounds is the most widely researched aspect of honey
as a therapeutic agent to date. A plethora of in vitro and
in vivo studies have been performed.
The Efficacy of Honey in the Treatment of
Skin Wounds: In Vitro Studies
In vitro studies have revealed that honey from
diverse floral origins can kill a wide range of wound
pathogens, including; methicillin resistant
Staphylococcus aureus (MRSA), Staphylococcus
aureus, Escherichia coli, Pseudomonas aeruginosa and
Acinetobacter baumannii.15-18 As an example, the work
of Cooper et al, (2002) demonstrated that manuka and
pasture honey from New Zealand were active against 17
strains of P. aeruginosa isolated from infected burns
with minimal inhibitory concentrations (MICs) below
10%.19 The authors concluded that these honeys have
the potential to be effective treatments for burns
MCLOONE
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infected with P. aeruginosa. Also, Cooper et al (2014)
later demonstrated the ability of medihoney to disrupt
the structure and inhibit the growth of P. aeruginosa
biofilms grown in vitro.20 As well as killing microbes,
studies have shown that sub-lethal concentrations of
honey can reduce microbial pathogenicity, for example,
Kronda et al (2013) demonstrated that sub-lethal
concentrations of manuka honey reduced siderophore
production, a virulence factor that scavenges iron for
bacterial growth, in strains of P. aeruginosa.21 Even
more remarkable are the in vitro findings that honey can
reverse antimicrobial resistance. Jenkins and Cooper
(2012) reported that manuka honey and oxacillin
worked synergistically to inhibit the growth of MRSA
and that manuka honey reversed oxacillin resistance in
MRSA in vitro.22
Table 1. Honey as a therapeutic agent for skin disorders;
Summary of the key in vitro findings
Importantly, studies have also shown that
honey from a variety of sources can modulate
immunological parameters related to the skin immune
system.23 For example, in vitro, honey has been shown
to stimulate cytokine production by skin cells such as
keratinocytes and other immune cells such as
monocytes.24,25 It has been proposed that increased
cytokine production in an early wound could enhance
wound healing because cytokines such as TNF-α and
IL-6 play an important role in the early wound healing
process. Additionally, some studies have shown that
honey or its extracts can down regulate the production
of cellular molecules such as matrix metalloproteinases
(MMPs) and reactive oxygen intermediates (ROIs) that
may contribute to excessive inflammation in the chronic
wound.26,27 It has been suggested that the
immunomodulatory properties of honey may contribute
to enhanced tissue repair or reduce chronic
inflammation in the wound, leading to enhanced
healing.
As well as its antimicrobial and
immunomodulatory properties, honey has been shown
to promote re-epithelialisation and angiogenesis in in
vitro models of wound healing. Ranzato et al (2012)
demonstrated that acacia, buckwheat and manuka
honey, purchased at an apiculture centre in Okayamo,
Japan, increased re-epithelialisation rates in scratch
wounds induced in keratinocyte (HaCaT) monolayers.28
Furthermore, the mechanism was shown to be due to
honey induced activation of pathways that regulate cell
locomotion and cell proliferation. Barui et al, (2013)
demonstrated that a honey alginate fibrous matrix
induced faster re-epithelialisation than an alginate only
matrix in a keratinocyte (HaCaT) wound model; E-
cadherin protein was enhanced in the honey alginate
model which may have promoted increased cell to cell
adhesion.29 Rossiter et al, (2010) reported that the
medicinal honey Activon containing 100% manuka
honey, the honey based ointment Mesitran as well as a
supermarket honey (Rowse) promoted angiogenic
activity in a rat aortic ring assay in vitro.30
In conclusion, in vitro studies have revealed
that honey has some remarkable scientific properties
that, plausibly, could promote the healing of wounds.
The Efficacy of Honey in the Treatment of
Skin Wounds: In Vivo Studies
Ideally, a wound will heal early but sometimes
wound healing is delayed and this can be the result of
systemic disease, malnutrition and infection of the
wound leading to excessive inflammation. Indeed,
excessive infiltration of neutrophils has been associated
with deficient wound healing.31 Micro-organisms can
sometimes attach to the wound bed and form a biofilm
which is disruptive to the healing process. Wound
infections exacerbate illness, cause anxiety and increase
patient morbidity and mortality. Surgical wound
infections lengthen hospital stay and chronic wounds
CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH
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require considerably more dressings. Hence, effective
prevention and management of wound infections will
impact positively on both patient health and cost.
Table 2. Honey as a therapeutic agent for skin disorders;
Summary of the key in vivo findings
There are a plethora of in vivo studies
investigating the efficacy of honey in the treatment of
wounds;32-55 many of the findings are controversial.
However, a recent Cochrane based review by Jull et al,
(2015)56 concluded that there is quality evidence that
honey heals partial thickness burn wounds more quickly
than conventional treatments and infected post-
operative wounds more effectively than gauze or
antiseptics. It was concluded that other studies
comparing honey with conventional methods in wound
healing were of insufficient quality to form any
definitive conclusions.
Larger, well designed, double blind, clinical
studies are required for a fuller understanding of the
efficacy of honey in the treatment of different types of
wounds. The mechanism of the skin healing properties
of honey in relation to burn wounds is not fully
understood but may, at least partially, be due to the
antioxidant content of honey. There is evidence for free
radical activity and reduced antioxidant scavenging
capacity in burn wounds leading to oxidative stress.57
Honeys that are rich in antioxidants are likely to
increase the antioxidant capacity of burn wounds and
mop up free radicals leading to reduced oxidative
stress.58 Of course, the antimicrobial and
immunomodulatory properties of honey may also
positively encourage the wound healing process in burn
wounds.
Mode of administration and combination
therapy with other agents such as antibiotics or other
natural products could be considered. Techniques such
as checkerboard and time kill studies are currently being
used to determine the synergistic effects of
antimicrobial agents (personal communication;
Oluwadun A. & Akinduti P., Olabisi Onabanjo
University).
The Efficacy of Honey in the Treatment of
Other Disorders of the Skin
In Vitro Studies
In vitro studies have revealed that honey can
inhibit the growth of a range of dermatologically
important microbes. As well as inhibition of microbes
responsible for wound infections, honey has been shown
to inhibit the growth of dermatophytes a cause of tinea
infections, Candida albicans a cause of cutaneous
candidiasis and Propionibacterium acnes a cause of
acne.16,59-61 Many studies have demonstrated the
antimicrobial effects of honey from a variety of sources
against S. aureus. As well as wound infections S. aureus
is an important cause of furuncles, styes and impetigo
and super-infection with S. aureus is common in atopic
dermatitis.62` Research should continue to investigate
the in vitro effects of honey against other
dermatologically important microbes such as
Malassezia species, human papilloma virus and Bacillus
oleronius.
Some skin disorders such as contact dermatitis,
atopic dermatitis and psoriasis have been classified as
immune mediated skin disorders. Although the
aetiology of the majority of immune mediated skin
disorders are not fully understood the immune system is
believed to play a significant role in the pathogenesis of
the disease. Such disorders commonly respond to
treatment with immunomodulating agents such as
corticosteroids or ultraviolet radiation therapy.
Recently, in vitro studies have revealed that honey is
able to modulate the immune system, for example, a
study by Majtan et al, (2010) demonstrated that acacia
honey from Slovakia stimulated TNF-α, TGF-β, IL-
and matrix metalloproteinase 9 (MMP-9) mRNA
MCLOONE
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expression by human primary keratinocytes isolated
from human foreskin.24 Subsequently, Majtan et al,
(2013) reported that an aqueous extract of fir honeydew
honey from Slovakia inhibited TNF-α induced matrix
metalloproteinase-9 (MMP-9) protein and mRNA
production by human keratinocytes (HaCaT) cells.27
Since the role of the immune system in skin disorders is
complex, it is difficult to infer what effects honey will
have in the treatment of immune mediated skin
disorders without further investigation. It is likely that
both the origin of the honey and the microenvironment
of the skin disorder will influence clinical outcome.
Clearly, more research is necessary for a better
understanding of the immunomodulatory properties of
honey and their relevance for skin disease.
The Efficacy of Honey in the Treatment of
Other Disorders of the Skin: In Vivo Studies
The majority of clinical studies performed to
date have investigated the efficacy of honey in the
treatment of skin wounds. There is a paucity of clinical
studies investigating the effects of honey on other types
of skin disorders; however, some of the studies that
have been carried out have produced positive results.
Al-Waili (2001) reported a remarkable improvement of
symptoms in patients with seborrheic dermatitis (n=30)
following topical application of a diluted crude honey
(90%).63 The same researcher, later reported that a
honey mixture containing natural honey of multi-floral
origin from Lootah Farm, Al-Theed City, United Arab
Emirates, olive oil and beeswax (1:1:1) markedly
improved the symptoms of patients with atopic
dermatitis (n=21) and psoriasis (n=18).64 Some of the
psoriatic and atopic dermatitis patients received a honey
mixture treatment in combination with corticosteroids
and this allowed the concentration of corticosteroid to
be reduced over time without exacerbation of
symptoms. Al-Waili, (2003) suggested that the anti-
microbial, anti-inflammatory and antioxidant properties
of honey may explain the observed therapeutic effects.
The same honey mixture was found to cure the
symptoms of the fungal skin infections pityriasis
versicolor in 79% of patients (n=14), tinea cruris in 71%
of patients (n=14) and tinea corporis in 62% of patients
(n=8).65 In 2005, Al-Waili reported that the same honey
mixture significantly reduced mean lesion scores in
infants with diaper dermatitis (n=12); the presence of C.
albicans was found to be reduced in some patients
treated with the honey mixture.66 In a small study
(n=16) by Al-Waili (2004) it was reported that honey
was more effective than acyclovir in the treatment of
patients with labial and genital herpes simplex lesions,
suggesting that honey could potentially be effective in
the treatment of oral herpes simplex lesions.67
Table 3. Studies investigating the efficacy of honey in
the treatment of skin disorders (excluding wounds)
Acasia honey (Yamada bee farm, Japan) and
the bee product Brazilian green propolis (BPE) have
also been shown to be efficacious in the treatment of
tinea infections in vivo.68 Two hundred and forty two
Congolese school children with either tinea capitis or
pityriasis versicolor were treated with either 2%
Miconazole (positive control), BPE (100mg/ml or
50mg/ml), acasia honey or Vaseline. The results showed
that acasia honey, BPE at both concentrations and
Miconazole significantly improved erythema,
desquamation and pruritis in tinea patients in
comparison to Vaseline.
Rosacea is an inflammatory skin disorder,
characterised by facial redness, papules, pustules and
telangiectasia. The bacterium Bacillus oleronius isolated
from the Dermodex folliculorum mite has been
implicated in the aetiology of the disease. A recent
study by Braithwaite et al (2015) has shown that kanuka
honey from New Zealand was efficacious in the
treatment of rosacea.69 Their study included 138
participants with a diagnosis of rosacea and a Global
Assessment of Rosacea Severity Score (IGA-RSS) of
CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH
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Central Asian Journal of Global Health
Volume 5, No. 1 (2016) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2016.241 | http://cajgh.pitt.edu
2.69. Sixty nine participants were treated with topical
Honevo (90% kanuka honey and 10% glycerine) for 8
weeks. The other 69 participants were treated with the
control cream Cetomacrogol, a moisturising cream,
commonly used as a vehicle for delivering topical
medications. The results showed that 34.3% in the
Honevo group and 17.4% in the control group had a ≥ 2
improvement in the IGA-RSS at week 8. The
researchers concluded that Honevo is an effective
treatment for rosacea and that future research should
compare Honevo with other conventional treatments,
such as topical Metronidazole and Azelaic cream, both
of which have limited efficacy. The mechanisms of the
therapeutic properties of kanuka honey in the treatment
of rosacea are not fully understood but both the anti-
bacterial and anti-inflammatory properties have been
considered.
A recent study involving 136 participants with
acne (Investigators Global Assessment (IGA) score of ≥
2.68 aged between 16 and 40 years was carried out to
investigate the efficacy of topical kanuka honey in the
treatment of acne.70 Sixty eight of the participants were
randomised to a treatment regime which involved
applying Protex, a trilocarbon-based antibacterial soap
twice daily for 12 weeks whilst the other 68 participants
applied the anti-bacterial soap treatment followed by
application of Honevo directly after washing off the
bacterial soap, twice daily for 12 weeks. The results
demonstrated that 4 out of 53 patients (7.6%) in the
honey treated group and 1 out of 53 (1.9 %) patients in
the anti-bacterial soap only treated group had a ≥ 2
improvement in IGA score. The authors concluded that
there was no evidence that adding Honevo to standard
anti-bacterial soap treatment for acne is more
efficacious than anti-bacterial soap alone. The authors
however did raise concerns about treatment compliance
due to the young age of many of the participants and the
high rate of withdrawal. Medical grade kanuka honey
has also been tested for its efficacy in the treatment of
eczema and psoriasis.71,72 No evidence of effectiveness
in the treatment of eczema above that of an aqueous
control cream was reported. The study involved 15
participants with bilateral eczematous lesions on the
limbs; medical grade kanuka honey was applied to a
representative lesion on one side and aqueous cream BP
to the other, every night for 2 weeks. Aqueous cream is
not a recommended treatment for eczema and therefore
represented a negative control. The authors concluded
that their study did not demonstrate any evidence that
kanuka honey is an effective treatment for eczema,
however, the small sample size and incomplete blinding
were acknowledged as limitations of the study. The
same study design was also used to investigate the
efficacy of kanuka honey in the treatment of psoriasis.
The results showed that kanuka honey was of similar
efficacy to aqueous cream; a recommended treatment
for psoriasis but with lower efficacy than
corticosteroids. Medical grade kanuka honey has also
been tested for its efficacy in the treatment of cold sores
and compared with Acyclovir.73 The study showed that
Kaplan-Meier estimates of median healing time were
similar for honey and Acyclovir. However, limitations
of the study were that participant size was small with
only 15 patients; the authors proposed that a larger
clinical study should be conducted.
Naidoo et al (2011) tested the efficacy of
manuka honey as a prophylactic treatment for dermatitis
in a phase II randomised controlled trial involving
patients undergoing radiation therapy for breast
cancer.74 81 patients were enrolled in the study; 43 of
which were treated with manuka honey and 38 with
standard aqueous cream. The results showed that there
was a lower incidence of grade >2 dermatitis in the
patients treated with honey (37.2%) compared with
those treated with aqueous cream (57.8%). When >
grade 2 dermatitis did occur the duration was shorter in
the honey treated group in comparison to the group
treated with aqueous cream.
One study also investigated the therapeutic
value of honey in the treatment of cutaneous
leishmaniasis.75 In this study, 90 patients with cutaneous
MCLOONE
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Central Asian Journal of Global Health
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leishmaniasis were allocated to a treatment regime; 45
patients were treated for 6 weeks with topical honey
soaked gauze twice daily and intra-lesional injection of
glucantime weekly. The other 45 patients were treated
with intra-lesional injection of glucantime only. By the
end of the treatment more patients had complete cure in
the glucantime only treated group (71%) than in the
glucantime and honey treated group (51.1%), suggesting
that the honey used in this study is not of therapeutic
value in the treatment of cutaneous leishmaniasis.
The aforementioned studies investigating the
efficacy of honey in the treatment of other types of skin
disorders are relatively small scale and several of them
have been carried out by the same researcher,
nevertheless, they support the possibility that honey
may be therapeutic in the treatment of other types of
skin disorder such as fungal skin infections and
inflammatory skin conditions. Systematic reviews are
important for evidence based method and this approach
has been adopted by Jull et al (2015)56 to evaluate the
efficacy of honey in the treatment of wounds. Clinical
studies investigating the efficacy of honey in the
treatment of other types of skin disorders are more
limited and we have described all published findings
irrespective of the quality of the study design. It is
important that all future studies carried out follow
international standards for clinical trial reporting.
Undoubtedly, further research is necessary,
incorporating in vitro, animal and clinical studies to
determine the medical value of honey in the treatment
of a range of dermatological disorders. Even if honey is
found to be an ineffective treatment for certain skin
diseases such studies are important because the
knowledge will inform patients and clinicians
considering alternative therapies for dermatological
disorders.
Honey and Skin Cancer
Recently, Fernandez-Cabezudo et al, (2013)
reported that manuka honey could inhibit the
proliferation and induce apoptosis in three cancer cell
lines, one of which was the murine melanoma cell line
B16.F1.76 Additionally, Pichichero et al, (2010)
reported that acacia honey inhibited proliferation of
murine and human melanoma cells by inducing cell
cycle arrest at G0/G1.77 In vivo, a murine melanoma
tumour model treated with intravenous manuka honey
displayed a significant reduction in tumour growth.76
Some of the mice received co-administration of manuka
honey and the chemotherapeutic drug taxol and this
resulted in a significant inhibition of the growth of the
tumour and improved overall animal survival suggesting
that manuka honey, as well as having anti-tumourogenic
properties, may reduce chemotherapy induced toxicity.
No changes in haematological and chemical markers
were observed in the mice treated with intravenous
manuka honey suggesting that it is safe to administer
honey in this way. In another study, tualang honey from
Malaysia was shown to protect murine keratinocytes
(PAM 212 cells) in vitro from the immunomodulatory
and photocarcinogenic effects of UVB radiation.78 UVB
irradiated keratinocytes treated with honey exhibited
reduced expression of COX-2 and NF-κB activation in
comparison to UVB only treated cells. Furthermore,
UVB irradiated keratinocytes treated with tualang honey
displayed a marked reduction in DNA damage in the
form of cyclobutane pyrimidine dimers and 8-oxo-7, 8-
dihydro-2-deoxyguanosine compared with UVB
irradiated controls. Tualang honey may therefore be
able to protect the skin against the immunomodulatory
and photocarcinogenic effects of sunlight exposure.
The ability of honey to inhibit the proliferation
of tumour cells is thought to be due to the various
flavonoid and phenolic compounds present in honey.
Evidence for this comes from the work of Pichichero et
al, (2010; 2011) showing that chrysin, a flavanoid found
in acacia honey inhibited proliferation of melanoma
cells via cell cycle arrest and apoptosis.77,79 Honey has
also been shown to regulate expression of p53, the
tumour suppressor protein and down regulate Bcl-2 an
anti-apoptotic protein, found at high levels in numerous
cancers.80 The anti-inflammatory effects of honey may
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of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press.
Central Asian Journal of Global Health
Volume 5, No. 1 (2016) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2016.241 | http://cajgh.pitt.edu
also contribute to its anti-carcinogenic properties,
particularly as inflammation has been shown to
contribute to the progression of cancer.81
The anti-carcinogenic properties of honey
observed to date are promising but more research is
necessary, particularly in vivo, for a fuller understanding
of the potential efficacy of honey in the treatment or
prevention of skin cancer.
Discussion
The ability of honey in vitro to kill skin
relevant microbes, alter microbial pathogenicity, reverse
antibiotic resistance, modulate immunological
parameters, promote tissue repair, inhibit tumour cell
growth and protect against UV induced DNA damage is
really quite remarkable considering it is a scientifically
unaltered, purely natural substance produced by bees. In
vitro studies have sparked excitement amongst
researchers about the therapeutic potential of honey for
clinical practice. Some of the properties observed in
vitro are particularly relevant today when the current
global crisis of antimicrobial drug resistance has
rendered many infectious diseases, including wound
infections, untreatable and malignant melanoma
incidence is increasing faster than any other cancer.82,83
Skin Cancer is also a significant problem in Central
Asian countries; in Kazakhstan for example, incidence
figures from the Ministry of Health (2013) show that
skin cancer is one of the most common forms of cancer
along with lung and breast cancer.84 Furthermore, a
particularly high incidence of basal cell carcinomas was
recorded around the Semipalatinsk nuclear testing site
in Kazakhstan.85
There are countless varieties of honey being
produced worldwide and some may have superior
healing abilities that are yet to be discovered. Central
Asia possesses a unique biodiversity with open steppe,
deserts and high mountains; honey production is
abundant in Kazakhstan, Kyrgyzstan, Uzbekistan and
Tajikistan. Beekeeping trailers enable honey producers
to reach diverse locations in the region, despite this, the
regions honeys have not been fully examined for
potential biomedical uses. Other local bee products,
such as propolis could also be investigated for their
medicinal value as research has demonstrated
antimicrobial, anti-carcinogenic and wound healing
properties.86-88 The development of locally produced
honeys into medical grade honeys suitable for use in
clinical practice could be economically advantageous
for the country concerned.
A recent review has highlighted that there is no
statistical monitoring on the prevalence of chronic
wounds in Kazakhstan and no approved protocols for
wound care.89 The authors described that wound care
products made from plant extracts have been developed
in Kazakhstan although they have not been officially
approved for clinical use. The review did not list honey
as a treatment used for wound care in Kazakhstan
despite its approved use in other parts of the world.
In conclusion, research has demonstrated that
the bioactive properties of honey and the aetiology of
skin diseases are complex and that there are
considerable gaps in our knowledge and understanding
of both. Innovative research that can maximally exploit
the bioactive properties of this natural substance may in
the future lead to the production of a medicinal product
that is highly valued in dermatology.
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Table 1: Honey as a therapeutic agent for skin disorders; Summary of the key in vitro
findings
Key References
Key Findings (in vitro)
14-17,59-61,90,91
Honeys from around the world have potent antimicrobial activity
against skin relevant microbes.
22
Honey can reverse antimicrobial resistance.
21,92-94
Pathogenicity of skin relevant microbes is reduced by honey.
23-25,95-99
Honey modulates cytokine production by cells of the skin immune
system.
26,27,58,100
Anti-inflammatory effects of honey are observed in vitro.
28-30
Honey promotes re-epithelialisation and angiogenesis in in vitro
wound models.
76-78
Honey induces apoptosis of a murine melanoma cell line and
protects keratinocytes from the photocarcinogenic effects of UVB
radiation.
CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH
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of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press.
Central Asian Journal of Global Health
Volume 5, No. 1 (2016) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2016.241 | http://cajgh.pitt.edu
Table 2: Honey as a therapeutic agent for skin disorders; Summary of the key in vivo
findings
Key References
Key Findings (in vivo)
56
Clinical studies suggest that topical application of honey is more
efficacious than conventional treatments in healing partial thickness burn
wounds.
34,36-38,43,45,46,53
The efficacy of honey in the treatment of non-burn acute wounds and
chronic wounds is controversial.
63-66,68,69
Limited human studies suggest that honey is therapeutic in the treatment
of some inflammatory skin disorders and fungal skin infections.
76
Honey reduces tumour growth in a murine melanoma model.
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Table 3: Studies investigating the efficacy of honey in the treatment of skin disorders
(excluding wounds)
Population
Honey Application
Outcome
Ref.
37 patients; 14 with
pityriasis versicolor, 8
with tinea corporis, 14
with tinea cruris and 1
with tinea faciei
Honey mixture containing honey, olive oil
and beeswax (1:1:1) applied to the lesions
3 times daily for a maximum of 4 weeks.
Honey was multi-floral from the United
Arab Emirates.
Complete cure obtained in 79% of
patients with pityriasis versicolor;
71% of patients with tinea cruris and
62% of patients with tinea corporis.
Patient with tinea faciei obtained
clinical cure 3 weeks after start of
therapy.
65
242 Congolese school
children with either
tinea capitis or
pityriasis versicolor
Treated with either 2% Miconazole,
Brazilian green propolis extract or acasia
honey (Yamada bee farm, Japan) or
Vaseline.
Acasia honey (p < 0.05), Brazilian
green propolis extract (p < 0.05) and
2% Miconazole (p < 0.01)
significantly improved erythema,
desquamation and pruritis in tinea
patients in comparison to Vaseline.
68
10 patients with atopic
dermatitis
Lesions on the right side of the body
treated with vaseline. Lesions on the left
side of the body treated with a multifloral
honey mixture, containing honey beeswax
and olive oil in a ratio of 1:1:1 for 2
weeks. Each treatment was applied three
times daily. Honey was from the United
Arab Emirates.
Significant improvement was seen in
lesion scores on the left side of the
body in 8 out of the 10 patients.
64
8 patients with
psoriasis
Lesions on the right side of the body were
treated with paraffin and lesions on the left
were treated with honey mixture (as
described above), 3 times daily for 3
weeks.
Significant improvement was seen in
lesion scores on the left side of the
body in 5 out of 8 patients.
64
12 infants with diaper
dermatitis
Topical application 4 times daily with a
multifloral honey mixture containing
honey, beeswax and olive oil in a ratio of
1:1:1 for 7 days.
Mean total rash score at baseline was
2.91 ± 0.79. Decreased to 0.66 ± 0.98
at day 7. At the end of the study 10 of
the 12 infants had either mild or no
diaper dermatitis.
66
81 patients undergoing
radiation therapy for
breast cancer
Prophylatic treatment: 43 treated with a
pure sterilized manuka honey UMF=18.
Thirty eight patients treated with standard
aqueous cream. Topical treatments were
applied twice daily starting on day 1 of
radiation and continued until 10 days post
treatment.
Lower incidence of > grade 2
dermatitis in the patients treated with
honey (37.2%) compared with those
treated with aqueous cream (57.8%).
When grade 2 dermatitis did occur
duration was shorter in honey treated
group. p = 0.08
74
138 patients with
rosacea (IGA-RSS)
2.69
69 patients treated with topical application
of Honevo (90% kanuka honey and 10%
glycerine) for 8 weeks. 69 patients treated
with the control cream Cetomacrogol.
34.3 % in the Honevo group and
17.4% in the control group had a 2
improvement in the IGA-RSS at
week 8. p = 0.02
69
CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH
This work is licensed under a Creative Commons Attribution 4.0 United States License.
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Central Asian Journal of Global Health
Volume 5, No. 1 (2016) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2016.241 | http://cajgh.pitt.edu
136 patients aged 16-
40 years with acne
IGA ≥ 2.68
68 participants applied Protex, a
trilocarbon based antibacterial soap twice
daily for 12 weeks. Another 68
participants followed the antibacterial soap
treatment regime and applied Honevo
(90% kanuka honey and 10% glycerine)
directly after washing off the anti-bacterial
soap, twice daily for 12 weeks.
4/53 (7.6%) of participants in the
honey group and 1/53 (1.9%) in the
control group had a ≥ 2 improvement
in IGA score at week 12. Trial did
not show evidence that adding
Honevo to the antibacterial soap
regime was more effective than soap
alone.
70
15 patients with
bilateral eczematous
lesions on the limbs
Medical grade kanuka honey was applied
to a representative lesion on one side and
aqueous cream BP on the other, every
night for 2 weeks.
Kanuka honey was not more
efficacious than aqueous cream BP in
the treatment of eczema. Aqueous
cream BP is not a recommended
treatment for eczema.
71
15 patients with
psoriasis with bilateral
lesions on the limbs.
Medical grade kanuka honey was applied
to a representative lesion on one side and
aqueous cream BP on the other, every
night for 2 weeks.
Efficacy was similar to that of the
aqueous cream which is a
recommended treatment for psoriasis.
72
15 participants aged 16
or over with recurrent
Herpes Simplex
Labialis
Participants applied either medical grade
kanuka honey or acyclovir to the lesion 5
times per day until the lesion resolved.
Kaplan-meier estimates of median
healing time were similar for honey
and acyclovir.
73
90 patients with
cutaneous
leishmaniasis
45 patients treated with topical honey
twice daily along with intra-lesional
injection of glucantime once weekly for a
maximum of 6 weeks. 45 patients treated
with glucantime only.
More patients had complete cure in
the glucantime only treated group
(71%) than in the glucantime and
honey treated group (51%). p = 0.04
75
... 8028- and is classified as a humectant/emollient/moisturizing product. A huge amount of skin care formulations enclosing honey or other beehive products are available in the literature [114]. ...
... Honey is antibacterial, fungicidal, and a hygroscopic agent, and it can nurture the skin, contributing to normalizing the mildly acidic pH of the higher protective skin layer [114]. ...
... skin, contributing to normalizing the mildly acidic pH of the higher protective skin layer [114]. ...
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There is a long and interesting history between honeybees and humans. From the beginning, honey has been utilized not only as a sweetener, but also as an ointment and a drug to treat several diseases. Until the discovery of antibiotics, honey was a very popular product used to protect and preserve skin and promote wound healing, to counteract gastrointestinal pains and disorders of the oral cavity, and for other diseases. After the development of antibiotic resistance, honey again gained interest for its use in wound management. Subsequently, more recently, in vitro and in vivo studies have displayed antimicrobial, antioxidant, and other effects of honey and honeybee products, as well as protection of cardiovascular, respiratory, nervous, and gastrointestinal systems. Moreover, recent studies have demonstrated that beehive products are also able to influence the phenotype of skin cells, such as keratinocytes, fibroblasts, and endothelial cells, involved in correct wound healing. This review will characterize the great potential of honeybee products in the field of health and skin care, considering that honey is a virtually inexhaustible natural resource which people, as bees have been domesticated over the centuries, can freely access.
... Recently, MH has been shown to downregulate IL-4-induced production of the potent eosinophil chemoattract CCL26 in HaCaT keratinocytes, and to ameliorate erythema, edema and excoriation in a proof-of-principle clinical study involving 14 atopic dermatitis patients [4]. Thus, there is an emerging interest in MH as a potential therapeutic beyond wound care [5,6]. ...
... By evaluating CYP1 enzymatic activity over time, we show that MH activate the AHR through both direct and indirect means, possibly due to the presence of both CYP1 inhibitors and AHR ligands. Importantly, MH significantly down-regulated IL-4induced CCL26 and upregulated FLG expression through AHR activation, thus providing a mechanistic rationale to its anecdotical use for skin atopy [5]. ...
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Manuka honey (MH) is a complex nutritional material with antimicrobial, antioxidant and anti-inflammatory activity. We have previously shown that MH down regulates IL-4-induced CCL26 expression in immortalized keratinocytes. As MH contains potential ligands of the Aryl Hydrocarbon Receptor (AHR), a key regulator of skin homeostasis, we hypothesize that this effect is mediated via AHR activation. Here, we treated HaCaT cell lines, either stable transfected with an empty vector (EV-HaCaT) or in which AHR had been stable silenced (AHR-silenced HaCaT); or primary normal human epithelial keratinocytes (NHEK) with 2% MH for 24hours. This induced a 15.4-fold upregulation of CYP1A1 in EV-HaCaTs, which was significantly reduced in AHR-silenced cells. Pre-treatment with the AHR antagonist CH223191 completely abrogated this effect. Similar findings were observed in NHEK. In vivo treatment of the Cyp1a1Cre x R26ReYFP reporter mice strain's skin with pure MH significantly induced CYP1A1 expression compared with Vaseline. Treatment of HaCaT with 2% MH significantly decreased baseline CYP1 enzymatic activity at 3 and 6hours but increased it after 12hours, suggesting that MH may activate the AHR both through direct and indirect means. Importantly, MH downregulation of IL-4-induced CCL26 mRNA and protein was abrogated in AHR-silenced HaCaTs and by pre-treatment with CH223191. Finally, MH significantly upregulated FLG expression in NHEK in an AHR-dependent manner. In conclusion, MH activates AHR, both in vitro and in vivo, thereby providing a mechanism of its IL4-induced CCL26 downregulation and upregulation of FLG expression. These results have potential clinical implications for atopic diseases and beyond.
... It is noteworthy that several clinical trials correlate the consumption of honey with wound healing [4], antimicrobial [5], anticancer [6], antidiabetic [7], cardio-protective [8], nephro-protective [9], anti-atherosclerotic [10], neuroprotective [11], and anti-aging activities [12]. In addition, various studies support the potential of honey to treat respiratory diseases, manage mental disorders, control gastrointestinal complications, and promote skin health [13][14][15]. Researchers also linked the beneficial effects of honey on amelioration of chronic and acute diseases with its special phenolic composition [16]. ...
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Hydroxycinnamic acids are an essential phenolic group in honey that are related with its diverse health effects. Furthermore, they can be considered as potential biomarkers for botanical and geographical origin. The extraction of hydroxycinnamic acids from honey requires complicated extraction techniques due to their low contents and matrix particularity. The goal of the present work was to develop a green sample preparation method for the solubilization of hydroxycinnamic acids in honey samples. Thus, a Box–Behnken design has been used to investigate the effect of four factors: (i) percentage of ethanol (60–90%, v/v), (ii) temperature (30–60 °C), (iii) solvent-honey ratio (10–30 mL g−1), and (iv) sonication time (10–40 min) on the contents of caffeic, chlorogenic, and ferulic acids. Based on the desirability index, the ultrasound-assisted mixing of honey with 60.0% (v/v) ethanol at a solvent-honey ratio of 10 mL g−1 for a period of 17.8 min at a temperature of 54.6 °C resulted in the maximum solubilization of hydroxycinnamates. Subsequently, the greenness of developed method was assessed and applied successfully on the analysis of honeys. The present study reports for first time the hydroxycinnamic acid fingerprint of multi-floral honey produced in Cyprus.
... Additionally, their emollient and moisturizing qualities add to their potential advantages in skin care and cosmetic compositions. With positive results, studies have examined their potential for treating wound-related dermatological problems, atopic dermatitis, and acne (McLoone et al., 2016). However, more investigation is required to develop standardized procedures and recommendations for their use in dermatology. ...
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Full-text available
Context: Honey has been employed for its therapeutic attributes since ancient eras, with a history of medicinal utilization, and recent studies have highlighted its diverse clinical applications. The medicinal benefits of honey can be ascribed to various mechanisms, encompassing its osmotic and acidic characteristics, hydrogen peroxide generation, and particular bioactive compounds. While honey generally has a good safety profile, rare risks exist, particularly in infants under one year of age. More rigorous clinical trials and standardized protocols are needed to establish its optimal dosage, application methods, and specific indications. Economic considerations and regional variations in honey composition and quality should also be considered. Aims: To provide an overview of the clinical uses of honey in the medical field, emphasizing its effectiveness and potential therapeutic benefits. Methods: A comprehensive literature search was conducted to gather relevant studies on the clinical applications of honey. The search encompassed various databases and included studies published with the range from May 2001 to May 2023. The selected studies were critically reviewed to extract pertinent information for this critical review. Results: Natural honey comes from two types of honey-producing bees: honeybees and stingless bees. Honey constitutes a multifaceted amalgamation of sugars, enzymes, minerals, vitamins, and bioactive compounds, all contributing to its therapeutic attributes. It exhibits antibacterial, anti-inflammatory, wound healing, and antioxidant effects. In wound management, honey promotes healing, reduces infection rates, and minimizes scarring. It also shows promise in treating bacterial and fungal infections. Furthermore, honey has effectively alleviated symptoms associated with respiratory tract infections, gastrointestinal disorders, and dermatological conditions. Conclusions: Honey possesses multifaceted clinical applications in the medical field. Its diverse therapeutic properties and minimal adverse effects make it an attractive option for various conditions. However, further research is necessary to solidify its role in evidence-based clinical practice, including conducting more rigorous clinical trials, establishing standardized protocols, and considering economic and regional factors. Resumen Contexto: La miel se ha empleado por sus atributos terapéuticos desde la antigüedad, con una historia de utilización medicinal, y estudios recientes han puesto de relieve sus diversas aplicaciones clínicas. Los beneficios medicinales de la miel pueden atribuirse a diversos mecanismos, que abarcan sus características osmóticas y ácidas, la generación de peróxido de hidrógeno y determinados compuestos bioactivos. Aunque en general la miel tiene un buen perfil de seguridad, existen riesgos poco frecuentes, sobre todo en lactantes menores de un año. Se necesitan ensayos clínicos más rigurosos y protocolos estandarizados para establecer su dosis óptima, métodos de aplicación e indicaciones específicas. También deben tenerse en cuenta las consideraciones económicas y las variaciones regionales en la composición y calidad de la miel. Objetivos: Ofrecer una visión general de los usos clínicos de la miel en el ámbito médico, haciendo hincapié en su eficacia y sus posibles beneficios terapéuticos. Métodos: Se realizó una exhaustiva búsqueda bibliográfica para recopilar estudios relevantes sobre las aplicaciones clínicas de la miel. La búsqueda abarcó varias bases de datos e incluyó estudios publicados con un intervalo entre mayo de 2001 y mayo de 2023. Los estudios seleccionados se revisaron críticamente para extraer información pertinente para esta revisión crítica. Resultados: La miel natural procede de dos tipos de abejas productoras de miel: las abejas melíferas y las abejas sin aguijón. La miel constituye una amalgama polifacética de azúcares, enzimas, minerales, vitaminas y compuestos bioactivos, que contribuyen a sus atributos terapéuticos. Tiene efectos antibacterianos, antiinflamatorios, cicatrizantes y antioxidantes. En el tratamiento de heridas, la miel favorece la cicatrización, reduce las tasas de infección y minimiza las cicatrices. También resulta prometedora en el tratamiento de infecciones bacterianas y fúngicas. Además, la miel ha aliviado eficazmente los síntomas asociados a infecciones de las vías respiratorias, trastornos gastrointestinales y afecciones dermatológicas. Conclusiones: La miel posee aplicaciones clínicas polifacéticas en el campo de la medicina. Sus diversas propiedades terapéuticas y sus mínimos efectos adversos la convierten en una opción atractiva para diversas afecciones. Sin embargo, es necesario seguir investigando para consolidar su papel en la práctica clínica basada en la evidencia, incluyendo la realización de ensayos clínicos más rigurosos, el establecimiento de protocolos estandarizados y la consideración de factores económicos y regionales. Palabras Clave: aplicación clínica; miel de Kelulut; miel de Tualang.
... Apart from honey, other bee products like propolis, bee pollen, bee bread, royal jelly, beeswax, and bee venom are also used in dermatology for their therapeutic or cosmetic potential. [29] The dermatological uses of honey are summarized in Table 3. [28][29][30] ...
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... Honey [46][47] ...
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Fournier's gangrene is a progressive polymicrobial necrotising infection. The purpose of this study was to assess the outcome of Fournier's gangrene infection in patients who received topical honey with their therapeutic regimens. The cross-sectional study included 17 patients with Fournier's gangrene. Under spinal anaesthesia, the necrotic areas were debrided. In the first week, every day, the wounds were cleansed with Betadine, normal saline, and 2% oxygenated water, then 30-50cc of honey was used after the wounds were dried. The wounds were then dressed. This method of dressing was taught to the patients' attendants. The granulation tissues, generally bright pink, were observed on the 10th day. Four (23.5%) patients underwent colostomy and 1 (5.9%) died. All the patients were discharged two weeks after the initial debridement. Compared with other studies, honey reduced the healing and hospitalisation time as well as additional costs.
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Aims Propolis is a naturally occurring anti-inflammatory bee derived protectant resin. We have previously reported that topically applied propolis reduces inflammation and improves cutaneous ulcer healing in diabetic rodents. The aim of this study was to determine if propolis shows efficacy in a pilot study of human diabetic foot ulcer (DFU) healing and if it is well tolerated. Materials Serial consenting subjects (n = 24) with DFU ≥ 4 week’s duration had topical propolis applied at each clinic review for 6 weeks. Post-debridement wound fluid was analyzed for viable bacterial count and pro-inflammatory MMP-9 activity. Ulcer healing data was compared with a matched control cohort of n = 84 with comparable DFU treated recently at the same Centre. Results Ulcer area was reduced by a mean 41% in the propolis group compared with 16% in the control group at week 1 (P < 0.001), and by 63% vs 44% at week 3, respectively (P < 0.05). In addition, 10% vs 2% (P < 0.001), then 19% vs 12% (P < 0.05) of propolis treated vs control ulcers had fully healed by weeks 3 and 7, respectively. Post-debridement wound fluid active MMP-9 was significantly reduced, by 18.1% vs 2.8% week 3 from baseline in propolis treated ulcers vs controls (P < 0.001), as were bacterial counts (P < 0.001). No adverse effects from propolis were reported. Conclusions Topical propolis is a well-tolerated therapy for wound healing and this pilot in human DFU indicates for the first time that it may enhance wound closure in this setting when applied weekly. A multi-site randomized controlled of topical propolis now appears to be warranted in diabetic foot ulcers.
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Melanoma is the more dangerous skin cancer, and metastatic melanoma still carries poor prognosis. Despite recent therapeutic advances, prolonged survival remains rare and research is still required. Propolis extracts from many countries have attracted a great deal of attention for their biological properties. We here investigated the ability of an ethanolic extract of Algerian propolis (EEP) to control melanoma tumour growth when given to mice bearing B16F1melanoma tumour either as preventive or as therapeutic treatment. EEP given after tumour occurrence increased mice survival (+30%) and reduced tumour growth (-75%). This was associated with a decrease of the Mitotic Index (-75%) and of Ki-67 (-50%) expression. When given either before or both before and after tumour occurrence, EEP reduced tumour growth but without prolonging mice life. Isolation of B16F1 melanoma cells from resected tumour showed that preventive and curative EEP treatments reduced invasiveness by 55% and 40% respectively compared to control. Galangin, one of the most abundant flavonoids in propolis, significantly reduced the number of melanoma cell in vitro and induced autophagy/apoptosis dose dependently. In conclusion, we showed that EEP reduced melanoma tumour progression/dissemination and could extend mice lifespan when used as therapeutic treatment. Then, EEP may help patients with melanoma, when use as a complementary therapy to classical treatment for which autophagy is not contraindicated.
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Background: Honey is a viscous, supersaturated sugar solution derived from nectar gathered and modified by the honeybee, Apis mellifera. Honey has been used since ancient times as a remedy in wound care. Evidence from animal studies and some trials has suggested that honey may accelerate wound healing. Objectives: The objective of this review was to assess the effects of honey compared with alternative wound dressings and topical treatments on the of healing of acute (e.g. burns, lacerations) and/or chronic (e.g. venous ulcers) wounds. Search methods: For this update of the review we searched the Cochrane Wounds Group Specialised Register (searched 15 October 2014); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 9); Ovid MEDLINE (1946 to October Week 1 2014); Ovid MEDLINE (In-Process & Other Non-Indexed Citations 13 October 2014); Ovid EMBASE (1974 to 13 October 2014); and EBSCO CINAHL (1982 to 15 October 2014). Selection criteria: Randomised and quasi-randomised trials that evaluated honey as a treatment for any sort of acute or chronic wound were sought. There was no restriction in terms of source, date of publication or language. Wound healing was the primary endpoint. Data collection and analysis: Data from eligible trials were extracted and summarised by one review author, using a data extraction sheet, and independently verified by a second review author. All data have been subsequently checked by two more authors. Main results: We identified 26 eligible trials (total of 3011 participants). Three trials evaluated the effects of honey in minor acute wounds, 11 trials evaluated honey in burns, 10 trials recruited people with different chronic wounds including two in people with venous leg ulcers, two trials in people with diabetic foot ulcers and single trials in infected post-operative wounds, pressure injuries, cutaneous Leishmaniasis and Fournier's gangrene. Two trials recruited a mixed population of people with acute and chronic wounds. The quality of the evidence varied between different comparisons and outcomes. We mainly downgraded the quality of evidence for risk of bias, imprecision and, in a few cases, inconsistency.There is high quality evidence (2 trials, n=992) that honey dressings heal partial thickness burns more quickly than conventional dressings (WMD -4.68 days, 95%CI -5.09 to -4.28) but it is unclear if there is a difference in rates of adverse events (very low quality evidence) or infection (low quality evidence).There is very low quality evidence (4 trials, n=332) that burns treated with honey heal more quickly than those treated with silver sulfadiazine (SSD) (WMD -5.12 days, 95%CI -9.51 to -0.73) and high quality evidence from 6 trials (n=462) that there is no difference in overall risk of healing within 6 weeks for honey compared with SSD (RR 1.00, 95% CI 0.98 to 1.02) but a reduction in the overall risk of adverse events with honey relative to SSD. There is low quality evidence (1 trial, n=50) that early excision and grafting heals partial and full thickness burns more quickly than honey followed by grafting as necessary (WMD 13.6 days, 95%CI 9.82 to 17.38).There is low quality evidence (2 trials, different comparators, n=140) that honey heals a mixed population of acute and chronic wounds more quickly than SSD or sugar dressings.Honey healed infected post-operative wounds more quickly than antiseptic washes followed by gauze and was associated with fewer adverse events (1 trial, n=50, moderate quality evidence, RR of healing 1.69, 95%CI 1.10 to 2.61); healed pressure ulcers more quickly than saline soaks (1 trial, n= 40, very low quality evidence, RR 1.41, 95%CI 1.05 to 1.90), and healed Fournier's gangrene more quickly than Eusol soaks (1 trial, n=30, very low quality evidence, WMD -8.00 days, 95%CI -6.08 to -9.92 days).The effects of honey relative to comparators are unclear for: venous leg ulcers (2 trials, n= 476, low quality evidence); minor acute wounds (3 trials, n=213, very low quality evidence); diabetic foot ulcers (2 trials, n=93, low quality evidence); Leishmaniasis (1 trial, n=100, low quality evidence); mixed chronic wounds (2 trials, n=150, low quality evidence). Authors' conclusions: It is difficult to draw overall conclusions regarding the effects of honey as a topical treatment for wounds due to the heterogeneous nature of the patient populations and comparators studied and the mostly low quality of the evidence. The quality of the evidence was mainly downgraded for risk of bias and imprecision. Honey appears to heal partial thickness burns more quickly than conventional treatment (which included polyurethane film, paraffin gauze, soframycin-impregnated gauze, sterile linen and leaving the burns exposed) and infected post-operative wounds more quickly than antiseptics and gauze. Beyond these comparisons any evidence for differences in the effects of honey and comparators is of low or very low quality and does not form a robust basis for decision making.
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