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Table 1 The healing properties of natural unheated honey

From: Does application of honey improve surgical outcome in pilonidal cyst excision with secondary intention healing? A prospective randomized placebo-controlled clinical trial

Cause Effect
Stimulation of inflammatory cytokines (TNF-α, IL-1β, and IL-6 release from Mono-Mac 6 (MM6) cells (A monocytic cell line) Healing and tissue repair
Proliferation and activation of peripheral blood B and T lymphocytes Healing and tissue repair
Glucose oxidase catalyzes the oxidation of glucose to gluconic acid and release hydrogen peroxide (H2O2), which causes a decrease in the honey pH and ruins the
outer membrane of the bacteriae
Anti-bacterial activity and stimulates the wound healing process
Methylglyoxal Anti-bacterial activity
Viscosity and hyperosmolarity Anti-bacterial activity helps to absorb exudate and provide a protective barrier to prevent infection
Varying concentrations of antioxidants (flavonoids, ascorbic acid, carotenoids, catalase, peroxidase, and phenolic acids) Anti-oxidant properties may be beneficial to wound healing
Provides a moist environment (physical properties) Create a moist wound healing environment that does not stick to the underlying wound tissues
Acidity Reduce protease activity, increase fibroblast activity, and increase oxygen release, assist in the bacterial-killing action of macrophages, aiding wound healing, but increase pain
Increase nitric oxide (NO) production Affect immunity, bacterial infections, and wound healing
Inhibitory effect on prostaglandins Affect inflammation, pain, immunity, and wound healing
Nutritional composition (glucose, fructose, sucrose, minerals, vitamins, antioxidants, amino acids, and other products) Wide biological and therapeutic effects
Enhancing wound contracture Healing and tissue repair
Increased granulation tissue formation Healing and tissue repair