Role of Honey in Advanced Wound Care

Janus Films Wound Dressing Comprising Electrospun Gelatin/PCL Nanofibers and Gelatin/Honey/Curcumin Thawed Layer

A promising approach for wound treatment is using multilayer wound dressings that offer multifunctional properties. In this study, a bilayered electrospun/hydrogel gelatin-based scaffold integrated with honey and curcumin was developed to treat wounds under an in vivo study. The first layer consisted of an enzymatic cross-linked gelatin hydrogel containing honey and curcumin, which gelatin/PCL nanofibers reinforced. The physicochemical, mechanical, and biological properties of both layers were evaluated. Then, the bilayered wound dressing was compared to a commercial wound dressing in an in vivo study. The results showed that this strategy provided the wound dressing with a strength of 40 MPa, 70% elongation, 800% swelling rate, and 8 g/h/m2 water vapor permeability. Furthermore, MTT and histopathological staining demonstrated that the bilayered wound dressing promoted wound closure accelerated collagen production and tissue granulation, and promoted immune system response and re-epithelialization compared to other groups. The presence of a nanofibrous layer on the surface of the wound dressing facilitated its use, and the inclusion of honey and gelatin in the hydrogel layer prevented adhesion to the wound tissue and allowed for easy replacement without damaging the wound bed. Overall, the bilayered dressing with multifunctional properties holds great potential for developing wound dressings.

Anti-Inflammatory and Wound Healing Properties of Different Honey Varieties from Romania and Correlations to Their Composition

The complex composition of honey plays a crucial role in wound healing, exhibiting varying effects at different stages of the healing process. This study investigated seven honey varieties sourced from different regions of Romania using in vitro experimental models developed in macrophage-like, fibroblast, and keratinocyte cell lines to explore the mechanisms by which honey promoted the healing process. This study assessed the impact of honey on inflammatory cytokine production in macrophage-like cells, cell proliferation and collagen synthesis in fibroblasts, and cell proliferation and migration in keratinocytes. Additionally, correlation analysis was conducted to examine the relationship between honey composition and its biological properties. Honey varieties presented both anti- and pro-inflammatory effects. Moreover, they displayed dose-dependent pro-proliferative effects, stimulating collagen synthesis and cell migration, thereby enhancing the re-epithelialization process. The Pearson coefficient analysis indicated a strong positive correlation between biological activities and phenolic content. Additionally, there was a medium positive correlation with the ascorbic acid content and a medium negative correlation with the glucose content in the different honey varieties. Romanian honey varieties rich in phenolics showed potential in modulating inflammation, proliferation, collagen synthesis, and cell migration, suggesting their suitability for further evaluation and development of innovative dressings for skin tissue regeneration.

Wound pH-Modulating Strategies for Diabetic Wound Healing

Significance: Chronic diabetic wounds on the lower extremities (diabetic foot ulcers, DFU) are one of the most prevalent and life-threatening complications of diabetes, responsible for significant loss of quality of life and cost to the health care system. Available pharmacologic treatments fail to achieve complete healing in many patients. Recent studies and investigational treatments have highlighted the potential of modulating wound pH in DFU. Recent Advances: Data from in vitro, preclinical, and clinical studies highlight the role of pH in the pathophysiology of DFU, and topical administration of pH-lowering agents have shown promise as a therapeutic strategy for diabetic wounds. In this critical review, we describe the role of pH in DFU pathophysiology and present selected low-molecular-weight and hydrogel-based pH-modulating systems for wound healing and infection control in diabetic wounds. Critical Issues: The molecular mechanisms leading to pH alterations in diabetic wounds are complex and may differ between in vitro models, animal models of diabetes, and the human pathophysiology. Wound pH-lowering bandages for DFU therapy must be tested in established animal models of diabetic wound healing and patients with diabetes to establish a comprehensive benefit-risk profile. Future Directions: As our understanding of the role of pH in the pathophysiology of diabetic wounds is deepening, new treatments for this therapeutic target are being developed and will be tested in preclinical and clinical studies. These therapeutic systems will establish a target product profile for pH-lowering treatments such as an optimal pH profile for each wound healing stage. Thus, controlling wound bed pH could become a powerful tool to accelerate chronic diabetic wound healing.

Efficacy and Safety of Honey Dressings in the Management of Chronic Wounds: An Updated Systematic Review and Meta-Analysis

Chronic wounds impose a substantial economic burden on healthcare systems and result in decreased productivity. Honey possesses diverse properties, rendering it a promising, cost-effective, and efficacious intervention strategy for the management of chronic wounds. However, the findings are controversial. We have presented an updated and comprehensive systematic review and meta-analysis to evaluate the efficacy and safety of honey dressings in the management of chronic wounds. Nine electronic databases were systematically searched to identify relevant studies published prior to 22 March 2024. A total of eight studies, including 906 individuals that met the inclusion criteria, were incorporated. The findings demonstrated a significant acceleration in wound healing time with honey dressings (MD = -17.13, 95% CI -26.37 to -7.89, p = 0.0003) and an increase in the percentage of wound healing (MD = 18.31, 95% CI 8.86 to 27.76, p = 0.0001). No statistically significant differences were observed in the healing rate (RR = 2.00, 95% CI 0.78 to 5.10, p = 0.15), clearance time of bacteria (MD = -11.36, 95% CI: -25.91 to 3.18, p = 0.13) and hospital stay duration. Honey may decrease the VAS score but may increase the incidence of painful discomfort during treatment. The topical application of honey is an effective therapeutic approach for managing chronic wounds, but the quality of the evidence was very low due to the quality of risk of bias, inconsistency, and publication bias, highlighting the necessity for larger-scale studies with adequately powered RCTs to ensure the safety and efficacy of honey dressings in chronic wound healing.

Antifungal efficacy of natural antiseptic products against Candida auris

Candida auris is an emerging fungal pathogen responsible for healthcare-associated infections and outbreaks with high mortality around the world. It readily colonizes the skin, nares, respiratory and urinary tract of hospitalized patients, and such colonization may lead to invasive Candida infection in susceptible patients. However, there is no recommended decolonization protocol for C. auris by international health authorities. The aim of this study is to evaluate the susceptibility of C. auris to commonly used synthetic and natural antiseptic products using an in vitro, broth microdilution assay. Synthetic antiseptics including chlorhexidine, povidone-iodine, and nystatin were shown to be fungicidal against C. auris. Among the natural antiseptics tested, tea tree oil and manuka oil were both fungicidal against C. auris at concentrations less than or equal to 1.25% (v/v). Manuka honey inhibited C. auris at 25% (v/v) concentrations. Among the commercial products tested, manuka body wash and mouthwash were fungicidal against C. auris at concentrations less than or equal to 0.39% (w/v) and 6.25% (v/v) of products as supplied for use, respectively, while tea tree body wash and MedihoneyTM wound gel demonstrated fungistatic properties. In conclusion, this study demonstrated good in vitro antifungal efficacy of tea tree oil, manuka oil, manuka honey, and commercially available antiseptic products containing these active ingredients. Future studies are warranted to evaluate the effectiveness of these antiseptic products in clinical settings.

Incorporation of natural and synthetic polymers into honey hydrogel for wound healing: A review

Background and Aims

The difficulty in treating chronic wounds due to the prolonged inflammation stage has affected a staggering 6.5 million people, accompanied by 25 billion USD annually in the United States alone. A 1.9% rise in chronic wound prevalence among Medicare beneficiaries was reported from 2014 to 2019. Besides, the global wound care market values were anticipated to increase from USD 20.18 billion in 2022 to USD 30.52 billion in 2030, suggesting an expected rise in chronic wounds financial burdens. The lack of feasibility in using traditional dry wound dressings sparks hydrogel development as an alternative approach to tackling chronic wounds. Since ancient times, honey has been used to treat wounds, including burns, and ongoing studies have also demonstrated its wound-healing capabilities on cellular and animal models. However, the fluidity and low mechanical strength in honey hydrogel necessitate the incorporation of other polymers. Therefore, this review aims to unravel the characteristics and feasibility of natural (chitosan and gelatin) and synthetic (polyvinyl alcohol and polyethylene glycol) polymers to be incorporated in the honey hydrogel.

Methods

Relevant articles were identified from databases (PubMed, Google Scholar, and Science Direct) using keywords related to honey, hydrogel, and polymers. Relevant data from selected studies were synthesized narratively and reported following a structured narrative format.

Results

The importance of honey's roles and mechanisms of action in wound dressings were discussed. Notable studies concerning honey hydrogels with diverse polymers were also included in this article to provide a better perspective on fabricating customized hydrogel wound dressings for various types of wounds in the future.

Conclusion

Honey's incapability to stand alone in hydrogel requires the incorporation of natural and synthetic polymers into the hydrogel. With this review, it is hoped that the fabrication and commercialization of the desired honey composite hydrogel for wound treatment could be brought forth.

Antimicrobial Effect of Honey Phenolic Compounds against E. coli-An In Vitro Study

Growing concern over antimicrobial resistance in chronic wound patients necessitates the exploration of alternative treatments from natural sources. This study suggests that honey's phenolic compounds may offer antimicrobial benefits, warranting further investigation for therapeutic development. The main aim of this study was to investigate the antimicrobial activity of phenolic compounds and to determine the effects of their sub-inhibitory concentrations against Escherichia coli (E. coli). 3-phenyllactic acid (PLA), p-coumaric acid (PCA), and phloretin were tested against the bacterial strain of E. coli ATCC 25922. Comparison of the antimicrobial activity of honey constituents in vitro was performed using a broth culture assay. Measurement of the inhibitory properties of constituents in vitro was conducted using disc and well diffusion assays. The effects of sub-inhibitory concentrations of PCA on the susceptibility of E. coli ATCC 25922 to penicillin-streptomycin were tested. The results demonstrated that PLA was the most efficient antimicrobial agent, followed by PCA, whereas phloretin, at lower (2 mg/mL) concentrations, led to an increase in the growth of E. coli. Various modifications of the agar diffusion assay did not reveal the antibacterial properties of the studied phytochemicals. The enhancing effect of a sub-inhibitory concentration of PCA in cooperation with penicillin-streptomycin was shown. These findings might be helpful for the further investigation and development of new antimicrobial agents for the treatment of skin infections and wounds.

Medical-Grade Honey as a Potential New Therapy for Bacterial Vaginosis

The prevalence of bacterial vaginosis (BV) among women of reproductive age is 29%. BV arises from a vaginal imbalance marked by reduced levels of lactic acid-producing lactobacilli and an overgrowth of pathogenic anaerobes. The multifactorial nature of BV's pathogenesis complicates its treatment. Current antibiotic therapy exhibits a recurrence rate of about 60% within a year. Recurrence can be caused by antibiotic treatment failure (e.g., due to antimicrobial resistance), the persistence of residual infections (e.g., due to biofilm formation), and re-infection. Because of the high recurrence rates, alternative therapies are required. Medical-grade honey (MGH), known for its antimicrobial and wound healing properties in wound care, emerges as a potential novel therapy for BV. MGH exerts broad-spectrum antimicrobial activity, employing multiple mechanisms to eliminate the risk of resistance. For example, the low pH of MGH and the production of hydrogen peroxide benefit the microbiota and helps restore the natural vaginal balance. This is supported by in vitro studies demonstrating that MGH has an antibacterial effect on several pathogenic bacteria involved in the pathophysiology of BV, while lactobacilli and the vaginal microenvironment can be positively affected. In contrast to antibiotics, MGH exerts anti-biofilm activity, affects the microbiome as pre- and probiotic, and modulates the vaginal microenvironment through its anti-inflammatory, anti-oxidative, physicochemical, and immunomodulatory properties. More clinical research is required to confirm the positive effect of MGH on BV and to investigate the long-term cure rate.

Honey therapies for dermatological disorders: more than just a sweet elixir

Honey possesses antibacterial, anti-inflammatory, and healing properties that benefit wound healing and tissue regeneration. For centuries, honey has been utilized in traditional medicine as a binder or vehicle for creams and lotions and also for therapeutic purposes. The overuse of antibiotics and antimicrobial agents leading to drug resistance has emphasized the resurgence of honey's application in wound care. For many dermatological disorders, there is an interest in developing therapeutics with fewer side effects than traditional therapies and enhanced wound healing abilities to expedite tissue regeneration. This paper reviews the properties and components of honey that contribute to its wound-healing-based applications, the types of honey employed in medicine, and its dermatological applications. Based on the evidence from case reports, clinical trials, and in vitro studies, honey has been characterized as a safe, cost-effective, and readily available treatment option for many skin conditions, including microbial infections, atopic dermatitis, psoriasis, necrotizing fasciitis, ulcers, as well as thermal and other types of wounds.

Analysis of Free Amino Acid Composition and Honey Plant Species in Seven Honey Species in China

Honey is well-known as a food product that is rich in active ingredients and is very popular among consumers. Free amino acids (FAAs) are one of the important nutritional components of honey, which can be used not only as a nutritional indicator of honey but also as an indicator of plant source identification. In this study, the contents of 20 FAAs in seven types of honey from 11 provinces in China were examined for the first time. The 20 FAAs were analyzed by ultra-performance liquid chromatography-mass spectrometry/mass spectrometry (UPLC-MS/MS). By analyzing 93 honey samples from seven types of honey, the FAAs were found to range from 394.4 mg/kg (linden honey) to 1771.7 mg/kg (chaste honey). Proline ranged from 274.55 to 572.48 mg/kg, and methionine was only present in some of the linden honey, chaste honey, acacia honey, and rape honey. Evaluated by amino acid principal component analysis, multifloral grassland honey had the highest overall evaluation score, acacia and jujube honey were the most similar, while chaste honey was the least similar to the other types of honey. In addition, DNA was extracted from 174 Xinjiang grassland honey samples and different plant leaves for PCR and sequencing to identify the species of nectar plants. As a result, 12 families and 25 species of honey plants were identified. The results confirmed the diversity of FAAs in dissimilar types and sources of honey. This study provides a reference for expanding honey quality standards and verifying the authenticity of honey.

The Effect of Honey, Aloe Vera, and Hydrocolloid Dressing on the Healing Process of Murine Excisional Wounds

Chronic ulcers are a major health problem associated with high costs and a loss of quality of life. Because of this, the search for products that accelerate wound healing is a constant, given the need for alternatives that help to alleviate this serious health problem. We analyzed the efficacy of 2 natural products-honey and aloe vera-versus hydrocolloid (HC) dressings as a control group in healing full-thickness wounds. For this purpose, we performed full-thickness excisions of the skin, including the panniculus carnosus, in mice. We inserted a nitrile ring into the subcutaneous cellular tissue simulating the second-intention wound healing course. We found that aloe vera reduced the diameter of the wounds compared to honey (p < .001) and the control group (p < .001).

The Leptospermum scoparium (Mānuka)-Specific Nectar and Honey Compound 3,6,7-Trimethyllumazine (LepteridineTM) That Inhibits Matrix Metalloproteinase 9 (MMP-9) Activity

3,6,7-trimethyllumazine (Lepteridine™) is a newly discovered natural pteridine derivative unique to Mānuka (Leptospermum scoparium) nectar and honey, with no previously reported biological activity. Pteridine derivative-based medicines, such as methotrexate, are used to treat auto-immune and inflammatory diseases, and Mānuka honey reportedly possesses anti-inflammatory properties and is used topically as a wound dressing. MMP-9 is a potential candidate protein target as it is upregulated in recalcitrant wounds and intestinal inflammation. Using gelatin zymography, 40 μg/mL LepteridineTM inhibited the gelatinase activities of both pro- (22%, p < 0.0001) and activated (59%, p < 0.01) MMP-9 forms. By comparison, LepteridineTM exerted modest (~10%) inhibition against a chromogenic peptide substrate and no effect against a fluorogenic peptide substrate. These findings suggest that LepteridineTM may not interact within the catalytic domain of MMP-9 and exerts a negligible effect on the active site hydrolysis of small soluble peptide substrates. Instead, the findings implicate fibronectin II domain interactions by LepteridineTM which impair gelatinase activity, possibly through perturbed tethering of MMP-9 to the gelatin matrix. Molecular modelling analyses were equivocal over interactions at the S1' pocket versus the fibronectin II domain, while molecular dynamic calculations indicated rapid exchange kinetics. No significant degradation of synthetic or natural LepteridineTM in Mānuka honey occurred during simulated gastrointestinal digestion. MMP-9 regulates skin and gastrointestinal inflammatory responses and extracellular matrix remodelling. These results potentially implicate LepteridineTM bioactivity in Mānuka honey's reported beneficial effects on wound healing via topical application and anti-inflammatory actions in gastrointestinal disorder models via oral consumption.

Development of Film-Forming Gel Formulations Containing Royal Jelly and Honey Aromatic Water for Cosmetic Applications

This study aimed to develop a film-forming gel containing honey aromatic water (HW) and royal jelly (RJ) for cosmetic applications as a facial peel-off mask. HW, which is industrial waste from the water-reduction process of honey, was sterilized by autoclaving and filtration through a 0.22 µm membrane. The film-forming gels were developed using various types of film-forming polymers, including polyvinyl alcohol (PVA 117), carboxymethyl cellulose (CMC), and hydroxyethyl cellulose (HEC). The gel formulations were characterized in terms of their external appearance, viscosity, pH, and drying time, whereas the films generated were characterized by a texture analyzer, microscopic investigation, Fourier transform infrared, and an X-ray diffractometer. The findings highlighted that HW has short storage shelf life due to microbial contamination. Sterilizations were required before further product development. The film-forming gel was created by using the combination of PVA 117, CMC, and HEC. HW and RJ were successfully incorporated into the film-forming gel. However, HW resulted in a decrease in the gel viscosity and mechanical properties of its film. Interestingly, the drying time was dramatically decreased, which would be more desirable for its use as a peel-off mask. Furthermore, incorporation of royal jelly enhanced the viscosity of the gels as well as improved the mechanical properties of the film. No effect on the chemical and crystal structure of the films was detected after the incorporation. Therefore, the film-forming gels containing HW and RJ, possessing aesthetic attributes that extended to both the gels themselves and the resultant films, were suitable for use as a peel-off mask.

Healing Effect of a Nano-Functionalized Medical-Grade Honey for the Treatment of Infected Wounds

Based on the qualities of Ulmo honey (Eucryphia cordifolia), a medical-grade honey (Ulmoplus®) has been developed. Relevant to this, the use of copper represents an emerging therapy for the treatment of wounds. Therefore, the aim of this study was to see how this medical-grade honey with copper nanoparticles (CuNPs) helped to heal infected or non-infected wounds. Twenty-four guinea pigs (Cavia porcellus) were divided into four groups for phase 1 (without and with infection, U + F1 and U + F2), and two groups for phase 2 (selected formulation, without and with infection, U + F2NI and U + F2I). Bacteriological and histopathological studies, collagen fibers content evaluation, and stereological analysis were performed. The selected formulation displayed the same antibacterial potency as Ulmoplus®, indicating that this medical-grade honey by itself can be used as an antibacterial agent. However, the evaluation of collagen content demonstrated a significant increase in fibroblast and type III collagen fibers for infected and uninfected groups, which correlated with the histopathological study. Therefore, it is correct to affirm that adding CuNPs to Ulmoplus® improved the maturation of collagen fibers. Finally, polymorphonuclear cells presented similar values between experimental groups, which would indicate that the formulation under study was able to regulate the inflammatory process despite their infectious condition.

Healing Effect of a Nano-Functionalized Medical-Grade Honey for the Treatment of Infected Wounds

Based on the qualities of Ulmo honey (Eucryphia cordifolia), a medical-grade honey (Ulmoplus®) has been developed. Relevant to this, the use of copper represents an emerging therapy for the treatment of wounds. Therefore, the aim of this study was to see how this medical-grade honey with copper nanoparticles (CuNPs) helped to heal infected or non-infected wounds. Twenty-four guinea pigs (Cavia porcellus) were divided into four groups for phase 1 (without and with infection, U + F1 and U + F2), and two groups for phase 2 (selected formulation, without and with infection, U + F2NI and U + F2I). Bacteriological and histopathological studies, collagen fibers content evaluation, and stereological analysis were performed. The selected formulation displayed the same antibacterial potency as Ulmoplus®, indicating that this medical-grade honey by itself can be used as an antibacterial agent. However, the evaluation of collagen content demonstrated a significant increase in fibroblast and type III collagen fibers for infected and uninfected groups, which correlated with the histopathological study. Therefore, it is correct to affirm that adding CuNPs to Ulmoplus® improved the maturation of collagen fibers. Finally, polymorphonuclear cells presented similar values between experimental groups, which would indicate that the formulation under study was able to regulate the inflammatory process despite their infectious condition.

Polymer-Based Hydrogel Loaded with Honey in Drug Delivery System for Wound Healing Applications

Excellent wound dressings should have crucial components, including high porosity, non-toxicity, high water absorption, and the ability to retain a humid environment in the wound area and facilitate wound healing. Unfortunately, current wound dressings hamper the healing process, with poor antibacterial, anti-inflammatory, and antioxidant activity, frequent dressing changes, low biodegradability, and poor mechanical properties. Hydrogels are crosslinked polymer chains with three-dimensional (3D) networks that have been applicable as wound dressings. They could retain a humid environment on the wound site, provide a protective barrier against pathogenic infections, and provide pain relief. Hydrogel can be obtained from natural, synthetic, or hybrid polymers. Honey is a natural substance that has demonstrated several therapeutic efficacies, including anti-inflammatory, antibacterial, and antioxidant activity, which makes it beneficial for wound treatment. Honey-based hydrogel wound dressings demonstrated excellent characteristics, including good biodegradability and biocompatibility, stimulated cell proliferation and reepithelization, inhibited bacterial growth, and accelerated wound healing. This review aimed to demonstrate the potential of honey-based hydrogel in wound healing applications and complement the studies accessible regarding implementing honey-based hydrogel dressing for wound healing.

Fighting postsurgical infection after myelomeningocele repair with medical honey (Medihoney): a case report

Surgical site infection (SSI) prolongs the treatment period, delays wound healing, increases antibiotic consumption, and leads to patient death in complicated cases. This case was a 10-day female infant born at 37-week- and 6-day of gestational age with a birth weight of 3700 g and Apgar 5/8 by emergency cesarean section due to spina bifida cystica with myelomeningocele (MMC). She was admitted to the neonatal intensive care unit (NICU) because of respiratory distress and hypotonic lower extremities on June 2, 2022. A cardiovascular and neurosurgery consult was okay for reconstructive surgery, and she had MMC repair surgery by a plastic surgeon on June 5, 2022. The surgical site was infected, and SSI had no improvement, despite regularly receiving wet and Vaseline gauze dressing and intravenous antibiotic therapy. We started the treatment using Medihoney™, honey antibacterial wound dressing, on SSI once a day for 2 weeks, then once every other day for the next 6 weeks. Her SSI was cured entirely after 2 months, and she was discharged from our wound treatment team in satisfactory general condition. Clinicians and wound care management teams could use honey antibacterial wound gel to treat SSI, particularly in newborns with weakened immune systems after spinal birth defects repair.

A retrospective case series of the postoperative outcome for 30 dogs with inflammatory interdigital nodules, surgically treated with carbon dioxide laser and a nonantimicrobial wound-healing protocol

BACKGROUND

Inflammatory interdigital nodules (IIN) affecting the paws of dogs is a multifactorial and painful condition. Surgery using carbon dioxide (CO ₂ ) laser has been shown to be helpful in the management.

HYPOTHESIS/OBJECTIVES

To assess a postoperative treatment protocol without use of antibiotics following CO₂ laser surgery for IIN treatment.

ANIMALS

Forty-seven paws, in 30 client-owned dogs, with IINs affecting the interdigital web between the 4th and 5th digits of the forepaws, surgically treated using CO₂ laser, were included.

MATERIALS AND METHODS

Medical records were reviewed for demographic details, medication use and wound healing using a set wound care protocol. Time to resolution of the surgical wounds and the postoperative outcome were assessed.

RESULTS

The mean healing time was 34 days. Resolution was seen in 42 of 47 paws with complications in five paws (11%), including development of new fistulae or nonhealing granulation tissue. Surgery was repeated in those five cases. Relapse occurred during the follow-up period of five-19 months in six paws (13%).

CONCLUSIONS AND CLINICAL RELEVANCE

This study shows that surgical treatment with CO₂ laser for interdigital nodules is successful in most cases. The postoperative outcome using a wound-healing protocol avoiding use of antimicrobials can be used without compromising patient care whilst following antimicrobial stewardship guidelines.

An Overview of Clinical Manifestations of Dermatological Disorders in Intensive Care Units: What Should Intensivists Be Aware of?

Acute skin failure is rarely the primary diagnosis that necessitates admission to an intensive care unit. Dermatological manifestations in critically ill patients, on the other hand, are relatively common and can be used to make a key diagnosis of an adverse drug reaction or an underlying systemic illness, or they may be caused by factors related to a prolonged stay or invasive procedures. In intensive care units, their classification is based on the aetiopathogenesis of the cutaneous lesion and, in the meantime, distinguishes critical patients. When evaluating dermatological manifestations, several factors must be considered: onset, morphology, distribution, and associated symptoms and signs. This review depicts dermatological signs in critical patients in order to lay out better recognition.

Antibacterial and Antibiofilm Effect of Unifloral Honeys against Bacteria Isolated from Chronic Wound Infections

Honey is known as an alternative remedy for the treatment of wounds. To evaluate the potential of five Hungarian honey types against wound-associated bacteria, in vitro microbiological assays were conducted on Pseudomonas aeruginosa, Staphylococcus epidermidis and methicillin-resistant Staphylococcus aureus (MRSA). Minimum inhibitory concentration (MIC) was determined with the broth macrodilution method, and biofilm degradation capacity was tested with a crystal violet assay. To understand the underlying mechanisms, the effects of honey treatments were assessed on bacterial membrane integrity and quorum sensing (QS). The highest antibacterial activity, indicated by the lowest MIC values, as well as the highest biofilm inhibition rates and membrane disruption, was displayed by chestnut and linden honeys. The most sensitive bacterium was S. epidermidis. Bacterial membrane degradation took place 40 min after treatment with honey solutions of at least a 40% concentration. Each honey sample exhibited anti-QS activity, which was most pronounced in the case of chestnut honey. It was concluded that the antibacterial, biofilm-inhibiting and anti-QS activities of linden and chestnut honeys were superior to those of acacia, goldenrod and milkweed honeys. In addition to the floral source, the antibacterial effect of honey is influenced by the microbial species treated. The use of honey in wound treatment can be justified by its diverse antibacterial mechanisms.

A review of stingless bees' bioactivity in different parts of the world

Stingless bees, also known as meliponines, live in beehives. However, reports on the distribution of stingless bees are scattered, resulting in a lack of precision. Honey and propolis are the main components that can be harvested from their beehive, with a great commercial value of up to 610 million USD. Despite the enormous potential profits, discrepancies in their bioactivities have been observed worldwide, leading to a lack of confidence. Therefore, this review provided oversight on the potential of stingless bee products and highlighted the differences between stingless bees in Asia, Australia, Africa, and America. The bioactivity of stingless bee products is diverse and exhibits great potential as an antimicrobial agent or in various diseases such as diabetes, cardiovascular disease, cancers, and oral problems.

Pediatric First-Degree Burn Management With Honey and 1% Silver Sulfadiazine (Ag-SD): Comparison and Contrast

Background The cardinal area of managing fire wounds is guided by adequately evaluating the burn-induced lesion's profundity and size. Superficial second-degree burns are often treated through daily reinstating with fresh sterile bandaging with appropriate topical antimicrobials to allow rapid spontaneous epithelialization. Around the world, a wide variety of substances are used to treat these wounds, from honey to synthetic biological dressings. Objective This study intended to determine honey's therapeutic potential compared with 1% silver sulfadiazine (Ag-SD) in arsenal-caused contusion medicament fulfillment. Methods A total of 70 cases were evaluated in this research work after fulfilling the required selection criteria during the study period of January 2014 to December 2014 and January 2017 to December 2017. Purposive selection criteria were adopted in the study to select research patients. The patients in Group-1 (n = 35) relied on honey as medication, while patients in Group-2 (n = 35) relied on 1% Ag-SD. Results In Group-1, exudation (68.4%) and sloughing (82.9%) were substantially reduced by Days 3 and 5 of therapeutic intervention, respectively. However, in Group-2, a reduction of exudation (17.1%) and sloughing (22.9%) occurred after Days 3 and 5 of treatment, respectively. Completion of the epithelialization process was observed among Group-1 and Group-2 cases. It was detected after Days 7 and 10 of treatment at 36.3% and 77% (Group-1) and 27% and 67% (Group-2), respectively. Around 3 ml of 1% honey was required per body surface area per dressing in Group-1. On the other hand, in Group-2, 2 gm Ag-SD was needed per body surface area per dressing. Conclusion Patients treated with honey found better clinical outcomes in managing superficial partial-thickness burns.

Intra-socket application of medical-grade honey after tooth extraction attenuates inflammation and promotes healing in cats

OBJECTIVES

Dental diseases are a major problem in cats and often necessitate tooth extraction. Medical-grade honey (MGH) has antimicrobial and wound-healing properties, and therefore the aim of this study was to investigate whether intra-socket application improved healing after tooth extraction. It was postulated that applying MGH would reduce inflammation, improve the viability of the surgical flap and enhance healing following tooth extraction.

METHODS

A prospective randomised controlled trial was performed in client-owned cats undergoing bilateral tooth extractions of the same element of the canine or (pre)molar tooth. A split-mouth design was used in which every animal served as its own control. After surgical extraction of the elements, the sockets on one side were filled with an MGH-based ointment (L-Mesitran Soft), whereas the contralateral side received no treatment (control). A mucoperiosteal flap was used on both sides, and simple interrupted monofilament sutures were placed. No antimicrobial drugs were administered. Clinical parameters (inflammation/redness, flap viability and wound healing) were subjectively analysed on days 3 and 7 post-extraction by a veterinarian blinded to the treatment.

RESULTS

Twenty-one cats were included. MGH significantly decreased signs of inflammation (P <0.01), improved mucoperiosteal flap viability (P <0.01) and promoted wound healing (P = 0.01), at both time points. MGH was easy to apply and there were no adverse events.

CONCLUSIONS AND RELEVANCE

Intra-socket application of MGH after tooth extraction positively affects the surgical wound, as it reduces redness, improves flap viability and enhances wound healing. Applying MGH represents a potent adjuvant therapy to support intra-oral wound healing after tooth extraction.

Herbal Arsenal against Skin Ailments: A Review Supported by In Silico Molecular Docking Studies

Maintaining healthy skin is important for a healthy body. At present, skin diseases are numerous, representing a major health problem affecting all ages from neonates to the elderly worldwide. Many people may develop diseases that affect the skin, including cancer, herpes, and cellulitis. Long-term conventional treatment creates complicated disorders in vital organs of the body. It also imposes socioeconomic burdens on patients. Natural treatment is cheap and claimed to be safe. The use of plants is as old as mankind. Many medicinal plants and their parts are frequently used to treat these diseases, and they are also suitable raw materials for the production of new synthetic agents. A review of some plant families, viz., Fabaceae, Asteraceae, Lamiaceae, etc., used in the treatment of skin diseases is provided with their most common compounds and in silico studies that summarize the recent data that have been collected in this area.

High-Pressure-Based Strategies for the Inactivation of Bacillus subtilis Endospores in Honey

Honey is a value-added product rich in several types of phenolic compounds, enzymes, and sugars recently explored in biomedical and food applications. Nevertheless, even though it has a low water activity (a_W ≈ 0.65) that hinders the development of pathogenic and spoilage microorganisms, it is still prone to contamination by pathogenic microorganisms (vegetative and spores) and may constitute harm to special groups, particularly by immunosuppressed people and pregnant women. Thus, an efficient processing methodology needs to be followed to ensure microbial safety while avoiding 5-hydroxymethylfurfural (HMF) formation and browning reactions, with a consequent loss of biological value. In this paper, both thermal (pressure-assisted thermal processing, PATP) and nonthermal high-pressure processing (HPP), and another pressure-based methodology (hyperbaric storage, HS) were used to ascertain their potential to inactivate Bacillus subtilis endospores in honey and to study the influence of a_W on the inactivation on this endospore. The results showed that PATP at 600 MPa/15 min/75 °C of diluted honey (52.9 °Brix) with increased a_W (0.85 compared to ≈0.55, the usual honey a_W) allowed for inactivating of at least 4.0 log units of B. subtilis spores (to below detection limits), while HS and HPP caused neither the germination nor inactivated spores (i.e., there was neither a loss of endospore resistance after heat shock nor endospore inactivation as a consequence of the storage methodology). PATP of undiluted honey even at harsh processing conditions (600 MPa/15 min/85 °C) did not impact the spore load. The results for diluted honey open the possibility of its decontamination by spores’ inactivation for medical and pharmaceutical applications.

The potential application of natural products in cutaneous wound healing: A review of preclinical evidence

Under normal circumstances, wound healing can be summarized as three processes. These include inflammation, proliferation, and remodeling. The vast majority of wounds heal rapidly; however, a large percentage of nonhealing wounds have still not been studied significantly. The factors affecting wound nonhealing are complex and diverse, and identifying an effective solution from nature becomes a key goal of research. This study aimed to highlight and review the mechanisms and targets of natural products (NPs) for treating nonhealing wounds. The results of relevant studies have shown that the effects of NPs are associated with PI3K-AKT, P38MAPK, fibroblast growth factor, MAPK, and ERK signaling pathways and involve tumor growth factor (TNF), vascular endothelial growth factor, TNF-α, interleukin-1β, and expression of other cytokines and proteins. The 25 NPs that contribute to wound healing were systematically summarized by an inductive collation of the six major classes of compounds, including saponins, polyphenols, flavonoids, anthraquinones, polysaccharides, and others, which will further direct the attention to the active components of NPs and provide research ideas for further development of new products for wound healing.

The use of Indonesian randu honey for chronic wounds in a patient with uncontrolled type 2 diabetes mellitus: A case report

Introduction and importance

Honey has been recorded as having healing properties at a low cost. Many studies have been conducted related to Manuka honey, but studies about Indonesian randu honey are still limited. We report the use of Indonesian randu honey as a wound dressing on non-pressure chronic skin ulcers in uncontrolled T2DM patient.

Case presentation

A 54-year-old man with uncontrolled T2DM came with an unrecovered wound. A thorough inspection revealed several exposed bones, tendons, muscles, and meniscus in the left lower leg region. It was supposed to be amputated, but he declined. He received insulin, debridement, STSG, and a combination of Indonesian randu honey dressing and VAC on the exposed wound before and after the debridement and STSG. There was skin graft lysis, and we intended to do another surgery, but he preferred to be an outpatient. As an outpatient, he received honey wound dressing and insulin. After 1.5 years, the wound was fully closed, and he could walk with the help of a walking stick.

Clinical discussion

Treatment for multiple exposed bones, tendons, and muscles in uncontrolled T2DM patient are complex. Studies reported that Indonesian honey could provide an antibacterial effect, cost-efficiency, speed up wound healing with no side effects, and no physical-chemical properties differences compared to Manuka honey.

Conclusion

Using Indonesian randu honey as wound dressing could stimulate wound healing with no side effects in chronic wounds with uncontrolled T2DM that were supposed to be amputated. However, it took several months for the wound to fully close.

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Honey has been recorded as having healing properties since ancient times.

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Indonesian randu honey can stimulate wound healing in chronic wounds with uncontrolled T2DM that had to be amputated.

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There were no allergic reactions or secondary infections related to the application of Indonesian randu honey.

Antimicrobial Evaluation of Various Honey Types against Carbapenemase-Producing Gram-Negative Clinical Isolates

The development of antibiotic resistance is a major public health issue, as infections are increasingly unresponsive to antibiotics. Emerging antimicrobial resistance has raised researchers’ interest in the development of alternative strategies using natural compounds with antibacterial activity, like honey, which has emerged as an agent to treat several infections and wound injuries. Nevertheless, the antibacterial effect of honey was mostly evaluated against Gram-positive bacteria. Hence, the objective of our study was to evaluate the antibacterial activity, as well as the physicochemical parameters, of genuine Greek honeys against multidrug-resistant Gram-negative pathogenic bacteria. In this vein, we aimed to study the in vitro antibacterial potential of rare Greek honeys against Verona integron-encoded metallo-β-lactamase (VIM)- or Klebsiella pneumoniae carbapenemase-producing multidrug-resistant Gram-negative pathogens. Physicochemical parameters such as pH, hydrogen peroxide, free acidity, lactonic acid, total phenols total flavonoids, free radical scavenging activities, tyrosinase enzyme inhibitory activity and kojic acid were examined. Moreover, the antimicrobial activity of 10 different honey types was evaluated in five consecutive dilutions (75%, 50%, 25%, 12.5% and 6.25%) against the clinical isolates by the well diffusion method, as well as by the determination of the minimum inhibition concentration after the addition of catalase and protease. Almost all the physicochemical parameters varied significantly among the different honeys. Fir and manuka honey showed the highest values in pH and H₂O₂, while the free acidity and lactonic acid levels were higher in chestnut honey. Total phenols, total flavonoids and free radical scavenging activities were found higher in cotton, arbutus and manuka honey, and finally, manuka and oregano honeys showed higher tyrosinase inhibition activity and kojic acid levels. The antimicrobial susceptibility depended on the type of honey, on its dilution, on the treatment methodology and on the microorganism. Arbutus honey was the most potent against VIM-producing Enterobacter cloacae subsp. dissolvens in 75% concentration, while fir honey was more lethal for the same microorganism in the 25% concentration. Many honeys outperformed manuka honey in their antibacterial potency. It is of interest that, for any given concentration in the well diffusion method and for any given type of honey, significant differences were not detected among the four multidrug-resistant pathogens, which explains that the damaging effect to the bacterial cells was the same regardless of the bacterial species or strain. Although the antimicrobial potency of different honey varieties dependents on their geographical origin and on their compositional differences, the exact underlying mechanism remains yet unclear.

Treating surgical site infection by honey antibacterial wound dressing in a neonate: a case report

Surgical site infection (SSI) increases length of treatment, delays wound healing, increases antibiotic use and causes patient death in severe cases. This case was a boy aged 38 weeks and 4 days with a birthweight of 2100 g, a height of 42 cm and a head circumference of 32 cm. Twelve days after birth, he was admitted to hospital where a surgeon removed a sacrococcygeal teratoma. The surgical site became infected, and the infection failed to improve despite him receiving routine normal saline dressings twice a day and intravenous antibiotic therapy. The authors started treatment using an antibacterial wound dressing containing honey (Medihoney) on the SSI twice a day for a month. The infant's SSI was wholly healed after 3 months, and he was discharged from the wound treatment team in good general condition. This case shows that SSIs can be treated with honey-containing antibacterial wound gel, especially in infants who have weaker immune systems.

Evaluation of the Healing Effect of Ointments Based on Bee Products on Cutaneous Lesions in Wistar Rats

The wound-healing capacity of ointments based on bee products was investigated in vivo on three experimental models of incision, excision and heat burn. For this purpose, four ointments were prepared with propolis, honey, apilarnil (drone brood homogenate) and a mixture of these three apitherapy products. The ointments were applied topically for 21 days. Clinical and macroscopic evaluation was performed throughout the experiment, with the recording of the re-epithelialization period and determination of the wound contraction rate on days 6 and 9. The histopathological examination was performed on days 1, 3, 12 and 21 of the treatment. The topical formulations were also characterized from a rheological point of view in order to verify their stability. HPLC analysis of propolis revealed the presence of phenolic compounds, particularly ferulic acid and p-coumaric which were found in high amounts. All ointments had beneficial effects on wound contraction and the re-epithelialization period, but the most significant result, both macroscopically and especially in terms of histological architecture, was presented by the ointment that contains all three apitherapy products, due to their synergistic effect.