Is manuka honey part of your home toolkit for healing skin ailments? This natural remedy is rich in antioxidant, antimicrobial, and anti-proliferative activity and a product we like to keep on hand to use as needed. In this guest blog, Dr. Joanna Jaros, MD, explores the medicinal history of manuka honey, the research behind using it for wound healing and skin conditions, and tips for using it safely at home.
Manuka honey is derived from the manuka tree (Leptospermum scoparium) and has been used for wound healing for centuries. Evidence from historic texts and burial sites reveals that the ancient Greeks, Egyptians, and Chinese used honey for burns, wound healing, pain relief, and anti-suppurative (anti-pus) properties. More recently, honey was used by the military1 in World War I and II for similar purposes. In this article, we will unpack the century-old secrets of Manuka honey and learn how its antimicrobial and wound healing properties can help heal skin!
The Evidence
One of Manuka honey’s key actions is antimicrobial activity. This means that Manuka honey kills bugs and bacteria that may be living on your skin or inside a wound. The high sugar content of Manuka honey pulls water out of cells and can dehydrate and kill harmful pathogens1. Manuka honey also contains two key antimicrobial ingredients: methylglyoxal and hydrogen peroxide. Hydrogen peroxide (H2O2) is found in all forms of honey and is toxic to cell walls, DNA, RNA, and proteins – including those found in bacteria. Methylglyoxal is an organic compound (CH3C(O)CHO) found specifically in the Manuka variety of honey. It functions by inhibiting the enzyme catalase and prevents bacteria like Staphylococcus aureus and Escherichia coli from surviving. Manuka honey may also prevent bacteria1 from setting up shop on your skin surface, which it likes to do by forming thick “biofilms.” One example of biofilms leading to disease is S. aureus colonization in atopic dermatitis. Chronic colonization can turn into a superinfection and flare-up!
Manuka honey has also been shown to improve the wound healing process. When a wound heals, it goes through the process of coagulating (clotting) followed by inflammation then proliferation and remodeling. Manuka honey has been shown to stimulate granulation and epithelialization2, which basically means the formation of new healthy skin. A large review of studies3 on honey in wound healing, particularly in burns, found that honey was more efficacious for wound healing than silver (measured in the number of days needed for wounds to heal) and less harmful to the surrounding normal skin. Manuka honey has also been shown to reduce wound swelling and pus drainage from wounds, leading to fewer symptoms.
Manuka honey can also be used in combination with conventional wound care treatments and strategies. A large systematic review4 showed that Manuka honey synergizes with antibiotics, bacteriophages, antimicrobial peptides, and natural agents such as ginger or propolis in a laboratory scenario (in vitro studies). Improved wound healing4 was also observed in mice when honey was combined with laser therapy or bacteriophage therapy.
A few small studies have looked at the applications of Manuka honey in skin conditions. A recent study of 14 patients showed that daily overnight application of Manuka honey improved lesions of atopic dermatitis after just one week. The authors found that Manuka honey application led to a downregulation of several cytokines5 including in IL-4-induced CCL26 release from keratinocytes (an eosinophil chemoattractant) and mast cell degranulation of histamine. Only two patients reported having to use topical corticosteroids in addition to the honey to control symptoms. A review of Pubmed reveals case reports of honey used for treatment of folliculitis decalvans (a type of alopecia), psoriasis, chapped lips, and so forth. These are anecdotal reports, and large studies are needed to confirm these findings.
Safety
Two randomized controlled trials using honey on the eyelids6 and in the vaginal area7 showed that postoperative treatment with honey was preferred by patients and led to equivalent or better wound healing than placebo or phenytoin cream. These trials seem to suggest that honey is safe and comfortable to use even in the most sensitive areas.
Choosing a product
Manuka honey potency is scored on a rating scale called Unique Manuka Factor (UMF). All honey supports wound healing, but Manuka is more therapeutic and higher UMF ratings can indicate even higher amounts still. But any kind of manuka honey is beneficial and it’s not necessarily worth limiting yourself to expensive high-UMF products. (Getting a UMF rating can be too costly small-batch (but still excellent) producers to go through the process.)
Precautions
Patients must be counseled that honey products should be avoided in children younger than 1 year of age because it can contain Clostridium botulinum spores and lead to infantile botulism. While new techniques such as gamma-irradiation may mitigate this risk, it is best practice to avoid honey in infants and young children.
Patients using Manuka honey should be advised to see a physician if their wound does not heal in 1-2 weeks, begins draining pus material, or if they develop fevers, chills, or muscle aches. In my experience, a patient with recurrent boils on the back side did not respond to Manuka honey treatment due to the severe stage of her disease. Manuka honey would likely be best for superficial and small wounds rather than deep or recurrent wounds that may harbor resistant bacteria.
Manuka honey has great potential in wound healing and dermatologic conditions. Evidence for its use in wound healing is robust while studies for treatment of dermatologic conditions need further research. Results may vary based on the type of honey that you use, and we encourage you to talk to your doctor if you are planning on using Manuka honey on your skin!
References:
[1] Saikaly, S. K. and A. Khachemoune (2017). “Honey and Wound Healing: An Update.” Am J Clin Dermatol 18(2): 237-251.
[2] Molan, P. (2011). “The evidence and the rationale for the use of honey as wound dressing.” Wound Pract Res 19(204-20).
[3] Lindberg, T., O. Andersson, M. Palm and C. Fagerstrom (2015). “A systematic review and meta-analysis of dressings used for wound healing: the efficiency of honey compared to silver on burns.” Contemp Nurse 51(2-3): 121-134.
[4] McLoone, P., D. Tabys and L. Fyfe (2020). “Honey Combination Therapies for Skin and Wound Infections: A Systematic Review of the Literature.” Clin Cosmet Investig Dermatol 13: 875-888.
[5] Alangari, A. A., K. Morris, B. A. Lwaleed, L. Lau, K. Jones, R. Cooper and R. Jenkins (2017). “Honey is potentially effective in the treatment of atopic dermatitis: Clinical and mechanistic studies.” Immun Inflamm Dis 5(2): 190-199.
[6] Lavaf, M., M. Simbar, F. Mojab, H. Alavi Majd and M. Samimi (2017). “Comparison of honey and phenytoin (PHT) cream effects on intensity of pain and episiotomy wound healing in nulliparous women.” J Complement Integr Med 15(1).
[7] Malhotra, R., K. Ziahosseini, C. Poitelea, A. Litwin and S. Sagili (2017). “Effect of Manuka Honey on Eyelid Wound Healing: A Randomized Controlled Trial.” Ophthalmic Plast Reconstr Surg 33(4): 268-272