A randomised controlled trial of raw honey for the healing of ulcers in leprosy in Nigeria

Introduction Chronic neuropathic ulcers remain a debilitating complication of leprosy, with limited evidence for effective treatments. Honey has been recommended to promote wound healing in other chronic ulcers. However, its efficacy in leprosy-related ulcers has not been rigorously evaluated. Methods This dual-centre, prospective, single-blinded, randomised controlled trial compared raw honey dressings (n=65) versus standard saline dressings (n=65) for leprosy-associated foot ulcers in Nigeria. Participants with ulcers (2-20 cm2, ≥6 weeks duration) were randomised 1:1, stratified by ulcer size. Primary outcomes were complete healing by 84 days and healing rate, assessed through blinded digital planimetry. Secondary outcomes included ulcer recurrence and/or new ulcer development at 6 months. A total of 130 participants were randomised in the study. Results Complete healing occurred in 29.2% of honey-treated ulcers versus 24.6% with saline (adjusted HR 1.26, 95% CI 0.64-2.47). At 6 months, recurrence rates were similar (honey 13.5% vs saline 10.2%). The honey group showed a non-significant trend toward faster healing (p=0.076). No treatment-related adverse events occurred. Conclusion While honey dressings showed a modest advantage in healing rate, the difference was not statistically significant. The results suggest honey may be a safe, culturally acceptable option in resource-limited settings, but larger trials are needed to confirm efficacy. This study provides crucial baseline data for future research on alternative therapies for leprosy ulcers.