This report documents the use of manuka honey to suc-cessfully treat a recalcitrant wound resulting from surgi-cal treatment of hidradenitis suppurativa. The wound hadfailed to heal during 3 years of treatment with conven-tional therapies and following four surgical procedures.After treatment with dressings impregnated with irradiat-ed manuka honey was initiated, the patient’s recurrentstaphylococcal infections ceased, and healing wasachieved within 4 months.In March 1999 a 38-year-old female with a recalci-trant surgical wound of 36 months’ duration requestedtreatment with topical honey. She had first been diag-nosed with hidradenitis suppurativa localised in the leftaxilla in January 1977. Her right axilla, inframammaryfolds and groin were unaffected, and she was otherwisefit and healthy. Abscesses in the left axilla were treatedwith incision and drainage in 1977, 1991 and, again, inMarch 1996. However, the wound that resulted from thesurgical treatment in 1996 failed to heal, and the patientcomplained of pain, limited movement and offensiveodour emanating from the wound. Wide excisions ofchronically indurated, recalcitrant tissue from the left ax-illa were performed in 1997 and 1998, but the woundstill failed to heal. A wide range of therapeutic dressingswas applied with limited effect.Recurrent wound infections complicated the healingprocess. Staphylococcus aureus(resistant to penicillinbut sensitive to methicillin, flucloxacillin, erythromycin,fusidic acid, cephalexin and gentamicin) was isolated onfive occasions, twice in combination with coryneformbacteria, and once with nonhaemolytic streptococci.Atypical mycobacteria were not sought. Antimicrobialtreatment regimens included systemic co-amoxiclav, ci-profloxacin, flucloxacillin, metronidazole, topical silversulphadiazine, silver nitrate and povidone-iodine. DuringSeptember and October 1997 a prolonged course of flu-cloxacillin combined with metronidazole was adminis-tered. Although healing progressed with this therapy, ab-normal granulation tissue developed and regression oc-curred within 10–14 days of treatment cessation.The patient’s shoulder was marginally abducted as aresult of scarring. In an attempt to reintroduce healthyundamaged skin to the area and to improve the range ofshoulder movement, the scarred area was excised andcovered by a rotational skin flap in November 1998. Ini-tially, the range of movement of the shoulder joint im-proved, but 3 months later the distal end of the flapbroke down and Staphylococcus aureuswas again isolat-ed. At this point (having endured 4 operations and 36months of failure to heal), the patient requested treat-ment with honey.Thus, in March 1999, co-amoxiclav was prescribed(375 mg thrice daily for 7 days) and Combine dressings(Smith & Nephew, UK) impregnated with 25–35 g activemanuka honey and sterilised by gamma radiation wereapplied to the infected wound and covered by absorbentpads. The manuka honey used had inhibitory activityagainst Staphylococcus aureusATCC 25923 equivalentto that of 13% (w/v) phenol, as determined by an in vitroassay with catalase added to exclude activity due to hy-drogen peroxide [1]. The patient was provided with hon-ey dressings and instructed to redress the wound at 24-hintervals, following showering. The wound was moni-tored and swabbed at weekly visits to the clinic.A noticeable improvement in the appearance of thewound was observed within 1 week of applying the hon-ey-impregnated dressings; it became smaller and less in-flamed, and the already healed, scarred area becamemore pliable. Bacteria were absent at 7 days, and the re-