## 7 Commercially Available Honey-Based Products for Skin Repair  
Various honey-based products are available on the market and have been approved for medical use with different indications, such as Actilite(r), Activon Tulle(r), Activon Tube(r), L-Mesitran(tm), TheraHoney(r), MediHoney(r), Revami(r), Principelle IFTM, examples of which are shown in Figure 1. Honey and honey-containing commercial products are currently used in clinical practice for the treatment of wounds of different aetiology. [PERSON] et al. described a statistically significant amelioration in patients aged over 65 with refractory wounds of various nature, with reduced wound size and improved pain relief (measured with the Visual Analog Scale) reported in the intervention group. This group was treated with the commercial honey dressings Actilite(r) (containing a mixture of Manuka honey and Manuka oil, respectively 99% and 1%, as shown in Figure 1) [140] for 90 days, compared to the control group [141]. A commercial ointment with 48% Medical Grade Honey (MGH-L-Mesitran(tm) [142] than been used in monotherapy to treat wounds of different origin (post-surgical and not) in pediatric patients. No discomfort was reported upon application, and minimal scarring was observed [143; 144]. However, the antioxidant vitamins C and E, and the other components (calendula officinalis, alo vera, essential oils, lanolin) also contained in the formulation might have played a role in this positive outcome, given their intrinsic advantageous properties for skin health [145; 146; 147; 148]. L-Mesitran(tm) Soft (gel containing 40% MGH supplemented with vitamin C and E) has been reported to be effective against clinical isolates of vaginal _Candida albicans_ (_C. albicans_), with a minimal inhibitory concentration (MIC) of 25-50% and a minimal fungicidal effect observed at 50% (MFC). Interestingly, when raw Mexican Yucatan MGH (declared as the same honey used in the commercial product) was directly applied, no fungistatic or fungicidal effect was observed at 40% dilution (maximum concentration tested) [149]. Similar results were also reported against clinical isolates of multi-resistant _C. auris_ and other Candida species responsible for nosocomial infections. A dose-dependent inhibition was achieved with L-Mesitran(tm) Soft on all fungal species investigated, while equal honey concentrations (Brasilian blossom honey) not only were shown to be significantly less effective in reducing fungal proliferation but even stimulated the growth of _C. albicans_ and _Candida glabrata_ (_C. glabrata_). The antifungal effect for the raw medical grade honey was observed instead at a minimum concentration of 40% [150]. These findings suggest again that the other components of the formulations are critical to the successful clinical outcome, possibly potentiating the beneficial properties of honey [151; 152; 153; 154]. ThereaHoney(r) impregnated dressings [155] were compared to sustained-release ionic silver hydrophilic dressings in a prospective, double-blind, randomised clinical trial to evaluate the capacity to enhance the healing of neuropathic diabetic foot ulcers and eradicate concurring infections, thus reducing hospitalisation. No statistically significant difference was observed between the two groups, indicating that both treatments are comparably effective and represent valuable options for the management of DFUs [156]. ThereaHoney(r) gel (with medical-grade Manuka honey) has been used in association with conventional antibiotic drugs to treat wounds following cochlear implants in three pediatric patients, with the remarkable promotion of surgical site repair on previously non-healing ulcerations [157]. MediHoney(r) paste (with Active Leptosperm Manualuka Honey) [158] was successfully used as an alternative to conventional mouth rinses to topically treat oral mucositis following chemotherapy treatments in ten pediatric patients, showing enhanced healing observed after 3 days as well as alleviated pain and reduced bleeding within 5 days [159].