Editorial
Hydrogen peroxide solution 30% BP
Honey and sugar as a
dressing for wounds and
ulcers
A letter reporting the use of honey appears in this issue of
the journal in response to the recent papers by N H Antia
et al. on the Eusol management of burnsl-', Two articles
ha ve appeared since 1980 in Tropical Doctor 3,4 advocating
the use of honey and it seems appropriate to remind
readers again of the value of honey or sugar dressings in
the management of wounds. The use of honey has been
known since 2000 BC 5 and articles concerning its use have
occurred frequently in the literature. The alternative to
honey is the use of granulated sugar or sugar paste. One
problem with the use of honey is its 'runny-ness' - it seeps
out under the dressing and attracts ants and flies. The
Senior Editor remembers the need for placing cans filled
with oil or water under the legs of the bed when he was
working in Kilimanjaro Christian Medical Centre to
prevent ants climbing up into the bed! Sugar, and
especially sugar paste, have the advantage of ease of
handling't? and are less attractive in particular to flies.
Both honey and sugar work by their hiyh osmality
which inhibits the growth of bacteria ro-t and also
accelerates the cleansing and desloughing of dirty
wounds", Honey also contains a thermolabile bacterioci-
dal factor, inhibine--, der:ending on the plant source of
the honey. Twenty-six 10, 1,13 types of honey have been
described depending on the source of the nectar. Manuka
and pasture honey are active against 58 strains of
coagulase positive Staphylococcus aureus lO. Honey is
also reported to be active against E. coli l 4 and to be
antifungaI 5, 15, but not to be active against Pseudomonas'>.
Certain honeys, e.g. pasture honey, contain an enzyme
(catalase) which leads to the release of hydrogen ~er­
oxideJ(}-\2 in the wound. The pH of honey is 3.6-3.7 6,17
which increases its antibacterial effect. Nonetheless, both
sugar and sugar paste are effective in wound healing.
Rapid desloughing, the early appearance of healthy
granulation tissue, early epithelialization and accelerated
healing 18 have been reported with the use of both honey
and sugar 3,4,7,11,19-22. Honey has been used in the
treatment of burns. Compared with silver sulphadiazine
it is more efficient in the sterilization of burns- . It can be
used for the storage of skin grafts!", Grafts have been
stored for up to 18 weeks. They become yellow brown and
firm, but regain their normal texture when soaked in
normal saline. Sugar can be used as granulated sugar for
the packing of cavities 4,9,20 but its drying effect may cause
a distressing burning sensatiou-'. Sugar paste avoids
this 6,9,20,22 and is particularly applicable to surface wounds
or ulcers. It is applied once or twice daily and covered with
a dry dressing. It is particularly useful in the management
of neuropathic ulcers in leprosy or diabetic patients 4,6,8.
A useful formula for sugar paste is:
Caster sugar 400 g
Icing sugar 600 g
Glycerine BP 480 ml
Tropical Doctor January 2000, 30
(100 vol) 7.5 ml
The hydrogen peroxide is added to the glycerine and
stirred. The sugars are then added and mixed. A domestic
mixer is useful for this. It should be remembered that 30%
hydrogen peroxide can cause burns if in direct contact
with skin.
Frank Tovey
Assistant Editor
References
1 Antia NH, Daner BM, Arora S. Management of burns. Trap
Doct 1999;9:7-11
2 Tovey Frank. Management of burns - Euso1 [Editorial].
Trap Doct 1999;29:2-3
3 Armon Pl. The use of honey in the treatment of infected
wounds. Trap Doct 1980;10:1037-40
4 Kamat N. Use of sugar in infected wounds. Trap Doct
1993;23: 185
5 Zumla A, Lulat A. Honey - a remedy rediscovered. J R Soc
Med 1989;82:384-5
6 Tovey FI. Honey and healing. J R Soc Med 1991;84:447
7 Chirife 1, Scarmato G, Herszage L. Scientific basis for use of
granulated sugar in treatment of infected wounds. Lancet
1982;1:560-1
8 Gordon H, Middleton K, Seal D, Sullens K. Sugar and
wound healing. Lancet 1985;ii:663-4
9 Archer H, Middleton K, Millidge 1, Seal D. Toxicity of
topical sugar. Lancet 1987;1:1485-6
10 Cooper RA, Molan OC, Harding KG. Antibacterial activity
of honey against strains of Staphylococcus aureus from
infected wounds. J R Soc Med 1999;92:283-5
II Greenwood D. Wound healing. Honey for superficial
wounds and ulcers. Lancet 1993;341:90-1
12 White lW, Subers Ml, Scheparto AI. The identification of
inhibine, the antibacterial factor in honey, as hydrogen
peroxidase and its origin in a honey glucose oxidase system.
Biochem Biophys Acta 1963;73:57-70
13 Allen KI, Molan OC, Reed GM. A survey of the
antibacterial activity of some New Zealand honeys. J Pharm
Pharmacal 1991;43:817-22
14 Cavanagh D, Beazley 1, Ostapowicz F. Radical treatment of
carcinoma of the vulva. A new approach to wound healing. J
Obstet Gynaecol 1970;77:1037--40
15 Obaseiki-Ebor EE, Ofonya TCA. In vitro evaluation of the
anti-candidiasis activity of honey distillate (HY-I) compared
with that of some anti-mycotic agents. J Pharm Pharmacal
1984;34:283-4
16 Bose D. Honey or sugar in treatment of infected wounds.
Lancet 1982;1:963
17 Subrahmanyan M. Storage of skin grafts in honey. Lancet
1993;341:63-4
18 Effem SE. Clinical observation on the wound healing
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19 Branicki Fl. Surgery in Western Kenya. Ann Roy Call Surg
Eng 1981;63:348-52
20 Seal DV, Middleton K. Healing of cavity wounds with
sugar. Lancet 1991;338:571-2
21 Middleton K. Sugar paste in wound management. Dressing
Times 1990;3:2
22 Tanner AG, Owen ERTC, Seal DV. Successful treatment of
clinically infected wounds with sugar paste. Eur J Clin
Microbial Infect Dis 1985;7:524-5
23 Subrahmanyan M. Topical application of honey in treat-
ment of burns. B J Surg 1991;78:497-8