For wound healing, honey is probably the best all round product.  It is definitely what I use and works great for wounds and burns as well as for fungal and herpes virus infections.  Tretinoin (Retin-A) or other sources of vitamin A, such as cod liver oil, also help wound healing, but cod liver oil is malodorous and messy.  Oxygen seems useful when available, but keep wounds covered for at least 5 days.  Resurfix and Silvadene are both worth while, but may not be as good as honey.  Neosporin is OK, but is definitely inferior to honey.  Petrolatum is definitely less effective, although some authors say it is better than antibiotic ointments like neosporin. Cabbage leaves helped inflamed breasts in nursing mothers.  For individuals with serious full-thickness burns, skin grafting is best.  Carnitine and Vitamin C helped wound healing in a rat study.

Cover Wounds and Avoid Antibiotic ointments: Wounds kept moist and covered help blood vessels regenerate faster and the number of cells that cause inflammation drop more rapidly than allowing wounds to air dry. Keep covered for at least 5 days. Antibiotic ointments may cause an allergic reaction. Removing scabs may be good so as to reduce scarring. NYTimes 8/1/06 D5.

Hyperoxygenated Fatty Acid Helped Prevent Pressure Ulcers: In a DB PC study of 331 patients, Mepentol, a hyperoxygenated fatty acid preparation, had a pressure-ulcer rate of 7.3% vs. 17.4% for placebo (p 0.006)(NNT = 9.95). The average cost of Mepentol during the study was 7.74 Euro. The effectiveness of a hyperoxygenated fatty acid compound in preventing pressure ulcers. Torra i Bou JE, Segovia Gomez T, et al. Advanced Wound Care Division, Smith & Nephew, Spain. J Wound Care. 2005 Mar;14(3):117-21.

Resurfix Better than Petrolatum: Study of 20 patients with topical ulcers. 6 wk DB. Over-the-counter ointment. Ostomy Wound Manage 2001 Feb;47(2):52-6

Petrolatum Not As Good: Silver-coated dressings provide a moist environment for the healing wound combined with an effective antimicrobial agent, and this significantly accelerates healing compared with wounds dressed with traditional petrolatum gauze. Eur J Surg 2000 Jun;166(6):486-9

Petrolatum As Good As Onion Extract: Scar hydration is an important factor in wound healing and can be achieved with topical petrolatum-based ointment. Topical onion gel extract was ineffective in improving scar erythema and pruritus in our patients. Dermatol Surg 1999 Apr;25(4):267-9

Topical Anti-oxidants Help: TTA compound enhances and hastens wound healing. White petrolatum as a base occlusive vehicle shortens reepithelialization compared with "melting" petrolatum. Dermatol Surg 1998 Jun;24(6):661-4

White Petrolatum as Good as Bacitracin: White petrolatum is a safe, effective wound care ointment for ambulatory surgery. In comparison with bacitracin, white petrolatum possesses an equally low infection rate and minimal risk for induction of allergy. 922 patients randomized. JAMA 1996 Sep 25;276(12):972-7

Burns: Porcine Dermal Collagen Better than Petrolatum: Burns 1992 Dec;18(6):492-6. Re-epithelialization in 10 days instead of 14.

Cuts: Doing Nothing Was Better than Petrolatum: The superficial wounds were made with a dermatome on domestic white pigs and were not infected. In these studies, applications of U.S.P. white petrolatum retarded the rate of epidermal healing by 17% compared to untreated control wounds. J Invest Dermatol 1980 Feb;74(2):90-1

Neosporin, Silvadene Help: The effect of four commonly used topical antimicrobial agents on the rate of reepithelialization of clean wounds was evaluated in white domestic pigs. Neosporin Ointment was found to significantly increase the rate of reepithelialization by 25%, while Furacin significantly retarded the healing rate by 24%. Pharmadine, a preparation containing povidone-iodine, did not affect the rate of healing. Both Silvadene and its vehicle significantly increased the rate of reepithelialization by 28% and 21%, Arch Dermatol 1979 Nov;115(11):1311-4

Oxygen Helps: Ohio State University surgical scientists used topical oxygen therapy to treat 30 patients with a total of 56 wounds. The therapy required placing a bag containing pure oxygen over the wound for 90 minutes a day. More than two-thirds of the difficult wounds healed with the oxygen treatment alone. Pathophysiology 1/03

Retinoic Acid Helps: Animals pre-treated with retinoic acid overall seemed to heal wounds earlier. In conclusion, pretreatment with retinoic acid may reduce the depth of injury in laser resurfacing and speed healing rates. Plast Reconstr Surg 1999 Dec;104(7):2229-35. But see=topical tretinoin do not appear to enhance the healing of high-tension excisional surgery wounds in a porcine model. Tretinoin does not appear to improve the survival of full-thickness skin grafts and, in fact, a detrimental effect was apparent. Dermatol Surg 1999 Sep;25(9):716-21. Supportive=This study implies that if patients are treated with Retin-A before undergoing chemical peel or dermabrasion, they will likely observe accelerated healing. Aesthetic Plast Surg 1995 May-Jun;19(3):243-6

Retinoic Acid Pretreatment Helps: Wound areas were 35-37% smaller on days 1 and 4, and 47-50% smaller on days 6, 8, 11, compared with the controls. Clinically and histologically, reepithelialization occurred more rapidly. Thus tretinoin dramatically accelerated wound healing in photodamaged skin. Four elderly men had forearms treated for 12 weeks then a punch biopsy. Br J Dermatol 1995 Jan;132(1):46-53

Cod Liver Oil Beats Vaseline: Plast Reconstr Surg 1999 Dec;104(7):2229-35. Mice ear wounds healed in 9 days with 25% cod liver oil ointment instead of 14 days with vaseline. Cod liver oil has vitamin A, vitamin D, and omega-3 fatty acid, all of which might be helping. Cod liver oil is available cheaply in some pharmacies.

Cabbage Leaves are Good Poultice: Cabbage leaves are often used by breast-feeding women to soothe engorged painful breasts. Their success in my personal trial of one has led to my recommendation of them, not only to breastfeeding women but to any one with an acutely inflamed bodily part, with reasonable success. BMJ 8/22/03. There is nothing new about this ancient remedy used to help reduce all types of painful swelling. You may even find that there is a cache of cabbage in the fridge of your local maternity unit.

Burns: Honey Great for Burns and Wound Healing, Beats Silver Sulfadiazine: Skin grafting was superior to honey dressings (99% vs 74%) in burn patients in randomized study. Burns 1999 Dec;25(8):729-31. 

Burns: Honey Better than Sulfadiazide for Burns: Honey dressing or silver sulfadiazine (SSD) was used in 25 randomly assigned patients. With honey 84 per cent showed satisfactory epithelialization by the 7th day, and in 100% by the 21st day. In wounds treated with silver sulfadiazine, epithelialization occurred by the 7th day in 72% and in 84% by 21 days. Reparative activity was seen in 80 per cent of wounds treated with the honey dressing by the 7th day with minimal inflammation vs. 52% with SSD. A prospective randomised clinical and histological study of superficial burn wound healing with honey and silver sulfadiazine. Subrahmanyam M. Dr Vaishampayan Memorial Medical College, Maharashtra, India. Burns. 1998 Mar;24(2):157-61.

Burns: Honey Good for Burns and Leg Ulcers: Used for leg ulcers. Boiled potato peel dressings definitely inferior to honey in randomized Indian study of 50 burn patients. Burns 1996 Sep;22(6):491-3. 

Burns: Honey Better than Polyurethane Film for Burns: Honey dressing much better than polyurethane film (OpStie) for burns in randomized study. Br J Plast Surg 1993 Jun;46(4):322-3. 

Burns: Honey Better than Silver Sulfadiazine for Burns: Honey dressings much better than silver sulfadiazine with faster healing, less pain, less scarring in study of 104 burn patients. Br J Surg 1991 Apr;78(4):497-8.

Burns: Early Skin Grafting Appears Better than Honey: In a randomized study of 50 burn patients (23% burned with 12% full thickness on average), skin grafting was done in the first grouop in 3-6 days, while the other group was treated with honey dressings.  Eleven of the HT patients eventually required skin grafting. One of the early grafting and three of the honey patients had unsuccessful skin grafting. The mean percentage of blood volume replaced was 35% in TE patients vs. 21% in HT patients (P < 0.01). Only one TE patient died due to status asthmaticus, while there were 3 deaths, all from sepsis, in the HT patients. At 3 month follow-up, 92% of the TE patients had good to excellent functional and cosmetic results vs. 55% in HT patients, 3 of whom had significant contractures. Early tangential excision and skin grafting of moderate burns is superior to honey dressing: a prospective randomised trial. Subrahmanyam M. Dr Vaishampayan Memorial Medical College, Maharashtra, India. Burns. 1999 Dec;25(8):729-31.

Burns: Carnitine plus Vitamin C Aid Burn Healing: The areas of flap necrosis in rats were measured. The median surviving areas and areas of flap necrosis were: controls, 16.0 cm(2) and 14.0 cm(2); vitamin C 0.5 mg/kg, 18.25 cm(2) and 11.75 cm(2); carnitine 100 mg/kg, 20.0 cm(2) and 10 cm(2); and both, 23.75 cm(2) and 6.25 cm(2). Arslan E, et al. Mersin University, Turkey. Med Sci Monit. 2005 May 25;11(6):BR176-180

Burns: Hyaluronic Acid Helped Sulfadiazine Work Faster: In a DB PC study of 111 adult burn patients with 2nd degree burns, those treated with 0.2% hyaluronic acid and 1% silver sulfadiazine (HA-SSD) (Connettivina Plus cream) had more rapid re-epithelialization of burns, i.e. a shorter time to healing, than SSD alone: 4.5 days (p = 0.0073). Second-degree burns: a comparative, multicenter, randomized trial of hyaluronic acid plus silver sulfadiazine vs. silver sulfadiazine alone. Costagliola M, et al. Toulouse, France. Curr Med Res Opin. 2005 Aug;21(8):1235-40.

Carnitine: Skin Flap Survival Helped by Carnitine in Rat Study: Skin flap survival area was 57% in the control group, 71% in the dexamethasone group, 73% in the carnitine group, 85% in the dexamethasone plus carnitine group. Dual Synergistic Effect: The Effect of Dexamethasone Plus Carnitine on Skin Flap Survival. Kargi E, Deren O, et al. Ankara, Turkey. Ann Plast Surg. 2004 Nov;53(5):488-491   

Honey

Fungal Infections: Honey Appears to Help Tinea and Pityriasis Versicolor Infections: In an open, non-scientific report using a mixture of honey, olive oil and beeswax three times a day for up to 4 weeks to treat 37 patients with fungal infections (pityriasis versicolor, tinea cruris, tinea corporis and tinea faciei), clinical response occurred in 86% of patients with pityriasis versicolor, 78% of patients with tinea cruris and in 75% of patients with tinea corporis. Negative fungal cultures were obtained in 75, 71 and 62% of patients with PV, tinea cruris and tinea corporis, respectively. Tinea faciei disappeared clinically and mycologically in 3 weeks. An alternative treatment for pityriasis versicolor, tinea cruris, tinea corporis and tinea faciei with topical application of honey, olive oil and beeswax mixture: an open pilot study. Al-Waili NS. Islamic Establishment for Education, Dubai, United Arab Emirates. Complement Ther Med. 2004 Mar;12(1):45-7.

Gangrene: Honey Better for Scrotal Gangrene: Honey was a superior topical treatment in patients getting oral antibiotics for scrotal gangrene in randomized study of 20 patients vs. group B who underwent wound debridement, wound excision, secondary suturing, and in some cases scrotal plastic reconstruction. Surgery 1993 Feb;113(2):200-4. 

Herpes: Honey Did Better than Acylovir for Oral and Genital Herpes: In a study with 16 adults with a history of recurrent attacks of herpetic lesions, 8 labial and 8 genital, all were treated by topical application of honey for one attack and acyclovir cream for another attack. For labial herpes, the mean duration of attacks and pain, occurrence of crusting, and mean healing time with honey treatment were 35%, 39%, 28% and 43% better than with acyclovir treatment. For genital herpes, the mean duration of attacks and pain, occurrence of crusting, and mean healing time with honey treatment were 53%, 50%, 49% and 59% better than with acyclovir. Two cases of labial herpes and one case of genital herpes remitted completely with honey. The lesions crusted in 3 patients with labial herpes and in 4 patients with genital herpes. With acyclovir treatment, none of the attacks remitted, and all the lesions, labial and genital, developed crust. No side effects were observed with repeated applications of honey, whereas 3 patients developed local itching with acyclovir. Topical honey application vs. acyclovir for the treatment of recurrent herpes simplex lesions. Al-Waili NS. Dubai, United Arab Emirates. Med Sci Monit. 2004 Aug;10(8):MT94-8.  

Infected Wounds: Honey Helped Large Infected Wounds in Children: Used for gangrene in Africa. Nine Israeli infants with large, open, infected wounds that failed to heal with 14 days of conventional treatment did well in 5 days with crude honey applied BID and wounds able to be closed after 21 days of honey. Acta Paediatr 1998 Apr;87(4):429-32. 

Psoriasis: Honey-Beeswax-Olive Olive Seems to Help: In a small, hard-to-understand, randomized 2-week study of 39 patients with either atopic dermatitis (AD) or psoriasis vulgaris (PV), each used a mixture of honey, beeswax and olive oil (1:1:1). Mixtures A, B, and C contained honey mixture with the corticosteroids ointment in a ratio of 1:1, 2:1, and 3:1 respectively. These were compared by treating one-half the body with the honey mixture and the other half with Vaseline/paraffin or Vaseline/paraffin with a steroid. In honey mixture group, 8/10 patients with dermatitis showed significant improvement after 2 weeks. In psoriasis, 5/8 patients showed a significant response to honey mixture. Topical application of natural honey, beeswax and olive oil mixture for atopic dermatitis or psoriasis: partially controlled, single-blinded study. Al-Waili NS. Islamic Establishment for Education, Dubai, United Arab Emirates. Complement Ther Med. 2003 Dec;11(4):226-34. 

Seborrheic Dermatitis Relieved by Honey: In a study of 30 adults with chronic seborrheic dermatitis of scalp, face and front of chest (scaling macules, papules and dry white plaques with crust and fissures), diluted crude honey (90% honey diluted in warm water) every other day on the lesions with gentle rubbing for 2-3 mins was used by all. Honey was left for 3 hr before gentle rinsing with warm water. The patients were followed daily for itching, scaling, hair loss and the lesions were examined. Treatment was continued for 4 weeks. The improved patients were included in a prophylactic phase, lasting six months. Half patients were treated with the topical honey once weekly and the other half served as control. All the patients responded markedly with application of honey. Itching was relieved and scaling was disappeared within one week. Skin lesions were healed and disappeared completely within 2 weeks. In addition, patients showed subjective improvement in hair loss. None of the patients (15) treated with honey once weekly for six months showed relapse while the 12/15 patients who had no prophylactic treatment with honey experienced a relapse of the lesions 2-4 months after stopping treatment. Therapeutic and prophylactic effects of crude honey on chronic seborrheic dermatitis and dandruff. Al-Waili NS.Dubai, United Arab Emirates. Eur J Med Res. 2001 Jul 30;6(7):306-8.

Skin Graft Donor Sites Heal Well with Honey: In an open, non-scientific study of 88 patients undergoing skin grafting, the donor sites were studied for second-intention healing. The donor site was divided into two equal halves, with each half being treated with honey-soaked gauzes and the other half with paraffin gauzes (group 1A), hydrocolloid dressings (group 1B), and saline-soaked gauzes (group 1C) alternatively. In the treatment of split-thickness skin graft donor sites, honey-impregnated gauzes showed faster epithelization time and a low sense of pain than paraffin gauzes and saline-soaked gauzes. There was no significant difference between honey-impregnated gauzes and hydrocolloid dressings with regard to epithelization time and sense of pain. Use of honey as an adjunct in the healing of split-thickness skin graft donor site. Misirlioglu A, Eroglu S, et al. Dr. Lutfi Kirdar Kartal Education and Research Hospital, Bakirkoy-Istanbul, Turkey. Dermatol Surg. 2003 Feb;29(2):168-72.

Surgical Wounds: Honey Better than Povidone for Surgical Wounds: Crude honey applied hourly in randomized study was clearly superior to povidone-iodine and alcohol on c-section or abdominal hysterectomy wounds with much less wound dehiscence, shorter hospital stays, minimal scar formation, and less antibiotic exposure. Eur J Med Res 1999 Mar 26;4(3):126-30. 

Honey Better than Amniotic Membrane: Honey dressings also much better than amniotic membrane. Burns 1994 Aug;20(4):331-3.

Honey as Good as Mupirocin (Bactroban) for Hemodialysis Venous Catheters: In a DB study of 101 patients who were receiving hemodialysis via tunneled, cuffed central venous catheters, the incidences of catheter-associated bacteremias in 3 times/week at exit site honey-treated and mupirocin-treated patients were comparable (0.97 versus 0.85 episodes per 1000 catheter-days, respectively; NS). No exit-site infections occurred. During the study period, 2% of staphylococcal isolates within the hospital were mupirocin resistant. Randomized, controlled trial of topical exit-site application of honey (Medihoney) versus mupirocin for the prevention of catheter-associated infections in hemodialysis patients. Johnson DW, et al. University of Queensland, Australia. . J Am Soc Nephrol 2005 May;16(5):1456-62.

Bactroban: Each gram of Bactroban 2% contains 20 mg mupirocin in a bland water miscible base (polyethylene glycol ointment). Mupirocin is a naturally occurring antibiotic. The generic is $40 vs. $69 for Bactroban. In a study of 100 surgery patients, 21% were nasal carriers of staph aureus. Treating all patients after culture just before surgery and keeping those culturing positive on it for 7 more days reduced surgical wound infections from 1.68% to 0.37%. Am J Infec Control 2006 Feb;34(1):44-8. It's good for exzema. While mupirocin resistance occurs, infections are almost always sensitive to triple antibiotic ointment. A western Pennsylvania football team had MRSA soft tissue infections unresponsive to mupirocin. Pediatr Infect Dis J 2005 Sep;24(9):841-3. Daily exit site use for peritoneal dialysis patients did better with gentamycin ointment than mupirocin at the University of Pittsburgh. J Am Soc Nephrol 2005 Feb;16(2):539-45. Sweden recommends treating impetigo with soap and water or oral antibiotics so as to save mupirocin for MRSA and fusidic acid for IV against severe bone infections since resistant strains are increased by overuse. BMJ 2004 Oct 23;329(7472):979. MSRA is much more rare in Nordic countries than elsewhere. Nasal carrier states for SA range from 20-35% in college students and hospital patients in the U.S. Mupirocin did better than tea tree 10% cream for nasal carriers but tea tree oil did as well as other treatments for skin infections. J Hosp Infect 2004 Apr;56(4):283-6. Triple Antibiotic Ointment did better than mupirocin for 99 soft tissue injury patients at preventing infections. Am J Emerg Med 2004 Jan;22(1):1-3.

Thomas E. Radecki, M.D., J.D.

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