Using Leptospermum Honey to Manage Wounds Impaired by Radiotherapy: A Case Series

Val Robson, BSc, RGN; and Rose Cooper, BSc, PhD, PGCE

Two weeks later, she underwent a left mastectomy and axillary clearance. Between May and August 2004 following her operation, she underwent chest wall radiotherapy. By August 2004, Ms. K’s mastectomy wound failed to heal at the lateral end of the scar. Visiting district nurses redressed the wound with alginate packing. In December 2004, the lateral part of Ms. K’s wound was excised to debride the wound and encourage healing.

     At her January 2005 outpatient appointment, Ms. K’s wound still had failed to heal. The area exhibited localized redness and maceration caused by the wound exudate. A small cavity approximately 3 cm in depth was noted along with two smaller superficial broken areas along the original suture line (see Figure 4a). A honey-soaked hydrofiber rope was loosely packed into the wound and honey applied along the suture line. A no-sting barrier film was applied to the periwound area and an adhesive foam dressing was applied to the wound. Initially, Ms. K was advised to remove the dressing and shower daily. As the wound improved, dressing change frequency was reduced.

     After 2 weeks, Ms. K’s wound was substantially smaller (see Figure 4b). After 4 weeks of honey treatment, the cavity was almost closed (see Figure 4c) and, after a little more than 6 weeks of treatment the wound healed and localized redness subsided (Figure 4d). Table 1 summarizes patient treatment information.


     Four patients with radiotherapy-impaired wounds and compromised skin received care that included medical grade honey. In all cases, a change from conventional dressings to the topical application of honey was followed by a noticeable improvement in healing. It is not possible to report complete healing in all examples because Patient 1 (Mr. G) died and Patient 2 (Ms. H) was lost to follow-up but the latter reported a noticeable reduction in pain once honey was introduced. No adverse events were observed and even though Patient 3 (Ms. J) had type 2 diabetes, daily honey applications to her wound had no adverse effect on her blood sugar levels. All patients readily accepted honey as a dressing for their wounds.

     Radiation damage to healthy tissue begins immediately after radiation exposure but clinical and histological features may not be apparent for weeks, months, or years after treatment. In head and neck cancer patients, radiotherapy has been shown to affect not only skin, but also mucosa, subcutaneous tissues, bone, and salivary glands.23 Skin and oral mucosal reactions are not uncommon but because the extent of the damage is related to the radiation regimen implemented, as well as genetic and personal factors, they are not easily predictable.24 A prospective, descriptive, correlational study with repeated measures25 of 126 women undergoing radiotherapy for breast cancer noted that predictive factors for developing severe skin reactions included smoking, poor lymphatic drainage, weight and/or large breast size, and a history of breast cancer; however, as age increased, the risk of severe skin reaction decreased.

     The importance of choosing suitable dressings and topical treatments for wounds in patients undergoing radiation therapy is recognized, despite the absence of empirical evidence.12 Currently, the chronic irradiated wound is cared for in a manner similar to other chronic wounds because the exact microenvironment of the irradiated wound remains undefined.26 According to a review,26 adequate debridement followed by a use of a dressing that promotes granulation tissue formation have been recommended; adhesive dressings are avoided to prevent epithelial injury.


1. Parkin DM, Bray F, Ferlay J, Pisani P. Global Cancer Statistics, 2002. CA Cancer J Clin. 2005;55(2):74–108.
2. Bentzen SM, Overgaard J. Editorial. Sem Radiation Oncol. 1994;4(2):53–54.
3. Dormand EL, Banwell PE, Goodacre TEE. Radiotherapy and wound healing. Int Wound J. 2005;2(2):112–127.
4. Price NM. Radiation dermatitis following electron beam therapy. Arch Dermatol. 1978;114(1):63–66.
5. Fajardo LF, Berthrong M. Radiation damage in surgical pathology part I. Am J Surg Pathol. 1978;2(2):159–199.
6. Goldschmidt H, Sherwin WK. Reactions to ionizing radiation. J Am Acad Dermatol. 1980;3(6):551–579.
7. Fajardo LF, Berthrong M. Radiation damage in surgical pathology part III. Salivary glands, pancreas and skin. Am J Surg Pathol. 1978;5(3):279–296.
8. LeBoit PE. Subacute radiation dermatitis: a histologic imitator of acute cutaneous graft-versus-host disease. J Am Acad Dermatol. 1989;20(1):236–241.
9. Fisher J, Scott C, Stevens R, et al. Randomized phase III study comparing best supportive care to Biafine as a prophylactic agent for radiation-induced skin toxicity for women undergoing breast irradiation: radiation therapy oncology group (RTOG) 97-13. Int J Radiation Oncol Biol Phys. 2000;4(5):1307–1310.
10. McNees P, Meneses KD. Pressure ulcers and other chronic wounds in patients with and patients without cancer: a retrospective comparative analysis of healing patterns. Ostomy Wound Manage. 2007;53(2):70–78.
11. Denham JF, Hauer-Jensen M. The radiotherapeutic injury — a complex “wound”. Radiother Oncol. 2002:63(2):129–145.
12. Porock D, Nikoletti S, Kristjanson L. Management of radiation skin reactions: literature review and clinical applications. Plast Surg Nurs/Winter. 1999;19(4):185–191.
13. Barkham AM. Radiation skin reactions and treatments. Professional Nurse. 1993;8(11):734–736.
14. Nystedt KE, Hill JE, Mitchell AM, et al. The standardization of radiation skin care in British Columbia: a collaborative approach. Oncol Nurs Forum. 2005;32(6):1199–1205.
15. Wickline MM. Prevention and treatment of acute radiation dermatitis: a literature review. Oncol Nurs Forum. 2004;31(2):237–247.
16. Sitton E. Early and late radiation-induced skin. Part II: Nursing care of irradiated skin. Oncol Nurs Forum. 1992;19(6):907–912.
17. Heenan ALJ. Emollient applications for chronic skin problems. Professional Nurse. 1996;11(11):743–748.
18. Mendelsohn FA, Divino CM, Kerstein ED. Wound care after radiation therapy. Advances Skin Wound Care. 2002;15(5):216–224.
19. Bardy J, Slevin NJ, Mais KL, Molassiotis A. A systematic review of honey uses and its potential value within oncology care. J Clin Nurs. 2008;17(19):2604–2623.
20. Robson V, Cooper RA, Ehsan ME. The use of honey in wound management following ENT surgery. Primary Intention. 2007;15(4):176–180.
21. Robson V. The use of Leptospermum honey in chronic wound management. J Community Nurs. 2004;18(9):24–28.
22. Cooper RA, Molan PC, Krishnamoorthy L, Harding KG. Manuka honey used to heal a recalcitrant surgical wound. Eur J Clin Microbiol Infect Dis. 2001;20(10):758–759.
23. Stone HB, Cleman CN, Anscher MS, McBride WH. Effects of radiation on normal tissue: consequences and mechanisms. Lancet Oncol. 2003;4(9):529–536.
24. Porock D. Factors influencing the severity of radiation skin and oral mucosal reactions: development of a conceptual framework. Eur J Cancer Care. 2002;11(1):33–43.
25. Porock D, Kristjanson L, Nikoletti S, Cameron F, Pedler P. Predicting the severity of radiation skin reactions in women with breast cancer. Oncol Nurs Forum. 1998;25(6):1019–1029.
26. Hom DB, Adams G, Koreis M, Maisel R. Choosing the optimal wound dressing for irradiated soft tissue wounds. Otolaryngol Head Neck Surg. 1999;121(5):591–598.
27. Porock D, Kristjanson L. Skin reactions during radiotherapy for breast cancer: the use and impact of topical agents and dressings. Eur J Cancer Care. 1999;8(3):143–153.
28. Margolin SG, Breneman JC, Denman D, La Chapelle P, Weckbach L, Aron B. Management of radiation-induced moist skin desquamatation using hydrocolloid dressing. Cancer Nurs. 1990;13(2):71–80.
29. Borg M, Wilkinson D, Humeniuk V, Norman J. Successful treatment of radiation induced breast ulcer with hyperbaric oxygen. Breast. 2001;10(4): 336–341.
30. Schimp VL, Worley C, Brunello S, et al. Vacuum-assisted closure in the treatment of gynaecologic oncology wound failures. Gynecol Oncol. 2004;92(2):586–591.
31. Robson V, Martin L, Cooper RA The use of Leptospermum honey on chronic wounds in breast care. In: White R, Cooper R, Molan P. Honey: A Modern Wound Management Product. Aberdeen, UK: Wounds UK Publishing;2005.
32. Sofka K, Wiszniewsky G, Blaser G, Bode U, Simon A. Antibacterial honey (Medihoney™): an antiseptic option for wound care in paediatric oncology? Krh Hyg Infverh. 2004;26(5):183–187.
33. Simon A, Sofka K, Wiszniewsky G, Blaser G, Bode U, Fleischhack G. Wound care with antibacterial medical honey (Medihoney) in pediatric haematology oncology. Support Care Cancer. 2006;14(1):91–97.
34. Blaser G, Santos, K, Bode U, Vetter H, Simon A. Effect of medical honey on wounds colonised or infected with MRSA. J Wound Care. 2007;16(8):325–328.
35. Moolenaar M, Poorter RL, van der Toorn PPG, et al. The effect of honey compared to conventional treatment on healing of radiotherapy-induced skin toxicity in breast cancer patients. Acta Oncologica. 2006;45(5):623–624.
36. Biswal BM, Zakaria A, Ahmad NM. Topical application of honey in the management of radiation mucositis. A preliminary study. Support Cancer Care. 2003;11(4):242–248.
37. Motallebnejad M, Akram S, Moghadamnia A, et al. The effect of topical application of pure honey on radiation-induced mucositis: a randomized clinical trial. J Contemp Dent Pract. 2008:9(3):40–47.
38. Mustoe TA, Purdy J, Gramates P, Deuel TF, Thomason A, Pierce GF. Reversal of impaired wound healing in irradiated rats by platelet-derived growth factor BB. Am J Surg. 1989;158(4):345–350.
39. Bernstein EF, Harisiadis L, Salomon G, et al Transforming growth factor beta improves healing of radiation-impaired wounds. J Invest Dermatol. 1991;97(3):430–434.
40. Cromack DT, Porras-Reyes B, Purdy JA, Pierce GF, Mustoe TA. Acceleration of tissue repair by transforming growth factor beta 1: identification of in vivo mechanisms of action with radiation-induced specific healing deficits. Surgery. 1993;113(1):36–42.
41. Nall AV, Brownlee RE, Colvin CP, et al. Transforming growth factor beta 1 improves wound healing and random flap survival in normal and irradiated rats. Arch Otolaryngol Head Neck Surg. 1996;122(2):171–177.
42. Vegesna V, McBride WH, Taylor JM, Withers HR. The effects of interleukin-1 beta or transforming growth factor-beta on radiation-impaired murine skin wound healing. J Surg Res. 1995;59(6):699–704.
43. Jagetia GC, Rajanikant GK. Effect of curcumin on radiation-impaired healing of excisional wounds in mice. J Wound Care. 2004;13(3):107–109.
44. Maddocks-Jennings W, Wilkinson J M, Shillington D. Novel approaches to radiotherapy-induced skin reactions: a literature review. Complementary Ther Clin Pract. 2005;11(4):224–231.

Anonymoussays: March 29.2010 at 13:05 pm

yes its great,
iam a nurse in jordan ,also i have personal experiences by using honey in treatment pressure ulcers
my e-mail:

Reply to this comment »

Post new comment

  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
  • Use to create page breaks.

More information about formatting options

Enter the characters shown in the image.