Apitherapy: An overview of bee products for wound healing including clinical use guidelines

Every year in the United States, more than 1.25 million people have burns and 6.5 million have chronic skin wounds caused by pressure, venous stasis, or diabetes mellitus. Often disguised as a comorbid condition, chronic wounds represent a silent epidemic that affects a large fraction of the world population and poses a major and gathering threat to the public health and economy of the United States.

The burden of treating chronic wounds is growing rapidly due to increasing health care costs, an aging population and, in the United States and beyond, a sharp rise in the incidence of diabetes and obesity worldwide. It is claimed that an excess of $25 billion is spent annually on treatment of chronic wounds.

Prevalence of diabetes represents a major impact on wound healing outcome. In 2004, according to the World Health Organization, more than 150 million people worldwide suffered from diabetes. Its incidence is increasing rapidly and it is estimated that by the year 2025, this number will double.  It is estimated that up to 25% of all diabetics will develop a diabetic foot ulcer.

Because of the widespread development of antibiotic‐resistant bacteria, chronic wound healing is a challenging problem. This has led to a re-examination of honey and its by-products as therapeutic agents. Honey, propolis, royal jelly, and bee venom have strong antibacterial activity.  

The wound healing properties of honey include stimulation of tissue growth, enhanced epithelialization, and minimized scar formation. These effects are ascribed to honey’s acidity, hydrogen peroxide content, osmotic effect, nutritional and antioxidant contents, stimulation of immunity, and to unidentified compounds. Prostaglandins and nitric oxide play a major role in inflammation, microbial killing, and the healing process. Honey was found to lower prostaglandin levels and elevate nitric oxide end products.

Studies show that honey dressing applied to infected diabetic foot wounds showed beneficial changes in grade and stage of wounds, when using the University of Texas Diabetic Wound Classification index. One study utilizing honey dressing for infected diabetic foot wounds for a three month period achieved complete healing in 43.3% of ulcers while decrease in size and healthy granulation was significantly observed in another 43% of study participants. Bacterial load of all ulcers was significantly reduced after the first week of honey dressing.

The effects of bee products on bacteria vary considerably by the type of product and among varieties of the same product. Botanical origin is a major determinant of the honey’s antibacterial activity. Propolis has been found to have the strongest action against bacteria. Honey does not allow vegetative bacteria to survive; however, it does contain viable spores, including clostridia. Honey products should be filtered or otherwise checked for clostridia spores when used in an antimicrobial or topical manner. As a dressing on wounds, honey provides a moist healing environment, rapidly clears infection, deodorizes, and reduces inflammation, edema, and exudation.