Flashback Friday: Topical Honey for Canker Sores

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

We’ve known about painful aphthous ulcers—canker sores—for thousands of years: “the most common lesion” of the lining of our mouths, named, perhaps, by Hippocrates himself. Well, what did he prescribe for it? Well, he was a big fan of honey, for healing a bunch of sore body parts, though beat to the punch by a few millennia by the ancient Egyptians on that score. Also known by the ancient Chinese; perhaps “the oldest wound dressing…known to [humankind].” Well, how about a few thousand-year update?

Evidently, honey has been successfully used as a treatment for a number of types of wounds, including chronic ulcers. The evidence is apparently strongest for burns. Yeah, but okay; compared to what? Compared to a “boiled potato peel”? I’m not making that up. Apparently, honey works like twice as well as “boiled potato peel dressings,” perhaps because of an “antibacterial effect,” whereas the potato peels only seem to kind of cover things up, like slapping on cadaver skin. Ew! Maybe, I’ll stick to the potatoes. But, what else are you going to do in a resource-poor country?

Here, we have antibiotics to fight infections. So, quality of healing is often more defined as the aesthetic look of the resulting scar. So, plastic surgery patients had half of their surgical scar covered with conventional dressings, and the other half of the same scar covered in a honey dressing. And, the halves of the scars covered in honey healed about a third narrower than those covered conventionally, suggesting an improvement in the healing process.

Okay, but what about canker sores? Here, they report 19 cases. Started out with severe pain, but evidently, one day after rubbing honey on the sore, the pain was reduced drastically—in fact, gone, in “92% of patients,” and in most cases, the ulcer was gone completely by day three or four. Okay, but, there was no control group. Maybe they would have gotten better anyway; maybe there was a placebo effect.

Yeah, “modern medicine has neglected honey as a therapeutic agent,” because the science was poor—essentially a series of published anecdotes. But look, one could argue that there’s never been any significant side effects associated with the topical application of honey. So, what’s to lose? I sympathize with that logic, but would really like to see it put to the test. But, there hadn’t been any good studies, until…this one. A randomized, controlled trial: honey tested head-to-head against a steroid gel, against canker sores.

There’s all sorts of things doctors can prescribe for canker sores: topical agents like steroids and antibiotics, systemic medications—even laser therapy. But look, why not seek out “the least toxic…agent” first? May not be the most profitable, but why not start with the safest?

So, they randomized folks with canker sores into one of three groups, where they applied—with a Q-tip “three times a day (after meals)”—either an over-the-counter soothing pain-relieving paste, or a prescription steroid cream, or just plain “commercial honey,” directly onto the canker sore. Here’s what happened. Here are the pain scores. On the over-the-counter stuff, the pain was cut in half by day four and gone by day eight. On the prescription steroids, half by just two days, and gone by four. What about the honey group? Remember that series of cases that claimed total pain relief in one day? Well, it was put to the test, and…total pain relief within one day. That’s crazy! Pain for a week, or just pain for a day—and honey’s like 500 times cheaper.

What about ulcer size? Mostly gone by eight days, seven days, or…three days. And, cut in half in just one day, as opposed to three or four days. Here’s a before and after. Day one: massive canker sore, but dab a little honey on three times a day, and day one, two, and gone—day three.

So, a significant acceleration of healing and resolution of pain, all without “systemic side effects”—or local side effects for that matter, whereas the topical antibiotics that are sometimes used can have a variety of side effects. And, the nice thing about honey is that it doesn’t “lead to the development of” antibiotic resistance.

Now, this was a single-blind study, meaning the person evaluating the lesions didn’t know which group someone was in, but the patient surely knew, as honey would have had a very different taste and texture. And evidently, the Prophet Mohammad was a big fan of honey, and this study was done in Saudi Arabia. And so, it’s possible there was some bias. But, given the extraordinary results, one might want to give it a try.

Now, the benefits of honey may be due in part to the phytonutrients from the flowers the bee is making the honey from. So, why not try the flowers directly? A chamomile extract appeared to cut pain in half within ten minutes of application, but they didn’t follow them out in terms of healing. But, a 2% lavender oil in glycerin solution—two drops, three times a day—also had an immediate effect on pain, and, more importantly, seemed to accelerate healing—wiping out the ulcers by day four, with pain diminishing in a day or two, compared to over a week in the placebo group.

However you choose to treat your canker sores, if you keep getting them, you should see a medical professional to make sure it’s not some sign of an underlying disease. There are a number of conditions that can manifest with chronic canker sore-type lesions, like inflammatory bowel diseases, or acute necrotizing ulcerative gingivitis.

Uh, I think I’d rather have something like “Sweet syndrome”, or, even better, “MAGIC syndrome”. Who wouldn’t want to have “MAGIC syndrome”?! Anyone, I guess, who doesn’t want “genital ulcers.” I think I’ll stay a muggle.

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• Altenburg A, El-Haj N, Micheli C, Puttkammer M, Abdel-Naser MB, Zouboulis CC. The treatment of chronic recurrent oral aphthous ulcers. Dtsch Arztebl Int. 2014 Oct 3;111(40):665-73.
• Edgar NR, Saleh D, Miller RA. Recurrent Aphthous Stomatitis: A Review. J Clin Aesthet Dermatol. 2017 Mar;10(3):26-36.
• El-Haddad SA, Asiri FY, Al-Qahtani HH, Al-Ghmlas AS. Efficacy of honey in comparison to topical corticosteroid for treatment of recurrent minor aphthous ulceration: a randomized, blind, controlled, parallel, double-center clinical trial. Quintessence Int. 2014 Sep;45(8):691-701.
• Subrahmanyam M. Honey dressing versus boiled potato peel in the treatment of burns: a prospective randomized study. Burns. 1996 Sep;22(6):491-3.
• Goharshenasan P, Amini S, Atria A, Abtahi H, Khorasani G. Topical Application of Honey on Surgical Wounds: A Randomized Clinical Trial. Forsch Komplementmed. 2016;23(1):12-5.
• Saikaly SK, Khachemoune A. Honey and Wound Healing: An Update. Am J Clin Dermatol. 2017 Apr;18(2):237-251.
• El-Haddad S, Al-Shawaf MD. Effect of honey for treatment of some common oral lesions: Follow up of 50 cases. Journal of Dentistry and Oral Hygiene. Vol. 5(6), pp. 55-61, June 2013.
• Zubair R, Aziz N. As Smooth as Honey--The Historical Use of Honey as Topical Medication. JAMA Dermatol. 2015 Oct;151(10):1102.
• Cooper R. Honey for wound care in the 21st century. J Wound Care. 2016 Sep;25(9):544-52.
• Baccaglini L. There is limited evidence that topical lavender oil is effective for palliative treatment of recurrent aphthous stomatitis. J Evid Based Dent Pract. 2013 Jun;13(2):47-9.
• Ramos-e-Silva M, Ferreira AF, Bibas R, Carneiro S. Clinical evaluation of fluid extract of Chamomilla recutita for oral aphthae. J Drugs Dermatol. 2006 Jul-Aug;5(7):612-7.

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