Leprosy ulcers are well documented as being among the most challenging and serious complications of leprosy. Around 1 in 5 leprosy patients will suffer a foot ulcer and many of these people will suffer multiple ulcers over their lifetimes.
As well as being very unpleasant, ulcers often require patients to spend time in hospital so that infections in the wound can be treated and a saline dressing can be applied to heal the wound. For many patients who are already working hard just to feed their families, this time away from the communities and their livelihoods is most unwelcome. But if they do not receive this kind of treatment, potential infections can become so serious that they can lead to amputations.
TLM Nigeria are currently working on a new research project, the HELP (Honey Experiment on LeProsy Ulcer) Study, which is taking place under the RIGHT CALL-1 project. This project is attempting to confirm whether honey could be used to make life easier for leprosy ulcer patients.
We talk to Mr Israel, who is a physiotherapist in the TLM Nigeria team to find out more.
“Although using honey to treat ulcers might sound unusual to people who do not have a scientific background, it makes a lot of sense.
“Honey produces small amounts of hydrogen peroxide in a slow release manner, which serves as an antibacterial. It is currently being used in many skin clinics to treat burns and skin ulcerations that have been caused by accidents, so it is not a new concept. The HELP Study is aiming to clarify the efficacy of using honey to treat leprosy ulcers so that clinicians can have a scientifically proven basis for using honey in their own ulcer treatment practices.”
“The standard practice for leprosy ulcer treatment today is to apply a saline dressing to the wound. This is an effective way of treating the ulcers and has been for decades.
“However, there are reasons that honey could be a better option and they mostly relate to accessibility.
“Normal saline is only readily accessible in hospitals and through pharmacies. It is created by pharmaceutical companies and sold for use on ulcers and in other medical contexts. That means that a patient must come to the hospital or clinic in order to be treated. Treatment can last for months, so patients have to be away from their homes and families for long stretches, sometimes for 12 months or even longer. This is particularly tiresome for patients when the ulcers happen again and again.
“Honey is different, however. Many patients can access the honey in their community. In fact, much of the honey we are using in this Study is being sourced from some of the more remote communities in Nigeria where there are a number of leprosy patients.
“Patients will still need to attend hospital when they first develop an ulcer because the medical staff need to ensure that any potential infection has been cleared. However, once the wound is clear of infection, the patient can return home and apply the honey dressing on their own using the honey supplies that are available in their community. This is going to cut down significantly the amount of time patients spend away from their homes in hospital.
© Tom Bradley
“There is also a chance that the honey will heal wounds faster than a saline dressing because the honey has a natural and healing drying effect, which is better than saline dressings, which keep wounds wet, which in turn slows the healing process. Honey effectively pulls water out of the wound and allows them to heal faster.
“There are a number of different ulcer studies happening right now as part of the RIGHT-CALL project. One of those includes the LPRF Study that is being conducted by Dr Indra Napit at TLM Nepal. We are very excited about the potential of LPRF to heal wounds far quicker than the saline dressings.
“The LPRF treatment could revolutionise ulcer care in leprosy, so the honey dressings would not replace that. However, in low resource settings, where LPRF is not possible and where honey is a natural and readily available product, we are hoping the honey-based dressing could be particularly transformative for those patients.”
“Our plan is to recruit 130 patients to take part in a Randomised Controlled Trial at the Leprosy Referral Hospital in Chanchaga, Niger State. Each patient will have up to 30 dressing changes over a three-month period. The patients will still be discharged if the wound is healed before the completion of the 30 dressings. We will track their progress over this time and compare with the outcomes of the control group, who will use traditional saline dressings.
“We will also follow up with the patients after six months to see if the honey dressings have also reduced the number of ulcer recurrences for these patients.
© Sabrina Dangol
“We hope that we will be able to publish some findings in 2023.
“We hate seeing patients stuck in our hospitals for months at a time on end while their ulcers are treated; it’s heart breaking. Our sincere hope is that this study will provide the scientific basis for clinicians to begin using honey in contexts where traditional saline dressings are not serving patients well. We hope honey dressings might allow patients to spend much more time at home, with their families, earning a living, and living full lives."
