the exact number of burn cases is difficult to determine ; however , in a country like india , with a population of over 1 billion , there are around 700,000800,000 burn admissions per year . burn injuries to the skin result in loss of its protective function as a barrier to micro - organisms leading to the high risk of infection . thus , burn patients face high morbidity than mortality because of the large uncovered burn surface getting infected , healing of which takes long periods of dressings , leading to deformities and contractures . unfortunately , the management of the burn wounds still remains a matter of debate and an ideal dressing for burn wounds has not been discovered . various dressing materials have been used for dressing the burn wounds such as amniotic membrane , boiled potato peel , banana leaf , soframycin cream , silver sulfadiazene , skin grafting , epidermal growth factor , honey dressing , etc . honey being cheap and easily available is a reasonably good dressing material in developing countries . the present study is aimed to compare the effect of the honey dressing and silver sulfadiazene ( ssd ) dressing on wound healing . the records of patients with burns who had been treated with either honey dressings or silver sulfadiazine dressings at our center over a period of 5 years ( january 2004 to december 2008 ) were reviewed . records of a total of 108 patients ( complete records ) of both sexes aged 1468 years , with first and second degree burns , having a burned area less than 50% of the total body surface area ( tbsa ) were included . patients who were in an immunocompromised state , any organ failure , and on chemotherapy were not included . for convenience and comparison , the patients were divided into two groups :  honey group  and  silver sulfadiazine ( ssd ) group .  apart from age / sex and usual patient data , time elapsed since burn to reach the hospital , and results of routine blood investigations and wound swab samples all were collected . also , the results of the clinical assessment of the wounds done time to time in terms of site , affected surface area , degree , depth , presence or absence of slough , culture sensitivity every seventh day , any additional treatment , and the outcome were also noted . along with stabilization , in all the patients , intravenous or oral antibiotics were started as per hospital protocols . wound swab samples were taken on admission and every seventh day from the time of admission . antibiotics were given for minimum 5 days or after 48 hours of subsidence of fever . patients mentioned under the  honey group  were dressed with pure undiluted honey and those in the  ssd group  with ssd cream , everyday . after the application of the dressing material , we preferred to leave the burn area open . patients were followed up every fortnight for initial 2 months , monthly for next 4 months , and once in 6 months thereafter . formation of a soft scar , hypertrophic scar and/or contracture was labeled as an incomplete recovery . patients characteristics and time elapsed after burns to reach the hospital are shown in table 1 . out of a total of 108 patients , a majority ( n = 36 ) reported within 18 h of burns . sixty - five patients presented within first 24 h of burns [ table 1 ] . there were no significant differences among patients in both groups as far as patients characteristics were concerned except that more patients in the " honey group " presented within first 8 h. patients characteristics and time of reporting after burns only one patient in the  honey group ,  among those who presented in less than 1 h of the burn , had his wound swab cultures positive at the time of admission , while the corresponding figure for the  ssd group  was 35% . patients who came within 18 h following burns ( 83% and 75% in two groups , respectively ) had wound swab cultures positive at the time of admission . all patients in both groups reporting after 24 h ( 100% ) had wound swab cultures positive on admission [ table 2 ] . time elapsed after burns and till reporting , and the  wound swab culture  at admission in both groups the average duration of wound healing among patients in the  honey group  coming within 1 , 28 , and 924 h , and more than 48 h was 18.8 , 17.8 , 21.25 , and 14.25 days , respectively . among patients in the  ssd group  average durations of healing were 27.6 , 32.4 , 32.5 , 32.5 , and 38.6 days for similar times of reporting [ table 3 ] . thus average durations of healing of patients in the  honey group  ( 18.1 days , sd = 2.3 ) was significantly lower than that of patients in the  ssd group time elapsed after burns till reporting , and  healing  with treatment among patients treated with honey dressings , wound swab cultures became negative in less than 7 days , in 62% , 50% , and 40% of the total number of patients reporting in 28 , 924 , and after 48 h , respectively [ table 4 ] . among patients treated with ssd dressings , wounds of half ( 50% ) of the patients who presented within less than 1 h of burns became sterile in less than 21 days , those of 14% in less than 14 days , and of 16% in more than 28 days . among patients who presented within 28 h , 28.5% had their wounds sterile in less than 28 days , 42.8% in less than 21 days , and 14.2% in more than 28 days . among patients who presented after 48 h , 62.5% had their wounds sterile in more than 28 days , and 25% and 14.2% in less than 28 and 21 days , respectively [ table 4 ] . sterilization of wounds of different reporting times achieved by honey and ssd among 41 patients treated with honey dressings who reported within 24 h , 32 patients ( 80% ) had a complete recovery while 9 had incomplete . two among these nine progressed to the third degree . out of total 51 patient treated with honey dressings , 41 ( 81% ) had a complete recovery . in the ssd group out of 42 patients presenting within 24 h , only 17 patients ( 45% ) had a complete outcome , and out of total 57 patients , only 27 ( 47% ) achieved a complete outcome . these differences were statistically significant ( p = 0.002 for 24 h , and p = 0.003 for 48 h results ; [ table 5 ] ) . final outcome in the  honey group  and  ssd group  in relation to different times of reporting after burns for at least 2700 years , honey has been used to treat a variety of ailments through topical application , but only recently its antiseptic and antibacterial properties have been chemically explained . the antibacterial activity of honey is mainly due to the presence of inhibines , which consist of hydrogen peroxide , flavonoids , phenolic acids , and many other unidentified substances.[35 ] other features that impart antibacterial properties to honey are its low water activity causing osmosis and high acidity . , through a review of previous randomized controlled trials comparing honey with other materials , concluded that the confidence in a conclusion that honey is a useful treatment for superficial wounds or burns is low , however , recently in 2004 , professor peter molan from new zealand , based on his work at honey research unit at the university of waikato said that honey might be useful in treating methicillin - resistant staphylococcus aureus ( mrsa ) infections . the topical use of honey prevents the dressing from sticking to the healing wound , and may reduce odors , swelling , and scarring when used to treat wounds . infection is one of the most frequent complications of wound healing despite the use of antibiotics and modern sterile techniques ; it accounts for considerable patient morbidity , discomfort , and prolonged hospitalization and it must be avoided to permit proper healing . burn patients have great chances of infection due to the presence of necrotic tissue in the burn wounds . delayed reporting has been found to be an important factor that causes an increase in wound infection and thus morbidity . this is a major problem in the third world counties like india , owing to poor transport conditions , illiteracy , and distant tertiary health care centers . delay and inadequate fluid resuscitation and overwhelming infection were the major factors in the morbidity and mortality . honey because of its antiseptic and antibacterial properties can thus be a useful dressing material in such regions . in the presence of infection the situation becomes worse as the antibiotics are ineffective in this setting , and antiseptics cause tissue damage , further slowing the wound healing . honey on the other hand does not cause tissue damage , and appears to actually promote the healing process , decreasing the average duration of wound healing . patients treated with honey had a significantly lower average duration of wound healing than those who were treated with ssd [ table 3 ] . a similar type of result was found in the previous study done by subrahmanyam . in the present study , among patients in the honey group , 100% of patients wounds who reported within those who reported within 28 and 924 h and more than 48 h of burn ( 62.5% , 50% , and 50% , respectively ) had got their wounds sterile within 7 days [ table 4 ] . honey also has a positive effect in reducing the oxidative stressful state in burn trauma that results in rapid wound healing . on the other hand , although there is evidence of the antibacterial effect , there is no direct evidence of improved wound healing or reduced infection by ssd dressings in burn patients . subrahmanyam noted sustained inflammatory reaction even on epithelialization in ssd - treated burn wounds , but the early subsidence of acute inflammatory changes , better control of infection , and quicker wound healing were seen in those treated with honey . from the present study , it is clear that the increase in the time elapsed after burn trauma and admission to the hospital has adverse effects on wound healing and complications at follow - up . ssd dressings have been found to be lesser effective in counteracting this when compared to honey . subrahmanyam found better relief of pain and lower incidence of hypertrophic scars and postburn contractures with the honey dressing that , along with its low cost and easy availability , make it an ideal dressing in the treatment of burns . the delay in hospital admission increases the wound infection , wound contamination , and time in wound sterilization and healing , and has a detrimental effect on the final outcome . honey dressings improve wound healing , make wound sterile in lesser duration , and have better outcomes in terms of incidence of hypertrophic scars and postburn contractures when compared to ssd dressings .
objective : the aim was to evaluate the effect of honey dressing and silver sulfadiazene ( ssd ) dressing on wound healing in burn patients.materials and methods : we retrospectively reviewed the records of 108 patients ( 1468 years of age ) , with first and second degree burns of less than 50% of the total body surface area admitted to our institution , over a period of 5 years ( 20042008 ) . 
 fifty - one patients were treated with honey dressings and 57 with ssd . 
 time elapsed since burn , site , percentage , degree and depth of burns , results of culture sensitivity at various time intervals , duration of healing , formation of post - treatment hypertrophic scar , and/or contracture were recorded and analyzed.results:the average duration of healing was 18.16 and 32.68 days for the honey and ssd group , respectively . 
 wounds of all patients reporting within 1 h of burns became sterile with the honey dressing in less than 7 days while there was none with ssd . 
 all wounds treated with honey became sterile within 21 days while for ssd - treated wounds , this figure was 36.5% . 
 a complete outcome was seen in 81% of all patients in the  honey group  while in only 37% patients in the 
 ssd group.conclusion:honey dressings make the wounds sterile in less time , enhance healing , and have a better outcome in terms of hypertropic scars and postburn contractures , as compared to ssd dressings .