# A randomised controlled trial of raw honey for the healing of ulcers in leprosy in Nigeria

## TL;DR

A study in Nigeria tested raw honey versus saline dressings for healing leprosy-related foot ulcers but found no significant difference in healing rates.

## Contribution

This is the first randomized controlled trial evaluating raw honey's efficacy for leprosy-associated ulcers in a clinical setting.

## Key findings

- 29.2% of honey-treated ulcers fully healed by 84 days, compared to 24.6% with saline.
- No significant difference in ulcer recurrence rates at 6 months between the two groups.
- Honey dressings were safe and showed a non-significant trend toward faster healing.

## Abstract

Chronic neuropathic ulcers remain a debilitating complication of leprosy, with limited evidence for effective treatments. Honey has been recommended to promote wound healing in other chronic ulcers. However, its efficacy in ulcer healing has not been rigorously evaluated.

This dual-centre, prospective, single-blinded, randomised controlled trial compared raw honey dressings (n = 65) versus standard saline dressings (n = 65) for leprosy-associated foot ulcers in Nigeria. Participants with ulcers (2–20 cm2, ≥ 6 weeks duration) were randomised 1:1, stratified by ulcer size. Primary outcomes were complete healing by 84 days and healing rate, assessed through blinded digital planimetry. Secondary outcomes included ulcer recurrence and/or new ulcer development at 6 months. A total of 130 participants were randomised in the study.

Complete healing occurred in 29.2% of honey-treated ulcers versus 24.6% with saline (adjusted HR 1.26, 95% CI 0.64-2.47). At 6 months, recurrence rates were similar (honey 13.5% vs saline 10.2%). The honey group showed a non-significant trend toward faster healing (p = 0.076). No treatment-related adverse events occurred.

While honey dressings showed a modest advantage in healing rate, the difference was not statistically significant. The results suggest honey may be a safe, culturally acceptable option in resource-limited settings. This study provides high-quality data for inclusion in future systematic reviews.

ISRCTN10093277. Registered on 22 December 2021.

Leprosy causes neuropathic ulcers. These ulcers are often hard to heal, especially when they appear on the side of the foot where they are subjected to ongoing pressure. It has been suggested that honey applications may promote ulcer healing. This study tested whether raw, local honey (known for its natural antibacterial and healing properties) could do better than standard saline dressings. We enrolled 130 people with chronic foot ulcers, randomly allocated in a 1:1 ratio to either receive twice-weekly applications of honey or standard saline dressings. We tracked healing over 84 days using photographs measured by blinded experts. There was no statistical difference in the rate of healing across intervention and control groups, albeit with a slightly faster rate of healing with honey. By day 84, 29% of honey-treated ulcers had fully healed, compared to 25% with saline, but again, the result did not cross the conventional threshold. There were no treatment-related complications in either group. The overall improvement rate was slow, suggesting that the ulcers in this study were ‘hard-to-heal’. While our study offers scant support for honey treatment, it does not prove that it is ineffective.