Skin ulcers — especially on legs or feet — are a dastardly, devilish dilemma to deal with.

The witness to that is the almost inconceivably long list of options, devices, incantations and techniques used by doctors, wound-care clinics, wound-care specialists, physical therapists, postal carriers, uh, wait, no.

If you or someone else has dealt with one or unfortunately more of these, you can echo the travail they entail.

One substance used for centuries that had taken a back seat to newer approaches is being re-examined and re-employed in some settings with good results.

That would be honey, the all-natural sweet gooey stuff that gets everything it touches sticky, as seen when a 3-year-old consumes a bread slice coated with it. Its use in ulcers and skin defects goes back at least 2,000 years.

Dioscorides, an often-quoted Greek doctor, described honey in 50 A.D. as good “for all rotten and hollow ulcers.” Various medical writings appeared in ancient Middle Eastern and Asian papers espousing honey’s therapeutic benefits.

In contrast, a paper in the 1976 Archives Of Internal Medicine panned (jarred?) it. More recently, starting in the 1990s, it has been studied for its antibacterial effects in as many as about 60 bug species, including MRSA and pseudomonas types.

Some studies, done on ulcers refractory to antibiotics and costly wound-care treatments, show significant healing. These could be burns, venous or mixed types of leg ulcers, pressure sores, unhealed graft donor sites, open abscesses, pilonidal sinuses, etc. Two randomized, controlled trials, comparing honey to silver sulfadiazine antibiotic cream on partial thickness burns, showed honey gave better infection control.

There are thought to be three ways honey suppresses bacteria. First, it has a very high sugar concentration, which draws water to it and out of the bugs (called osmotic pressure) shriveling up the measly microbes. It also contains an enzyme, glucose oxidase, that produces hydrogen peroxide in the ulcer, which is antibacterial.

Certain honeys have been analyzed and found to contain antibacterial plant chemicals, called phytochemicals. The most touted honey is manuka honey from the manuka tree in New Zealand. It is even tested for antibacterial activity at the Waikato Honey Research Unit in New Zealand, and given a Unique Manuka Factor rating number for antibiotic effect.

The only drawback to honey is that it can contain spores of botulism bacteria, which (rarely) can incubate, turn into the bacteria and produce the botulism toxin. The medical honeys are X-irradiated to destroy the spores.

Various honey sources may not work the same, and humans have not been as busy as bees studying the differences.

A recent Turkish study compared wound-healing rates of pure chestnut, pure rhododendron and pure multifloral honeys to salt-water cleansing. They worked the same, and better than the saline.

The Internet is ridiculously riddled with copious, miraculous sounding, inflated, hyperbolic claims for beyond-belief results with honey. But, in a larger regimen of care, honey for your skin ulcer woes might be a sweet thought.

Frank A. Bures is a Winona dermatologist.

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