Many people believe in honey, particularly Manuka honey, to treat leg ulcers. However this belief is not backed up by good research.
Researchers have recently published a review of the world literature in the use of honey in the treatment of leg ulcers (http://www.ncbi.nlm.nih.gov/pubmed/26050953).
Not surprisingly they have shown that there is no proven benefit that honey improves the outcome from treating leg ulcers.
As most leg ulcers are usually caused by varicose veins, "hidden varicose veins" or venous obstruction, it is not surprising that honey doesn't show a great benefit. Honey is spread on the surface of the ulcer and does not have any effect on the underlying venous problem.
These underlying problems can only be fixed by performing a venous duplex ultrasound scan, and then fixing the problem with endovenous thermal ablation (endovenous laser ablation or radiofrequency ablation), foam sclerotherapy or – occasionally – by venous stents.
This is why the National Institute of Health and Clinical Excellence (NICE) produced guidelines saying that anyone with a leg ulcer has to be referred to a “vascular service” see: http://www.nice.org.uk/guidance/cg168/chapter/1-recommendations#referral-to-a-vascular-service-2
Of course there are a minority of patients who have open sores on the legs that will heal with good nutrition and good dressings. These are the cases that people hold up as “proof” that honey works. Although many dressings would work, honey might have some advantages in these cases.
However, in the majority of patients, the leg ulcer is caused by an underlying venous problems and this cannot be fixed by honey alone.
Rather than prescribe honey as the first line of action, and leaving the majority of people uncured, it would be far better to follow the NICE guidelines. All patients with leg ulcers should be referred to a specialist vascular service that can perform a venous duplex ultrasound and then fix the underlying venous cause. This would cure most patients, and the few that only need simple treatments like honey could easily be identified.
Prof Mark S Whiteley
