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Honey for Pilonidal Wounds

One of the interesting ways of dressing open wounds is with honey. It is available in “medical grade” form, and often Manuka honey is specifically used. (This is honey from the manuka tree which has a antibacterial compound not present in other types of honey.)

The characteristics of honey that make it something that can be used on open wounds are:

  • It has some antibacterial properties
  • Because it is such a concentrated substance it pulls water out of tissues, which may decrease swelling
  • It has a slightly acidic ph, which may help wound healing

But, the real question is whether or not the physical characteristics of honey promote better or faster wound healing than other topical wound treatments. One important concept in treating patients is that:

Just because something logically sounds like it would be beneficial, doesn’t mean it actually will be.

This is why clinical trials, research studies, and literature searches are so important in determining what we should actually do to solve clinical problems. A simple example of this is that Betadine, is a great antiseptic that we use all the time to sterilize skin. But, we’ve found that when used for any length of time on open, infected, wounds it not only impairs healing, but is toxic to the patient!

As far as honey goes, it doesn’t seem to be much better or worse than other topical treatments when used on open wounds. It may be beneficial for some types of burns.

As far as pilonidal wounds goes, there are studies that show that pilonidal wounds can heal when honey is used. But, when compared to other topical treatments, such as silver, zinc, hydrogel, foam, wound VAC, etc., there does not seem to be a particular advantage to any of them. The benefit of using something that has antibacterial properties at all is open to debate.

My analysis of all this is:

  • It is reasonable to use honey on an open wound, but it is not preferred over other modalities for any specific reason.
  • Honey is not an appropriate treatment for an acute abscess or for application on closed incisions.
  • The most important maneuvers to get pilonidal wounds to heal are to keep things clean and dry and get air circulation to the wound. Unfortunately, this may not be possible without further surgery.
  • If sinus tracts have formed, even the smallest wound will never stay healed with honey or any kind of wound care.
  • Proper nutrition, including high protein and vitamin intake is probably more important than the specific local wound care.

If pilonidal surgery is done properly, such that the cleft is flattened and the incision is off the midline, complex and prolonged wound care will not be needed. In our clinic we do not have to deal these issues, except in complicated situations where we are trying to fix poorly done surgery elsewhere.