Bedsore coccyx ulcer in an 8-years-old patient

An 8-year old female child suffered for four years from paraplegia and severe impairment in the motility of the upper body due to viral encephalitis. In addition, the child had a tracheostoma and suffered from chronic intestinal dysmotility, and previously received surgery because of intestinal volvulus. The patient was admitted to the hospital with respiratory problems and presented with severe bedsore ulcer and inflammation of her buttocks.

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  • Case Study by: E. Smaropoulos, MD PhD, e-mail:

The wound was treated with daily Medical Grade Honey (MGH) monotherapy and closely monitored.

On consultation for the ulcer, the coccyx ulcer was at stage IV, and MGH therapy was directly started (Figure A, day 0). The child was placed every 4 hours in different lateral positions to offload the pressure, and an inflatable rubber ring was used to keep the coccyx up from the bed surface. MGH therapy was started upon hospital admittance, and after two days, the slough was less pronounced, while hemostasis became visible and epithelialization from the edges started (Figure B). At day 8, the wound decreased in size, and the tissue was less inflamed and appeared healthier (Figure C). At day 24, the slough completely disappeared while the wound progressively healed, indicated by the reduced wound size, covering part of the periosteum, a more vascularized wound bed, granulation tissue formation and clear epithelialization (Figure D). After 32 days, the wound became smaller and more superficial, and the periosteum was completely covered (Figure E). MGH application was easy. As the patient suffered from paraplegia, no pain or discomfort was experienced. Follow up after 6 months showed a good cosmetic outcome (Figure F).

Pressure injuries are a challenging problem in the care of medically complex children, and therapies are mainly based on adult data, while there are considerable differences in body composition (1). Pressure injuries arise as a result of pressure and/ or shear and are often located over a bony prominence or related to a medical device. Risk factors include limited mobility, inability to reposition, loss of sensation, nutritional deficiency, cognitive impairment, or other pressure ulcers (1). We postulated that MGH would be effective to treat this coccyx ulcer with signs of inflammation, in particular by the antimicrobial and pro-healing properties.

MGH has a low pH, strong osmotic action, produces hydrogen peroxide, and holds antimicrobial constituents, all executing its antimicrobial activity. In addition, the application of MGH covers the wound and prevents invading pathogens and infection, while killing the bacteria that already are present, and thus has prophylactic potential (2). Moreover, MGH possesses pro-healing effects via multiple mechanisms. MGH keeps the wound moisturized, which enhances healing. The osmotic effects caused by the honey stimulates the blood flow and autolytic debridement. MGH reduces oxidative and inflammatory stress and promotes a regenerative wound environment. MGH serves as an important nutrient source for the newly forming tissue and promotes angiogenesis and reepithelialization (3).

In the presented case, resolution of inflammation was rapidly performed by the MGH, and the wound progressively healed without complications. MGH was easy to apply, and secondary dressings were easily changeable and did not adhere to the newly formed granulation tissue, or re-open the wounds. Since MGH is gamma-irradiated, any spores of Clostridium that can cause botulism are destroyed, and MGH can safely be used, also in pediatrics (4).

In conclusion, MGH is effective for treating a coccyx ulcer in this young patient. MGH holds much promise for the treatment of other wound types as well.

  1. Freundlich K. Pressure Injuries in Medically Complex Children: A Review. Children (Basel). 2017;4(4).
  2. Mandel HH, Sutton GA, Abu E, Kelmer G. Intralesional application of medical grade honey improves healing of surgically treated lacerations in horses. Equine Vet J. 2019.
  3. Smaropoulos E, Cremers NAJ. The pro-healing effects of medical grade honey supported by a pediatric case series. Compl Ther Med. 2019;45:14-18.
  4. Postmes T, van den Bogaard AE, Hazen M. The sterilization of honey with cobalt 60 gamma radiation: a study of honey spiked with spores of Clostridium botulinum and Bacillus subtilis. Experientia. 1995;51(9-10):986-9