Topical application of natural

honey, beeswax and olive oil

mixture for atopic dermatitis
or psoriasis: partially
controlled, single-blinded
study
Noori S. Al-Waili
Dubai Specialized Medical Center and Medical Research Laboratories,
Islamic Establishment for Education, Dubai, United Arab Emirates

SUMMARY. Objectives: To investigate the effects of honey, olive oil and beeswax
mixture on patients with atopic dermatitis (AD) or psoriasis vulgaris (PV). Materials and
methods: Twenty-one patients with dermatitis and 18 patients with psoriasis were
entered for patient-blinded, partially controlled study; 11 patients with dermatitis used
topical betamethasone esters and 10 patients with psoriasis used clobetasol propionate.
Honey mixture contained honey, beeswax and olive oil (1:1:1). Mixtures A, B, and C
contained honey mixture with the corticosteroids ointment in a ratio of 1:1, 2:1, and 3:1
respectively. Patients with dermatitis were subjected to controlled bilateral half-body
comparison to evaluate the efcacy of honey mixture against Vaseline, or mixture A
against Vaselinebetamethasone esters mixture (1:1) in patients using topical
corticosteroid treatment. In patients with psoriasis, the effect of honey mixture was
compared with parafn in an individual right/left-sites comparison, or mixture A against
parafnclobetasol propionate mixture (1:1) in patients using corticosteroid topical
therapy. In dermatitis, body lesions on right or left half-body were assessed for
erythema, scaling, lichenication, excoriation, indurations, oozing and itching on a 04
points scale. In psoriasis, lesions of selected site were assessed for redness, scaling,
thickening and itching, on a 04 points scale. Results: In honey mixture group, 8/10
patients with dermatitis showed signicant improvement after 2 weeks, and 5/11
patients pretreated with betamethasone esters showed no deterioration upon 75%
reduction of corticosteroid doses with use of mixture C. In psoriasis, 5/8 patients showed
a signicant response to honey mixture. In patients using clobetasol propionate, 5/10
patients showed no deterioration upon 75% reduction of corticosteroid doses with use of
mixture C. Conclusion: Honey mixture appears useful in the management of dermatitis
and psoriasis vulgaris.
2003 Elsevier Ltd. All rights reserved.
Noori S. Al-Waili, Dubai
Specialized Medical Center
and Medical Research
Laboratories, Islamic
Establishment for Education,
P.O. Box 19099, Dubai,
United Arab Emirates.
Fax: +971-4-2646025;
E-mail: noori1966@
yahoo.com

INTRODUCTION
Psoriasis and atopic dermatitis (AD) represent challenging problems regarding their management and
incidence. Atopic dermatitis is the most common

Complementary Therapies in Medicine (2003), 11, 226234

doi:10.1016/S0965-2299(03)00120-1

2003 Elsevier Ltd. All rights reserved.

inammatory skin disease in childhood,1 with a

1015% incidence. Moderate to severe AD can
have a profound effect on the quality of life. Treatments include Vaseline, corticosteroids, cetirizine,
antibacterial drugs and phototherapy, and there is

226

Topical application of natural honey, beeswax and olive oil mixture for atopic dermatitis or psoriasis

evidence to support the use of oral cyclosporin, topical steroids, psychological approach and ultraviolet
light therapy.2
Psoriasis vulgaris (PV) is one of the commonest skin problems seen by general practitioners,
affecting 12% of the population.3 Psoriasis is
a chronic inammatory and proliferative disorder
of skin that results in a rapid turnover of the
skin cells that move rapidly up to the surface
in 35 days. This leads to thickening of the supercial layers. Psoriasis is characterized by red,
elevated plaques that are overlaid with thick silvery white scale. Plaque psoriasis is known as
chronic stable plaque psoriasis or psoriasis vulgaris.
For PV involving less than 20% of body surface
area, initial treatment is topical including emollients (parafn), keratolytics (salicylic acid), coal
tar, zinc, retinoids, dithranol, betamethazone and
calcipotriene. Adverse effects include skin irritation,
salicylate intoxication, unpleasant odor, staining of
clothes, thinning of skin, steroid striae, telangiectasia, potential carcinogenic risk and tachyphylaxis
with repeated use of steroids. Other treatments such
as phototherapy and systemic therapy (methotrexate, cyclosporine, acitretine) are associated with
toxicity.
Natural remedies seem promising in the management of a wide range of dermatological diseases
including PV and AD. Large number of patients with
PV reported previous or current use of one or more
form of alternative medicine.4,5 It was estimated that
3569% of patients with dermatological diseases
used complementary/alternative medicine including
herbs, diet, hypnotherapy and natural supplement.6
Intravenous administration of omega oils is safe
and effective in the treatment of chronic psoriasis
vulqaris.7 Topical and oral sh oil can be useful in
the treatment of psoriasis.8,9 Topical application of
Aloe vera was found effective in psoriasis.10 Vitamin B12 cream containing avocado oil has potential
long-term topical therapy of psoriasis.11 Chamomile
preparation proves to be effective in relieving associated signs and symptoms in AD and enhancing
granulation and epithelization without deleterious
side effect.12
Honey is one of the oldest known medicines.
It has been valued highly in the Middle East and
was mentioned in the Quran 1400 years ago. It
has been used for treatment of respiratory diseases,
urinary diseases, gastrointestinal diseases, and skin
diseases including ulcers, wounds, eczema, psoriasis and dandruff.13 Honey reduces inammation,
edema, and exudation, promotes healing, diminishes
scar size, and stimulates tissue regeneration.1416
Olive oil, beeswax and honey are natural materials
that contain favonoids, antioxidants, antibacterial ingredients and effects cytokines production by skin
cells when applied topically.1721 The objective of the
study is to investigate the therapeutic effect of honey
mixture prepared by mixing natural honey, beeswax
and olive oil on the skin lesions in patients with AD

227

or psoriasis who are using either no treatment or

local steroids.

MATERIALS AND METHODS

Honey mixtures
Honey mixture was prepared by thorough mixing of
natural honey, olive oil and beeswax (v/v/v, 1:1:1).
Honey mixture with corticosteroid ointment was prepared in a v/v ratio of 1:1 (Mixture A), a ratio of 2:1
(Mixture B), and in a ratio of 3:1 (Mixture C), using
the corticosteroid (betamethasone esters or clobetasol propionate) which the patient was using prior to
inclusion. Natural unprocessed honey and beeswax
were obtained from Lootah Farm, Al-Theed City,
UAE. Honey was dark yellow in color, multioral
origin, and its composition included fructose 38%,
glucose 28%, acidity 13%, moisture 20%, Vitamin
C 2.3 mg%, copper 0.09 mg%, zinc 0.6%, sucrose
less than 0.5 mg%, pH 3.8, and glutathione reductase 0.5 mg%. Natural olive oil was prepared by cold
press.

Study design
The study was patient-blind partially controlled conducted in two parallel parts among patients referred
to the Dermatology Clinic, Dubai Specialized Medical Center and Medical Research Laboratories. The
study was approved by Human Ethical Committee,
Islamic Establishment for Education. Informed consent was obtained from the patients or their parents
after thorough explanation of the procedure. The
prepared mixtures and Vaseline or parafn were kept
in dark containers at room temperature with special
labeling to maintain patient blinding.

Atopic dermatitis
There were 21 patients with moderate to severe AD
diagnosed according to Hanin-Rajka criteria for
diagnosis of AD.22 The age range was 516 years,
with 4 females and 17 males. Patients suffering
from any other inammatory conditions, undergoing
ultraviolet treatment or taking any other systemic
steroid or immunosuppressive medications prior to
entry were excluded. Patients either had no current
treatment at time of inclusion or were treated exclusively with topical corticosteriods. Patients had
skin lesions on both sides of their body mainly arms
and/or legs. According to their previous treatment
the patients were divided into two groups. Group 1
included 10 patients who had no treatment at time
of inclusion; group 2 included 11 patients who were
under current treatment with topical application of
corticosteriods preparations (betamethasone esters
0.1%) during 36 months prior to time of inclusion.
In group 1, lesions on the right side of the body
were treated with Vaseline and lesions on the left
part of the body were treated with honey mixture.

228

Complementary Therapies in Medicine

Each treatment was applied three times daily with

gentle rubbing and was continued for 2 weeks with
weekly follow-up. If there was no response after 2
weeks with either treatment, other management was
commenced and the treatment recorded as failure.
In case of response to honey mixture but not to
Vaseline, Vaseline was replaced by honey mixture.
In group 2, skin lesions on the right side were treated
with mixture containing betamethasone esters 0.1%
and Vaseline (v/v, 1:1), while lesions on the left side
were treated with mixture A. In case of response to
mixture of Vaseline and betamethasone esters 0.1%
after 2 weeks, this treatment was continued and the
patients were dropped out from further comparison.
When there was no response to betamethasone esters 0.1%-Vaseline mixture after 2 weeks, a crossover
trial with use of mixture A was started. In patients
who responded to mixture A after 2 weeks, mixture
B was used for next 2 weeks, and, provided there
was a response, this was followed by mixture C for
2 weeks.
At each visit, the body lesions were assessed
separately by the author for signs including erythema, scaling, lichenication, excoriation, induration/papulation, oozing/crusting, and for the reported intensity of pruritis. The severity of each
sign and symptom was assigned a score of 04;
none = 0, mild = 1, moderate = 2, severe = 3, and
very severe = 4. This simple scoring system was
adapted from several others.2325 The scores of the
lesions at each site were summed and the mean was
calculated before and during therapy.

crossover trial with use of honey mixture instead of

parafn was carried out.
In group 2, the lesions on the left side of body
were treated with mixture A and on the right side
of body the lesions were treated with mixture of
parafn and clobetasol propionate 0.05% (v/v, 1:1).
In patients who responded to mixture A but not
to steroid mixture, the steroid mixture used on the
right side was replaced by mixture A. When there
was response to mixture A, this was replaced with
mixture B at end of third week, which in turn was
replaced, in the case of a response, with mixture C at
end of sixth week. After 3 weeks of using mixture C,
the responders to mixture C were treated with honey
mixture instead of mixture C for next 12 weeks;
cases of relapse upon complete withdrawal of clobetasol application with use of honey mixture were
recorded. Subsequently, mixtures A, B and C were
used to allow gradual reduction of corticosteroid
doses without relapse.
The patients were assessed on inclusion and
weekly during whole study period. Target lesions
were assessed for redness, scaling, thickening, and
itching; each on a 04 scale (none = 0, mild = 1,
moderate = 2, severe = 3, and very severe = 4).
The severity of lesions and efcacy of therapy
were evaluated by the investigator on each visit,
using the above simple scoring system adapted from
others.26,27 The scores of the lesions at each site
were summed and the mean was calculated before
and during therapy.

Statistical analysis
Psoriasis vulgaris
This part of the study included 18 patients aged 20
years or older (mean 32 years, range 2060), 14
males and 4 females, with plaque psoriasis. Skin
lesions were symmetrical, bilateral and involving at
least 10% of the body surface. Patients on systemic
treatment including steroids, etretinate, methotrexate, psoralen, and ultraviolet-PUVA were excluded.
According to their current treatment, the patients
were divided into two groups. Group 1 included
eight patients on no current treatment and group
2 included 10 patients using topical application of
corticosteriod preparations (Clobetasol propionate
0.05%) for last 36 months prior to their inclusion.
Pairs of comparable areas were selected, on right
and left sides of the body. The site of lesions which
was selected for study was 812 cm, including 23
plaques. In group 1, lesions on the right side were
treated with parafn and lesions on the left side were
treated with honey mixture. Both treatments were
applied three times daily with gentle rubbing. Treatment continued for 3 weeks with weekly follow-up. If
there was no response with any of the treatments during 3 weeks, the lesions would be treated by other
means and failure of the treatment was recorded. In
case of response, treatment was continued for further
3 weeks. When there was no response to parafn,

Mean and standard deviation was used to express

score of signs and symptoms of the lesions. ANOVA
was used to compare means of scores before treatment and at each time intervals after the treatment.
Students t-test was used to compare between means
of scores of lesions on the left and right part of the
body at same time and treatment. Clinical response
was monitored using these scores, and a response
in patients using steroids before inclusion was taken
to mean reduction of dose of corticosteroids without
deterioration in the clinical signs and symptoms and
increase in symptom score.

RESULTS
All the patients with AD or PV completed the trial.
The mixtures rubbed in well and did not leave the
skin oily or irritated. Honey mixtures were excellently tolerated and no side effects were reported in
patients with AD or PV.
Table 1 illustrates the degree and extent of AD
in individual patients and records the individual
responses. Table 2 shows the mean score of AD
lesions on the right and left parts of body and their
responses to honey mixture or Vaseline. In honey
mixture group, signicant improvement in signs and

Topical application of natural honey, beeswax and olive oil mixture for atopic dermatitis or psoriasis

229

Table 1 Severity scores for atopic dermatitis (AD) and psoriasis vulgaris (PV) lesions before
and after the different therapies (see text for details of scoring)
Number of
patients

Side of lesions
Right side

Patients
with
AD
1
2
3
4
5
6
7
8
9
10
Patients
with
PV
1
2
3
4
5
6
7
8

Left side

Total score
before
treatment

Total score
after Vaseline
treatment

Total score
before
treatment

Total score
after honey
mixture

17
18
22
15
15
17
22
14
15
14

7
14
15
15
12
18
19
6
14
21

16
18
20
14
14
18
22
14
14
21

6
6
4
3
2
3
4
6
16
17

Total score
before
treatment

Total score
after
parafn

Total score
before
treatment

Total score
after honey
mixture

11
10
11
13
7
9
13
10

10
9
10
11
3
8
10
8

11
12
10
11
13
14
8
8

10
11
10
2
4
2
2
3

symptoms of the lesions was obtained in eight out

of 10 patients during rst week of the treatment.
The earliest and most profound improvement was
obtained in pruritis, scaling and oozing. Improvement continued over time, with the lowest mean
score at end of the fourth week. Two patients showed
no response to honey mixture and were excluded
from further comparison. On the right side of body,
two patients responded well with Vaseline treatment;
they continued using Vaseline treatment and dropped
out from further comparison.

Eight patients showed no improvement with use

of Vaseline and were given honey mixture; two of
them showed no response with use of honey mixture
on the right side of their body too. The remaining six
patients all showed signicant improvement during
the rst week of the treatment. In case of response
with honey mixture, the treatment was discontinued
after 4 weeks; relapse occurred within 46 weeks
for lesions on left side (in four out of eight patients) and lesions on right side (in three out of six
patients).

Table 2 Effect of honey mixture or Vaseline topical application on AD skin lesions on

right and left side-body of the patients who had no current treatment at time of admission
Time

0 (Baseline)

Scores (mean S.D.)

Lesions on right half-body

Lesions on left half-body

16.9 2.9

17.1 3.1

Vaseline (10)a

Honey mixture (10)

15.4 3.6
14 4.8

11.2 4.2*
6.7 5.3,*

Honey mixture (6)

Honey mixture (8)

Between groups
P value
0.876

Treatment

Week 1
Week 2

Week 3
Week 4
F value
Total d.f.
P value
a

9.3 4.5
4.8 5.07

3.1 1.4
1.75 0.4

9.652
41
<0.0001

55.7
45
<0.0001

Number of patients right or left halves-body.

P < 0.05 as compared to baseline mean score on the same half-body.
* P < 0.05 as compared to mean score of lesions on the right halves-body.

0.022
0.0129

230

Complementary Therapies in Medicine

Table 3 Effects of mixtures A, B, and C and mixtures of steroids and Vaseline on
AD scores in the right and left halves of the body in patients using steroids
Scores (mean S.D.)

Time

Lesions on right half-body

0 (Baseline)

6.3 2.01

P value

Lesions on left half-body

6.5 1.6

0.690

Treatment

Week 1
Week 2

Week 3
Week 4

Week 5
Week 6
F value
Total d.f.
P value
a

Steroids and Vaseline (11)a

Mixture A (11)

12.4
12.1 5.4

12.3 2.6
8.5 2.6

Mixture A (7)

Mixture B (8)

11.6
8.4 1.7

10.75 1.8
7.87 2.1

Mixture B (6)

Mixture C (6)

4.7

1.5

11.6 1.5
7.5 1.2

9 1.09
6.66 1.5

4.98
58
0.0004

9.763
60
<0.0001

1.000
0.1256

Number of patients right or left halves-body.

P < 0.05 in comparison to Vaseline in the same half of the body.

In patients with AD using topical corticosteroid

therapy prior to their inclusion, signicant elevation
of mean score of the signs and symptoms of the
lesions on the left side of body during rst week
was obtained following treatment with mixture A.
Scores reduced to become not signicantly different
from baseline score during the second week of the
treatment in eight out of 11 left halves of bodies
(Table 3). Similar results were obtained with mixture B (response was obtained in six out of eight
halves-body) and mixture C (response was obtained
in ve out of six left halves of patients bodies).
On the right half of the patients bodies, there was
no response to betmethasone estersVaseline mixture (1:1) in 7/11 patients during rst 2 weeks of
treatment. Upon treatment with mixture A, 6/7 right
body-halves showed a response and after 2 weeks
they were treated with mixture B; ve out of six
patients showed response. After further 2 weeks,
mixture C replaced mixture B; four out ve showed
response. The mean scores reduced toward baseline
values with mixtures A, B and C in spite of reduction
of corticosteroid doses. The response was obtained
in 8/11 left halves of patients bodies upon 50%
reduction of steroid doses with use of mixture A, 6/8
upon 66% reduction in corticosteroid doses with use
of mixture B, and 5/6 upon 75% reduction of topical
corticosteroid doses with use of mixture C. After 6
weeks, replacement of mixture C by honey mixture
(complete withdrawal of corticosteroid treatment)
caused deterioration of signs and symptoms of patients with AD who had been treated with clobetasol
prior to their inclusion; in lesions of four out of ve
left halves of patients bodies and in three out of
four right halves of patients bodies.
Table 4 demonstrates the degree and extent of
PV at baseline and relates this to the individual

response. Five out of eight psoriatic patients who had

no treatment at time of inclusion showed signicant
response on their left sides during second to third
weeks of treatment by honey mixture (Table 5).
The effect of honey mixture was time related; the
greatest effect was obtained at end of the sixth week
of treatment. On the right side of body, parafn
caused insignicant response in 7/8 patients, three
of whom showed no response to honey mixture on
their left side. The remaining four patients received
honey mixture instead of parafn; two of them
showed signicant improvement. Discontinuation of
treatment with honey mixture after 6 weeks caused
relapse of psoriatic lesions in the left side of body
(3/5) and on the right side of body (3/4).
In psoriatic patients using topical clobetasol propionate therapy, no signicant deterioration in the
score occurred in 7/10 patients using mixture A on
the left side during 13 weeks of treatment (Table 6).
A similar result was obtained in 6/7 left sides treated
with mixture B and 5/6 with mixture C. With use
of mixture consisting of clobetasol propionate plus
parafn (1:1), lesions on 8/10 right part of bodies
showed signicant deterioration in the signs and
symptoms of psoriatic lesions during 13 weeks of
treatment. Six patients used mixture A instead of
mixture of parafn and clobetasol propionate on the
right side, ve of whom showed a response during
3 weeks of treatment. Similar results were obtained
in 4/5 right sides treated by mixture B, and 3/4 right
sides treated with mixture C (Table 7). Replacement
of mixture C by honey mixture (complete withdrawal
of clobetasol) caused relapse of lesions in 2/3 right
sides and in 3/4 left sides during the following 8
weeks. Only one patient out of 10 showed no relapse
of psoriatic lesions on the right and left side of
his body after replacement of mixture C by honey

Topical application of natural honey, beeswax and olive oil mixture for atopic dermatitis or psoriasis

231

Table 4 Severity of AD and PV lesions in patients treated with topical application of corticosteroid
prior to their inclusion
Number of
patients

Side of lesions
Right side

Patients
with
AD

Total score
before
treatment

Total score
after betamethasone
and Vaseline

Total score
before
treatment

Total score
after
mixture A

Total score
after
mixture B

Total score
after
mixture C

8
10
8
8
6
4
6
4
5
7
4

12
13
19
21
17
14
13
8
6
7
5

6
7
7
6
7
4
7
6
4
5
7

8
9
8
8
7
4
7
6
11
12
13

8
8
7
8
7
4
10
11

6
11
7
7
6
4

Total score
before
treatment

Total score
after clobetasol
parafn

Total score
before
treatment

Total score
after
mixture A

Total score
after
mixture B

Total score
after
mixture C

4
4
5
4
3
4
7
7
7
7

10
9
9
10
4
4
11
12
12
12

5
4
6
4
3
4
6
7
6
7

5
5
4
3
4
3
6
12
11
12

5
5
3
4
4
4
12

6
4
4
3
5
10

1
2
3
4
5
6
7
8
9
10
11
Patients
with
PV

Left side

1
2
3
4
5
6
7
8
9
10

Table 5 Effects of parafn or honey mixture on psoriatic lesions on right and left part of body in
patients who had no current treatment at time of inclusion
Scores (mean S.D.)

Time

0 (Baseline)

Lesions on right side of body

Lesions on left side of body

10.88 1.9

10.8 2.16

Parafn (8)a

Honey mixture (8)

Between groups
P value
1.000

Treatment

Week 1
Week 2
Week 3

10.38 2.26
9.37 2.26
8.6 2.5
Honey mixture (4)

Week 4
Week 5
Week 6
F value
Total d.f.
P value
a

7.7 3.3
6.2 3.8
5.7 3.3
3.026
43
0.0153

8.75 3.65
6.87 4.12
5.5 4.07

0.3214
0.163
0.0821

Honey mixture (5)

2.4 0.89
2 0.7
1.8 0.4
8.917
46
<0.0001

Number of patients right or left side-body with psoriatic lesions.

P<0.05 as compared to baseline mean score on the same part of body.

mixture, viz. honey mixture could replace clobetasol

treatment in 1/10 patients with psoriasis after gradual
reduction of clobetasol doses with use of mixtures
A, B and C.

DISCUSSION
Results showed that topical application of honey
mixture containing natural honey, beeswax and olive

oil was associated with signicant improvement of

signs and symptoms of AD in 80% of patients who
had no treatment at time of inclusion. In patients who
were under current corticosteroid therapy at time of
their inclusion, honey mixture enabled them to reduce the dose of corticosteroid without deterioration
in the condition. Regarding PV, there were marked
improvements in 50% of patients with honey, and
a great reduction in dose of corticosteroid in those
who were under corticosteroid therapy. This study

232

Complementary Therapies in Medicine

Table 6 Effects of mixtures A, B, and C and steroid plus parafn mixture on psoriatic scores in
patients using topical steroids preparation
Scores (mean S.D.)

Time

Lesions on right side

of body
0 (Baseline)

5.4 1.7

Lesions on left side

of body
5.2 1.3

Between groups
P value

0.3434

Treatment
Steroids plus parafn (10)a
Week 1
Week 2
Week 3

10
10.4 1.3
9.4 1.8
Mixture A (6)

Week 4
Week 5
Week 6

7.8 1.12
5.7 2.3
4.5 2.3

Week 7
Week 8
Week 9

8.8 1.6
6.2 2.6
6 2.8

0.0751
0.0235
0.082

Mixture B (7)
6.4 2.8
5.8 2.5
5.2 3.0

Mixture B (5)

F value
Total d.f.
P value

Mixture A (10)
7.8 3.7
7.1 3.7,*
6.7 3.5

Mixture C (6)
72
5.8 1.6
4.5 1.04

9.561
72
<0.0001

1.017
78
0.0222

Number of right or left side of body with psoriatic lesions subjected for treatment.
P < 0.05 as compared to baseline mean score on the same part of body.
* P < 0.05 as compared to mean score of lesions on the right side of body.

is the rst to report therapeutic effects of honey

mixture on patients with AD and psoriasis.
Many scoring system are available for AD or
psoriasis, but none has been uniformly accepted
and none allows quick and reliable assessment of
patients in busy clinic.2427 We therefore devised a
simple scoring system for estimating local signs and
symptoms, but not extension of the lesions since we
used local application. Lichenication and drying
were the most difcult feature to assess because they
respond slowly to treatment. The most pronounced
changes with use of honey mixture we found for
itching, erythema, scaling and oozing.
The pathogenic aspects of AD include imbalanced T-helper 1/T-helper 2 response, altered prosta-

glandin metabolism, defect in keratinocyte function,

delayed eosinophil apoptosis and IgE-mediated facilitated antigen presentation by epidermal dendritic
cell.34 Current treatment is directed to the reduction of cutaneous inammation and infection and to
the elimination of exacerbating agents. It is shown
that elevated concentrations of prostaglandin and
Leukotriene B4 are important in skin lesion of AD.28
Moreover, increased oxidative stress is important in
the pathophysiology of AD.29 .
Olive oil is a source of at least 30 phenolic
compounds such as hydroxytyrosol and oleuropein
which have bactericidal activity.30 Phenolic acid in
olive oil has protective effect against cytotoxic effect of reactive oxygen species.31 Olive oil inhibits

Table 7 Number of right or left halves of body with AD or PV lesions, which showed signicant
response to treatment
Types of treatment
in the study

Groups of patients
No active treatment at
time of inclusion

Right part-body

Left part-body

Mixture A

6/7 (AD)
5/6 (PV)

8/11 (AD)
7/10 (PV)

Mixture B

5/6 (AD)
4/5 (PV)

6/8 (AD)
6/7 (PV)

Mixture C

4/5 (AD)
3/4 (PV)

5/6 (AD)
5/6 (PV)

Honey mixture

Vaseline
Vaseline corticosteroid mixture
Parafn
Parafn corticosteroid mixture

Right part-body

Left part-body

5/6 (AD)
2/4 (PV)

8/10 (AD)
5/8 (PV)

Corticosteroid treatment at
time of inclusion

2/10 (AD)
3/11 (AD)
1/8 (PV)
2/10

Topical application of natural honey, beeswax and olive oil mixture for atopic dermatitis or psoriasis

platelet aggregation and prostaglandin.32 Hydroxytyrosol in olive oil inhibited in a dose-related manner
the production of leukotriene B4.18 Olive oil diet increased nitric oxide and decreased arachidonic acid
production.19 Olive oil appeared to be protective
against cutaneous actinic damage.33
A natural mixture of high molecular weight alcohol (D-002) isolated and puried from beeswax,
produces a signicant reduction of exudate volume in
carrageenan-induced pleuritic inammation.34 D-002
reduced leukotriene B4 and thromboxane B2 and diminished granuloma weight.20 In a mixture with a
boric acid and zinc oxide ointment, beeswax has been
used on patients with chronic eczema and psoriasis
with improvement.35 Beeswax was used as ointment
for skin burn care.21
Honey reduces pain, oedema, exudates and scar
formation.36 Honey seems to accelerate wound healing as measured by the thickness of granulation
tissue, epithelialisation from the periphery of the
wound and the size of the open wound.37 Pure honey
inhibited fungal growth and diluted honey appears
capable of inhibiting toxin production.38
In an earlier study, we found that conjunctival
application of honey could eradicate acute bacterial conjunctivitis due to Staphylococcus aureus.39
In comparison with antibiotics, honey eradicated
bacterial conjunctivitis in rats due to Pseudomonas
aerogenosae as effectively as antibiotics.40 . In vitro
studies, 3050% of honey in liquid broth inhibited growth of many human pathogenic bacteria including Candida albicans.41 In patients with
postoperative wound infections topical honey application causes faster eradication of bacterial infections, reduces antibiotic used and hospital stay,
accelerates wound healing, and results in minimal scar formation.17 In addition, we have used
honey to treat seborrheic dermatitis and dandruff.42
More recently, we have found that honey lowers
plasma concentrations of prostaglandin E2, prostagalndin F2 alpha and thromboxane B2 in healthy
subjects.43
The mechanism of action of honey has not been
denitely known though acidity, osmolality, and hydrogen peroxide production have been proposed as
an important factors.16 Recently we found that honey
increased nitric oxide in saliva taken from normal
individuals.44 In addition, it was found that various
honeys contained different amount of nitric oxide
metabolites and intravenous honey could increase
urinary nitrite excretion in the animals.45 Flavonoids,
rich in olive oil and honey, have potent antioxidant,
cytoprotective and anti-inammatory activities and
inhibited histamine, IL 6 and IL 8.46 Nitric oxide
reduced incidence of skin infection in psoriasis.47
Nitric oxide donors signicantly reduced the number of CD14 and CD3 cells inltrating the epidermis
in psoriatic skin.48 We and others have shown that
non-steroidal anti-inammatory drugs may be an
important therapy in the treatment of acne, psoriasis,
urticaria and others.49,50

233

The mechanism of therapeutic effects of honey

mixture on AD or psoriastic skin lesions might be
attributed to reduction in the prostaglandin synthesis
at site of application, elevation of nitric oxide in
the lesions, inhibition of fungal or bacterial growth,
inhibition of leukotriene B4, and to its antioxidant
and anti-inammatory activities. Further studies are
needed to substantiate the results of this study. In
spite of considerable limitation of the present study
including small number of participants, short duration of follow-up, simple method of scoring, and single blinding, the results obtained provide evidence
to justify proceeding to a denitive randomized
trial.

ACKNOWLEDGEMENTS
The author would like to thanks Haj Saeed Lootah,
Chairman of trustee, Dubai College of Medicine and Islamic
Establishment for Education for his kind support. Prof
Najeem Al-deen, Chairman, Lootah University, and Mr.
Amjed Ali, Miss Jaya David and Anni Koshi, nursing staff,
provided assistant.

REFERENCES
1. Schultz-Larsen F, Hanin J. Secular changes in the
occurrence of atopic dermatitis. Acta Derm Venereol
1992; 176: 712.
2. Hoare C, Li Wan Po A, Willaims H. Systematic review
of treatment for atopic eczema. Health Technol Assess
2000; 4: 1191.
3. Greaves M, Weinstein G. Treatment of psoriasis. N Engl
J Med 1995; 332: 581588.
4. Fleischer A, Feldman S, Rapp S. Alternative therapies
commonly used within a population of patients with
psoriasis. Cutis 1996; 58: 216220.
5. Jensen P. Alternative medicine and chronic skin
diseases. Use of alternative treatments among patients
with atopic eczema and psoriasis. Tidssk Nor
Laegeforen 1990; 110: 28692872.
6. Ernst E, Pittler M, Stevinson C. Complementary/
alternative medicine in dermatology: evidence-assessed
efcacy of two diseases and two treatments.
Dermatology 2000; 201: 191195.
7. Mayser P. Omega-3 fatty acid-based lipid infusion in
patients with chronic plaque psoriasis: results of a
double-blind, randomized, placebo-controlled,
multicenter trial. J Am Acad Dermatol 1998; 38:
539547.
8. Escober S. Topical sh oil in psoriasis: a controlled and
blind study. Clin Exp Dermatol 1992; 17: 159162.
9. Bittiner S. A double-blind, randomized,
placebo-controlled trial of sh oil in psoriasis. Lancet
1988; 20: 378380.
10. Vogler B, Ernst E. Aloe vera: a systematic review of its
clinical effectiveness. Br J Gen Pract 1999; 49:
823828.
11. Stucker M, Memmel U, Hoffmann M, Hartung J,
Altmeyer P. Vitamin B 12 cream containing avocado oil
in the therapy of plaque psoriasis. Dermatology 2001;
203: 141147.
12. Ross S. An integrative approach to eczema (atopic
dermatitis). Holist Nurs Pract 2003; 17: 5662.
13. Zaghloul A, El-Shattawy H, Kassem A. Honey, a
prospective antibiotic: extraction, formulation, and
stability. Pharmazie 2001; 56: 643647.

234

Complementary Therapies in Medicine

14. Molan P. The role of honey in the management of

wounds. J Wound Care 1999; 8: 415418.
15. Molan P. Why honey is effective as a medicine. 1. Its
use in modern medicine. Bee World 1999; 80: 8092.
16. Al-Waili N, Saloom K. Honey to treat post-operative
wound infections due to gram positive and gram
negative bacteria following caesarian section and
hysterectomies. Eur J Med Res 1999; 4: 126141.
17. Tuck K, Hayball P. Major phenolic compounds in olive
oil. J Nutr Biochem 2002; 13: 636644.
18. Petroni A, Blasevich M, Papini N. Inhibition of
leukocytes leukotriene B4 production by an olive
oil-dervied phenol indetied by mass-spectrometry.
Throm Res 1997; 87: 315322.
19. Moreno J, Carbonell T, Sanchez T. Olive oil decrease
both oxidative stress and the production of arachidonic
acid metabolites by the prostaglandin G/H synthase
pathway. J Nutr 2001; 13: 21452149.
20. Noa M, Mas R. Effect of D-002 on the pre-ulcerative
phase of carrageenan-induced colonic ulceration in the
guinea pig. J Pharma Pharmacol 1998; 50: 549553.
21. Zanoschi C, Ciobanu C, Verbuta A. The efciency of
some natural drugs in the treatment of burn. Rev Med
Chir Soc Med Nat Lsai 1991; 95: 6365.
22. Hanin J, Rajka G. Diagnostic feature of atopic
dermatitis. Acta Derm Venerol 1980; 92: 4447.
23. Maloney J, Morman M, Stewart D, Tharp M. Clobetasol
prpionate emollient 0.05% in the treatemtn of atopic
dermatitis. Int J Dermatol 1998; 37: 142144.
24. Bahmer F. Quantication of extent and severity of atopic
dermatitis: the ADASI score. Arch Dermatol 1991; 127:
12391240.
25. Stalder F, Atherton D. Consensus report of the European
Task Force on atopic dermatitis: severity scoring of
atopic dermatitis, the SCORAD index. Dermatology
1993; 186: 2331.
26. Kibby B, Fortune D, Bhushan M, Chalmers R. The
Salford psoriasis index: an holistic measure of psoriasis
severity. Br J Dermatol 2000; 142: 728732.
27. van de Kerkhof M. The psoriasis area and severity index
and alternative approaches for the assessment of
severity: persisting areas of confusion. Br J Dermatol
1997; 137: 661663.
28. Raskovic S, Bogic M, Peric-Popadic A, Arandjeloveic S.
The role of prostaglandins in allergic inammation. Srp
Arh Celok Lek 1998; 126: 388393.
29. Omata N, Tsukahara H, Ito S. Increased oxidative stress
in childhood atopic dermatitis. Life Sci 2001; 69:
223228.
30. Sudina F, Mirzoeva K, Pushkareva A, Korshunova K.
Caffeic acid phenethyl ester as a lipoxygenase inhibitor
with antioxidant properties. FEBS Lett 1993; 329:
2124.
31. Manna C, Angelo S, Migliard V. Protective effect of the
phenolic fraction from virgin olive oil against oxidative
stress in human cells. J Agric Food Chem 2002; 50:
65216526.
32. Petroni A, Blasevich M, Salami M, Papini N. Inhibition
of platelet aggregation and eicosanoid production by

33.
34.
35.

36.
37.

38.

39.
40.

41.
42.
43.
44.
45.
46.

47.

48.
49.
50.

phenolic components of olive oil. Thromb Res 1995;

78: 15111560.
Purba M, Kouris-Blazos A. Skin wrinkling: can food
make a difference? J Am Coll Nutr 2001; 20: 7180.
Carbajal D, Molina V, Valdes S, Arruzazbala L, Mas R.
Anti-ulcer activity of higher primary alcohols of
beeswax. J Pharm Pharmacol 1995; 47: 731733.
Kubota K, Kumakiri M, Miura Y, Hine K. Clinical
studies on zinc oxide ointment replacing boric acid and
zinc oxide ointment. Hokkaido Igaku Zasshi 1983; 58:
400405.
Molan P. Re-introducing honey in the management of
wounds and ulcer-theory and practice. Ostomy Wound
Manage 2002; 48: 2840.
Bergman A, Yanai J, Weiss J, Bell D, David P.
Acceleration of wound healing by topical application of
honey. An animal model. Am J Surg 1983; 145:
374376.
Wellford E, Eadie T, Liewellyn C. Evaluation the
inhibitory action of honey on fungal growth, sporulation
and aatoxin production. Z Lebensm Uters Forsch
1994; 166: 280283.
Al-Waili N, Jafari S, Ali A. Effects of natural honey on
acute bacterial conjunctivitis due to staphylococcus
aureus. FASEB J 2001; 15: A561.
Al-Waili N, Jafari S. Effects of honey and cloves extract
on bacterial conjunctivitis due to Pseudomonas
aerogenosae: compared with antibiotics. FASEB J
2001; 15: A586.
Al-Waili N, Al-Alak J, Haq A, Shabani M, Akmal M.
Effects of honey on gram positive and gram negative
bacterial growth in vitro. FASEB J 2001; 15: A586.
AL-Waili N. Therapeutic and prophylactic effects of
crude honey on chronic seborrheic dermatitis and
dandruff. Eur J Med Res 2001; 6: 306308.
AL-Waili N, Boni N. Natural honey lowers plasma
concentrations of prostaglandin in healthy individuals. J
Med Food 2003; 6: 129133.
Al-Waili N, Boni N. Effects of honey ingestion on nitric
oxide in saliva. FASEB J 2003; 17: A1250.
Al-Waili N. Identication of nitric oxide metabolites in
various honeys and effects of honey on plasma and
urinary nitrite/nitrate concentration. J Med Food 2003.
Theoharides T, Alexandrakis M, Kempuraj D.
Anti-inammatory actions of avonoids and structural
requirements for new design. Int J Immunopath
Pharmacol 2001; 14: 119127.
Weller R, Dykhuizen R, Leifert C, Ormerod A. Nitric
oixde release accounts for the reduced incidence of
cutaneous infections in psoriasis. J Am Acad Dermatol
1997; 36: 218282.
Giustizier M, Albanesi C, Scarponi C. Nitric oxide
donors chemokine production by keratinocytes in vitro
and in vivo. Am J Pathol 2002; 161: 14091418.
Friedman E, LaNatra N, Stiller M. NSAIDs in
dermatologic therapy: review and preview. J Cutan Med
Surg 2002; 6: 449459.
Al-Waili N. Two cases of psoriasis and high doses of
indomethacin. Emirates Med J 1987; 5: 6163.

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