Abstract

Introduction: Burn injuries are common in Kashmir valley particularly during winter months. There are numerous dressing materials available for burns but most of them are expensive. Honey which is cheaply available and easy to use can play a significant role in burn wound management. Materials and methods: This study was done prospectively in a tertiary care health facility in Indian side of Kashmir valley over a period of two years from Jan 2007 to Dec 2008 in 46 patients in whom burn wounds of various degrees were managed with topical application of honey. Results: Inability of the patients to purchase the newer and costly dressing material was the commonest indication for use of honey. In none of these patients, was a failure of therapy experienced.Conclusion: Bee's Honey can be cheaply, safely and effectively used topically as a burn wound dressing material.

Introduction

Kashmir is a sub Himalayan valley with very cold winters. The place is economically and technologically backward and people are forced to use traditional and most of the time very unsafe means for keeping them warm. This unfortunately results in a large number of burn injuries particularly in winter season. There is a wide range of dressing materials available for burn wounds but a vast majority of people cannot afford these dressings. Bee's Honey is a natural product which is mentioned in ancient literature as a panacea for wounds of various etiologies. But in recent decades, due to availability of newer drugs, the use of honey in wound management has become virtually obsolete. However honey can still play an important role in economically deprived regions where modern medicine either is unavailable or unaffordable.

Materials and Method

This pilot study was conducted in the Department of General surgery of the Medical College of Sheri Kashmir Institute of Medical Sciences, Srinagar, J&K, India from Jan 2007 –Dec 2008. All the patients in whom honey was the sole medication for management of burn wounds were included in the study. The cases which received any other form of local or systemic antibiotic in addition to topical honey were excluded from the study. Before considering any patient for the study, the patients were properly counseled and all the available alternative modes of wound management were explained to them. The honey applied was a locally available floral honey. It was applied as a thick layer and changed after every 1-4 (mean-2) days depending on the nature of the wound.

Results

A total of 46 patients suffering from burn wounds Consented and were treated over a period of two years with topical application of honey as is evident from Table 1, in 32 (70%) cases, the reason for adopting topical honey as sole management tool was the inability to afford the prevalent antibiotics and dressings. In rest of 14 (30%) cases honey was used as patients had either found other drugs ineffective or uncomfortable. Only one female patient of 1st degree burns felt mild tolerable stinging sensation as the adverse effect.

Table 1: Profile of burn patients treated with topical honey

The etiology of burns treated with honey was as depicted in Table 2.

Table 2 : Etiology of burn wounds treated with honey

Fig 1: a. Chemical burn forearm with pseudomonas infection

Fig 1: b. Same wound after 16 days of treatment with topical honey (fit for skin graft)

Fig 2.Kangri- a traditional clay pot used in Kashmir- a cause of burns.

Discussion

The use of honey for burn wound dressing is mentioned in many ancient written records.1-4 But in recent decades, due to availability of ever increasing number of dressing materials, honey as a primary medicine has become virtually obsolete. But as the resistance to antibiotics evolved5, even in developed countries of the world traditional medicines as honey are again making a comeback6. We were however compelled into using honey which is cheaply available in Kashmir - a sub Himalayan valley, due to the fact that most (70%) of our patients could not afford the modern medicines and had but no other available options. The results however were encouraging with 100% wound healing rate and virtually no adverse affects. However after approval from ethics committee , a comparative study will be undertaken to compare the effectiveness of honey in comparison with other available dressings . From the Table 2, Kangri has been the cause of burn injury in 20% of our cases. Kangri is a traditional small clay pot filled with hot charcoal and is carried next to the body as a source of warmth. Burns are caused by accidental spillage of hot charcoal from it.

Honey has been found to inhibit the growth of about 60 species of bacteria including aerobes and anaerobes, gram-positives and gram-negatives7-8. Besides an inhibitory action has also been observed for some fungi and species of Aspergillus and Penicillium and against most of the common dermatophytes. 9

As far as the mechanism of action is concerned, various studies ascribed the antibacterial action of honey to its high osmolarity due to the high sugar content. 10-12Besides honey has been shown to contain a factor called inhibine which leads to release of hydrogen peroxide which in turn inhibit bacterial growth .13 Besides some workers have also identified additional non-peroxidase antibacterial factors in honey.14, 15

At the cellular level, it is proposed by some workers that the glucose content of honey and the acidic pH (pH value of honey is 3-4) may assist in the bacteria-destroying action of macrophages.16 Other studies have shown that the proliferation of peripheral T-lymphocytes and blood B-lymphocytes in cell culture is stimulated by honey at concentrations as low as 0.1%; and phagocytes are activated by honey at concentrations as low as 0.1%.17 Honey (at a concentration of as low as 1%) also stimulates monocytes in cell culture to release cytokines, tumor necrosis factor (TNF)-alpha, interleukin (IL)-1 and IL-6, which activate the immune response to infection.18

In recent times, numerous studies have been published which have proved the efficacy of honey in burn wounds. Honey has been found by microscopic examination of the burnt tissues to speed up the process of burn wound healing at cellular level.19 Many other studies have found the honey to be superior to many commonly used modern dressings particularly in 1st and 2nd degree burns .20-24 Besides studies have shown that honey is very effective in infected burn wounds and most of the common bacteria including the resistant ones get eradicated with its application. 25-26Honey also has been found to have a distinct advantage in that the dressing changes are painless 27-28 and this finding was appreciated by the patients in our series also. The honey has been found to deodorize the infected wounds providing relief to the patients and caregivers from the offensive smell.21

It is however stressed that the quality of honey be verified before use as there are evidences of wrongly labeled honey in literature.29 Further it has been found that honey though does not allow the growth of vegetative bacteria but some spores may survive which can be sterilized with gamma irradiation.30 The treatment of honey with gamma irradiation does not however decrease the effectiveness of honey.31

Conclusion

From our personal experience of using honey in 46 patients over a period of 2 years and from the review of available literature, we concluded that honey can be safely, effectively and very cheaply used for the management of burn wounds. However after approval by the ethics committee, a case controlled study will be conducted to compare the effectiveness of honey in comparison with other available modes of burn wound management.

References