GETAT: Yara Tedavisinde Uygulanan Geleneksel Yöntemler: Apiterapi
Özet
Apiterapi, arı ve arı ürünlerinin geleneksel ve tamamlayıcı tıpta hastalıkları önleme ve tedavi amacıyla kullanılmasıdır. Geniş biyolojik özellikleri nedeniyle eski çağlardan beri kullanılan bal, propolis, arı poleni, arı ekmeği, arı sütü, arı zehri ve balmumu gibi ürünler yara tedavisinde aktif rol oynar. Bal, yüksek ozmotik basıncı, asitliği ve hidrojen peroksit içeriğiyle bakterilerin dehidrasyonunu sağlayarak güçlü bir antimikrobiyal etki gösterir; akut, kronik ve yanık yaralarının iyileşmesini hızlandırır. Arı tutkalı olarak da bilinen propolis, antiseptik, antienflamatuvar ve skarizan özellikleriyle doku onarımını ve reepitelizasyonu destekler, dekübit ve diyabetik yaralarda etkilidir. Besleyici bileşenler açısından zengin olan arı poleni ve arı sütü, sitokinleri inhibe ederek enflamasyonu azaltır ve granülasyon sürecini kolaylaştırır. "Apitoksin" olarak adlandırılan arı zehri, melittin içeriği sayesinde bakteri hücre duvarını tahrip eder ve yara boyutunu küçültür. Balmumu ise cilt üzerinde koruyucu bir bariyer oluşturarak antiseptik etki sunar. Apiterapinin konvansiyonel tedavilere göre maliyeti düşüktür ve dirençli patojenlere karşı etkilidir. Ancak nadiren de olsa polen kaynaklı alerjik reaksiyonlar ve steril edilmemiş ballarda botulizm riski gibi yan etkiler görülebilir. Türkiye'de 2014 yılında yürürlüğe giren mevzuatla apiterapi yasal bir boyut kazanmış ve uygulamanın sadece sertifikalı hekimler tarafından yapılması şartı getirilmiştir. Sonuç olarak, modern antibiyotiklere karşı gelişen direnç nedeniyle gelecekte bu kadim tedavi yöntemlerine öncelik verilmesi öngörülmektedir.
Apitherapy is defined as the use of bees and bee products in traditional and complementary medicine for prevention and treatment of various diseases. Utilized since ancient times due to their extensive biological properties, products such as honey, propolis, bee pollen, bee bread, royal jelly, bee venom, and beeswax play an active role in wound management. Honey exhibits a potent antimicrobial effect by causing bacterial dehydration through its high osmotic pressure, acidity, and hydrogen peroxide content, thereby accelerating the healing process of acute, chronic, and burn wounds. Propolis, also known as bee glue, supports tissue repair and reepithelialization through its antiseptic, anti-inflammatory, and cicatrizing properties, proving effective in decubitus and diabetic ulcers. Bee pollen and royal jelly, both rich in nutritional components, reduce inflammation by inhibiting cytokines and facilitate the granulation process. Bee venom, termed apitoxin, destroys bacterial cell walls via its melittin content and reduces wound size. Beeswax provides an antiseptic effect by creating a protective barrier on the skin surface. Apitherapy offers lower costs compared to conventional treatments and remains effective even against resistant hospital pathogens. However, adverse effects such as rare pollen-induced allergic reactions and the risk of botulism from unsterilized honey can occur. Legally regulated in Turkey by a 2014 decree, apitherapy is strictly restricted to certified physicians. Consequently, rising antibiotic resistance will likely necessitate prioritizing these ancient medical treatments in the future.
Referanslar
Balica G, Vostinaru O, Stefanescu C, et al. Potential Role of Propolis in the Prevention and Treatment of Metabolic Diseases. Plants (Basel). 2021;10(5):883. Published 2021 Apr 27. doi:10.3390/plants10050883
Mokhtari S, Sanati I, Abdolahy S, Hosseini Z. Evaluation of the effect of honey on the healing of tooth extraction wounds in 4- to 9-year-old children. Niger J Clin Pract. 2019;22(10):1328-1334. doi:10.4103/njcp.njcp_102_19
Nasir NAM, Halim AS, Singh KKB, Dorai AA, Haneef MNM. Antibacterial properties of tualang honey and its effect in burn wound management: A comparative study. BMC Complement Altern Med. 2010;10. doi:10.1186/1472-6882-10-31
Senel E. Apiterapi ve dermatoloji. Atayoğlu AT, editör. Apiterapi. 1. Baskı. Ankara: Türkiye Klinikleri; 2021. p.220-6.
Silici S. https://www.profdrsibelsilici.com/ (Erişim: Ocak 2022)
Chua AWC, Khoo YC, Tan BK, Tan KC, Foo CL, Chong SJ. Skin tissue engineering advances in severe burns: Review and therapeutic applications. Burn Trauma. 2016;4(1). doi:10.1186/s41038-016-0027-y
Tang Y, Lan X, Liang C, et al. Honey loaded alginate/PVA nanofibrous membrane as potential bioactive wound dressing. Carbohydr Polym. 2019;219:113-120. doi:10.1016/j.carbpol.2019.05.004
Majtán J. Apitherapy - The role of honey in the chronic wound healing process. Epidemiol Mikrobiol Imunol. 2009;58(3):137-140.
Senel E, Demir E. Bibliometric analysis of apitherapy in complementary medicine literature between 1980 and 2016. Complement Ther Clin Pract. 2018;31:47-52. doi:10.1016/j.ctcp.2018.02.003
Kwiecińska-Piróg J, Przekwas J, Majkut M, Skowron K, Gospodarek-Komkowska E. Biofilm formation reducing properties of manuka honey and propolis in proteus mirabilis rods isolated from chronic wounds. Microorganisms. 2020;8(11):1-15. doi:10.3390/microorganisms8111823
Lin Y, Zhang M, Wang L, et al. The in vitro and in vivo wound-healing effects of royal jelly derived from Apis mellifera L. during blossom seasons of Castanea mollissima Bl. and Brassica napus L. in South China exhibited distinct patterns. BMC Complement Med Ther. 2020;20(1). doi:10.1186/s12906-020-03138-5
Dorai AA. Wound care with traditional, complementary and alternative medicine. Indian J Plast Surg. 2012;45(2):418-424. doi:10.4103/0970-0358.101331
Kurek-Górecka A, Górecki M, Rzepecka-Stojko A, Balwierz R, Stojko J. Bee Products in Dermatology and Skin Care. Molecules. 2020a;25(3):556. Published 2020 Jan 28. doi:10.3390/molecules25030556
Malone M & Tsai G. Wound healing with apitherapy: a review of the effects of honey. J Apither 2016; 1: 2-9
Almasaudi S. The antibacterial activities of honey. Saudi J Biol Sci. 2021;28(4):2188-2196. doi:10.1016/j.sjbs.2020.10.017
Dina Jarjis R, Thomas Crewe B, Henrik Matzen S. Post-bariatric abdominoplasty resulting in wound infection and dehiscence-Conservative treatment with medical grade honey: A case report and review of literature. Int J Surg Case Rep. 2016;20:1-3. doi:10.1016/j.ijscr.2015.12.051
Chaudhary A, Bag S, Banerjee P, Chatterjee J. Wound healing efficacy of Jamun honey in diabetic mice model through reepithelialization, collagen deposition and angiogenesis. J Tradit Complement Med. 2019;10(6):529-543. Published 2019 Oct 10. doi:10.1016/j.jtcme.2019.10.002
Topal Hançer A, Yilmaz P. Balın yara iyileşmesi üzerine etkisinin değerlendirilmesi Bozok Tıp Derg 2019;9(1):152-59
Münstedt K, Männle H. Using Bee Products for the Prevention and Treatment of Oral Mucositis Induced by Cancer Treatment. Molecules. 2019;24(17):3023. Published 2019 Aug 21. doi:10.3390/molecules24173023
Cianciosi D, Forbes-Hernandez TY, Alvarez-Suarez JM, Ansary J, Quinzi D, Amici A, et al. Anti-inflammatory activities of Italian Chestnut and Eucalyptus honeys on murine RAW 264.7 macrophages. J Functional Foods. 2021 (87): 104752 https://doi.org/10.1016/j.jff.2021.104752.
Schnitzler P, Neuner A, Nolkemper S, et al. Antiviral activity and mode of action of propolis extracts and selected compounds [published correction appears in Phytother Res. 2010 Apr;24(4):632]. Phytother Res. 2010;24 Suppl 1:S20-S28. doi:10.1002/ptr.2868
Holcová S, Hladiková M. Efficacy and tolerability of propolis special extract GH 2002 as a lip balm against herpes labialis: a randomized, double-blind three-arm dose finding study. Health 2011(3)1:49-55. doi:10.4236/health.2011.31010
Stojko M, Wolny D, Włodarczyk J. Nonwoven releasing propolis as a potential new wound healing method-A Review. Molecules. 2021;26(18):5701. Published 2021 Sep 21. doi:10.3390/molecules26185701
Kubat M, Karabulut Z, Şengül S. Effect of propolis on wound healing in sacrococcygeal pilonidal disease: A randomized controlled clinical trial. Pak J Pharm Sci. 2021;34(3(Supplementary)):1063-1067.
Pahlevanneshan Z, Deypour M, Kefayat A, Rafienia M, Sajkiewicz P, Esmaeely Neisiany R, Enayati MS. Polyurethane-Nanolignin Composite Foam Coated with Propolis as a Platform for Wound Dressing: Synthesis and Characterization. Polymers (Basel). 2021 Sep 20;13(18):3191. doi: 10.3390/polym13183191. PMID: 34578092; PMCID: PMC8473208.
Caner A, Onal MG, Silici S. The effect of bee bread (Perga) with chemotherapy on MDA-MB-231 cells. Mol Biol Rep. 2021;48(3):2299-2306. doi:10.1007/s11033-021-06259-3
Kurek-Górecka A, Komosinska-Vassev K, Rzepecka-Stojko A, Olczyk P. Bee Venom in Wound Healing. Molecules. 2020b;26(1):148. Published 2020 Dec 31. doi:10.3390/molecules26010148
Kang DW, Choi JG, Kim J, Park JB, Lee JH, Kim HW. Bee venom reduces burn-induced pain via the suppression of peripheral and central substance P expression in mice. J Vet Sci. 2021;22(1):e9. doi:10.4142/jvs.2021.22.e9
Marshall C, Queen J, Manjooran J. Honey vs povidone iodine following toenail surgery. Wounds. 2005;1(1):10-18. http://www.epistemonikos.org/documents/941ecb083754d7bc304381eb2ded0c75b89a1093.
Ingle R, Levin J, Polinder K. Wound healing with honey - A randomised controlled trial. South African Med J. 2006;96(9):831-835. doi:10.7196/SAMJ.1258
Mcintosh CD, Thomson CE. Honey dressing versus paraffin tulle gras following toenail surgery. J Wound Care. 2006;15(3):133-136. doi:10.12968/jowc.2006.15.3.26877
Jull AB, Cullum N, Dumville JC, Westby MJ, Deshpande S, Walker N. Honey as a topical treatment for wounds. Cochrane Database Syst Rev. 2015;2015(3). doi:10.1002/14651858.CD005083.pub4
Boekema BKHL, Pool L, Ulrich MMW. The effect of a honey based gel and silver sulphadiazine on bacterial infections of in vitro burn wounds. Burns. 2013;39(4):754-759. doi:10.1016/j.burns.2012.09.008
Tasleem S, Naqvi SBS, Khan SA, Hashmi K. Efficacy of newly formulated ointment containing 20% active antimicrobial honey in treatment of burn wound infections. J Ayub Med Coll Abbottabad. 2013;25(1-2):145-148.
Subrahmanyam M. Honey impregnated gauze versus polyurethane film (OpSiteR) in the treatment of burns - a prospective randomised study. Br J Plast Surg. 1993;46(4):322-323. doi:10.1016/0007-1226(93)90012-Z
Subrahmanyam M. Honey-impregnated gauze versus amniotic membrane in the treatment of burns. Burns. 1994;20(4):331-333. doi:10.1016/0305-4179(94)90061-2
Subrahmanyam M. Honey dressing for burns - an appraisal. Ann Burns Fire Disasters. 1996a.
Subrahmanyam M. Honey dressing versus boiled potato peel in the treatment of burns: A prospective randomized study. Burns. 1996b;22(6):491-493. doi:10.1016/0305-4179(96)00007-1
Mashhood AA, Khan TA, Sami AN. Honey compared with 1% silver sulfadiazine cream in the treatment of superficial and partial thickness burns. J Pakistan Assoc Dermatologists. 2006;16(1):14-19.
Staniczek J, Jastrzębska-Stojko Ż, Stojko R. Biological activity of propolis ointment with the addition of 1% nanosilver in the treatment of experimentally-evoked burn wounds. Polymers (Basel). 2021;13(14). doi:10.3390/polym13142312
Al-Waili NS, Saloom KY. Effects of topical honey on post-operative wound infections due to gram positive and gram negative bacteria following caesarean sections and hysterectomies. Eur J Med Res. 1999;4(3):126-130.
Gethin G, Cowman S. Bacteriological changes in sloughy venous leg ulcers treated with manuka honey or hydrogel: an RCT. J Wound Care. 2008;17(6):241-247. doi:10.12968/jowc.2008.17.6.29583
Zemanova M, Slobodnikova L, Cambal M, Labas P. Excellent antibacterial activity of Slovak honeys on bacteria mostly infecting chronic wounds. Bratislava Med J. 2021;122(7):519-525. doi:10.4149/BLL_2021_084
Yusoff KM; Bekdemir Y, Öztürk F, Akka ZS, Suhaimi A, Ali MRM, Yusoff MYBM. Bal Sargısının Kronik Yaralar Ve Ülserlerin İyileşmesindeki Etkinliği in: Arı Ürünleri ve Sağlık (Apiterapi) Eds: Yücel B, Akçiçek E. Sidas Yayınları 1st ed. 2015
Nilforoushzadeh MA, Jaffary F, Moradi S, Derakhshan R, Haftbaradaran E. Effect of topical honey application along with intralesional injection of glucantime in the treatment of cutaneous leishmaniasis. BMC Complement Altern Med. 2007;7(13). doi:10.1186/1472-6882-7-13
Shukrimi A, Sulaiman AR, Halim AY, Azril A. A comparative study between honey and povidone iodine as dressing solution for Wagner type II diabetic foot ulcers. Med J Malaysia. 2008;63(1):44-46.
Kamaratos A V., Tzirogiannis KN, Iraklianou SA, Panoutsopoulos GI, Kanellos IE, Melidonis AI. Manuka honey-impregnated dressings in the treatment of neuropathic diabetic foot ulcers. Int Wound J. 2014;11(3):259-263. doi:10.1111/j.1742-481X.2012.01082.x
Jull A, Walker N, Parag V, Molan P, Rodgers A. Randomized clinical trial of honey-impregnated dressings for venous leg ulcers. Br J Surg. 2008;95(2):175-182. doi:10.1002/bjs.6059
Tu WC, Wu CC, Hsieh HL, Chen CY, Hsu SL. Honeybee venom induces calcium-dependent but caspase-independent apoptotic cell death in human melanoma A2058 cells. Toxicon. 2008;52(2):318-329. doi:10.1016/j.toxicon.2008.06.007
Molan PC. A brief review of the use of honey as a clinical dressing. Aust J Wound Manag. 1998;6(4):148-158.
Cooper R, Molan P. The use of honey as an antiseptic in managing Pseudomonas infection. J Wound Care. 1999;8(4):161-164. doi:10.12968/jowc.1999.8.4.25867
Cooper RA, Molan PC, Harding KG. Antibacterial activity of honey against strains of Staphylococcus aureus from infected wounds. J R Soc Med. 1999;92(6):283-285. doi:10.1177/014107689909200604
Aljady A, Kamaruddin, Jamal M, Yassim AM. Biochemical study on the efficacyof malaysian honey on inflicted wounds: an animal model. Med J Islam Acad Sci. 2000;13(3):125-132.
Tan HT, Rahman RA, Gan SH, et al. The antibacterial properties of Malaysian tualang honey against wound and enteric microorganisms in comparison to manuka honey. BMC Complement Altern Med. 2009;9:34. doi:10.1186/1472-6882-9-34
Sarkisova MN, Biriukova NV. Medicinal Uses of Honey. Interact Sci. 2020;(5 (51)):8-12. doi:10.21661/r-541133
Rocha MP, Amorim JM, Lima WG, Brito JCM, Stephanie da Cruz Nizer W. Effect of honey and propolis, compared to acyclovir, against Herpes Simplex Virus (HSV)-induced lesions: A systematic review and meta-analysis. J Ethnopharmacol. 2021;287:114939. doi:10.1016/j.jep.2021.114939
Hashemipour MA, Tavakolineghad Z, Arabzadeh SAM, Iranmanesh Z, Nassab SAHG. Antiviral activities of honey, royal jelly, and acyclovir against HSV-1. Wounds. 2014;26(2):47-54.
Tomczyk M, Tarapatskyy M, Dżugan M. The influence of geographical origin on honey composition studied by Polish and Slovak honeys. Czech J Food Sci. 2019;37(4):232-238. doi:10.17221/40/2019-CJFS
Schiesser A, Şimşek D, Sarımehmetoğlu İ, Esendemir G. Evaluation of Antimicrobial Activity of Methylglyoxal -The Major Antibacterial Component of Manuka Honey. Mellifera. 2018;18(2):1-6.
Andritoiu CV, Lungu C, Danu M, et al. Evaluation of the healing effect of ointments based on bee products on cutaneous lesions in wistar rats. Pharmaceuticals. 2021. doi:10.3390/ph14111146
