WHAM evidence summary: coffee powder for wound healing
Keywords Traditional wound management, coffee, coffee powder dressing, evidence summary.
For referencing Haesler E. WHAM evidence summary: coffee powder for wound healing. WCET® Journal 2023;43(3):36-39
DOI https://doi.org/10.33235/wcet.43.3 .36-39
What is the best available evidence for topical coffee powder for improving wound healing?
Coffee powder is used as a traditional wound healing option in low and middle resource communities, particularly in Indonesia1, 2. It is claimed to have antimicrobial, anti-inflammatory and antioxidant effects that promote growth of new tissue1-4. Additional possible benefits include absorption of wound exudate and concealing wound malodor. However, the evidence for the use of coffee powder for healing human wounds is very limited. Level 24 and Level 32 evidence reported complete wound healing within 12 weeks for diabetic foot ulcers (DFUs) treated with coffee powder without adverse effects. This was supported by Level 4 evidence1, 3, 5. However, all the studies were at high risk of bias, and there is a need for further research on the effectiveness and implications for using coffee powder before a recommendation could be made on this intervention for treating wounds.
Clinical practice recommendations
All recommendations should be applied with consideration to the wound, the person, the health professional and the clinical context.
|There is insufficient evidence to make a recommendation on the use of topical coffee powder to promote wound healing.|
Sources of evidence: search and appraisal
This summary was conducted using methods published by the Joanna Briggs Institute6-8. The summary is based on a systematic literature search combining search terms related to topical coffee treatments and wound healing. Searches were conducted for evidence reporting use of topical coffee in human wounds published up to 30 June 2023 in English in the following databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline (Ovid), Google Scholar, Embase (Ovid), AMED, Global Health, Health Internetwork Access to Research Initiative (Hinari, access via Research4Life) and Cochrane Library. Levels of evidence for intervention studies are reported in Table 1.
Table 1: Levels of evidence for clinical studies
Coffee powder is described as a traditional option for treating wounds, particularly in Indonesia. Coffee powder is reported to have antioxidant, antimicrobial and anti-inflammatory effects3, 4. Bench research suggests that these properties might derive from coffee’s chemical composition, including 5-hydroxymethylfurfural (5-HMF)9, polyphenols (e.g., caffeic acid and chlorogenic acid)10, 11 and growth factors12. Some bench research has reported accelerated wound healing in animal wounds treated with coffee powder13-16. Additional bench research has explored impregnation of coffee into wound dressing materials, but the literature search did not identify any clinical trials of these products10, 11 in humans.
When coffee powder is placed in a wound bed it mixes with wound exudate resulting in a hyperosmolar solution with a low minimum inhibitory concentration against Methicillin-resistant Staphylococcus aureus1-3, 5, Streptococcus spp. and gram-negative bacteria5. Coffee powder may absorb wound exudate4, 5 and its aromatic characteristics might conceal wound malodor1-4. Another possible benefit of coffee powder described in the literature is protection of the wound bed1-3. When applied directly to the wound, coffee powder adheres to the wound bed surface. When changing the coffee powder dressing, the wound is not cleansed and the coffee layer in contact with the wound bed is left untouched. This allows epithelial tissue to develop without disruption1, 3.
Clinical evidence on coffee powder for wound healing
Studies reporting clinical outcomes for treatment with coffee are summarised in Table 2.
Table 2: Summary of the evidence for coffee powder for wound healing
Coffee powder for promoting wound healing
The strongest evidence for coffee powder comes from a quasi-experiment at high risk of bias that was conducted in people with DFUs4. The intervention group (n = 16) were treated with saline wound cleansing and application of Robusta coffee powder into the wound bed every second day. The control group (n = 16) received daily saline cleansing and were packed with saline- or povidone iodine-soaked gauze. Almost all (n = 30/32) participants also received systemic antibiotics. Wounds were assessed using the Bates-Jensen Wound Assessment Tool (BWAT) administered prior to commencing treatment and after two weeks. Both groups achieved statistically significant improvements (p < 0.001) in BWAT scores over two weeks of treatment, but the improvement was statistically significantly (p = 0.005) greater in the coffee powder group. Many of the participants were recruited to the study after their DFU had been surgically debrided (44% in the treatment group and 25% in the control group), which might have influenced the findings4 (Level 2).
A comparative study2 at high risk of bias reported coffee powder held in situ with gauze (n = 82) compared with saline-soaked gauze dressing (n = 78) in DFUs with a baseline wound diameter of 3—5 cm. The wound dressing was changed every four weeks for the coffee powder group and daily for the saline group. At 12 weeks, 100% of the wounds treated with coffee powder were completely healed versus 72% in the saline group (p < 0.001)2 (Level 3).
The remaining evidence comes from case reports from Indonesia and Ethiopia. Two case reports3 at high risk of bias reported use of coffee powder for healing deep DFUs of the heel. For the first DFU, dry coffee powder was applied directly to the wound bed, secured in place with gauze and tape and changed every 1—2 weeks. The ulcer healed completely within six months. The second case was described as a “festering” DFU that was treated with coffee powder applied directly into the wound bed and changed every 7—14 days. Complete healing was achieved within four months. For both cases, the report indicated that using coffee powder was protective of the epithelializing wound bed and also facilitated the person’s mobility and independence3 (Level 4).
Another case report at high risk of bias1 described the treatment of DFUs with coffee powder. Following debridement of an abscess, the person had three DFUs on one foot. These were packed with 100 g of coffee powder and secured with a gauze bandage. As with the cases reported above, when changing the dressing the wound was not cleansed, the coffee powder directly in contact with the wound bed was left undisturbed and any loose, superficial coffee powder was replaced. The wounds healed completely within three months1 (Level 4).
The next case report5, also at high risk of bias, described the use of freshly roasted Robusta coffee to treat a paediatric patient with a thigh burn. Coffee powder applied directly to the child’s burn was initiated on day four by the child’s parent. The dressing was changed twice daily and maintained dry. After three weeks of home treatment with the coffee powder, the burn was completely healed5 (Level 4).
Considerations for use
- Consider local policies, procedures, and licensing before implementing traditional wound treatments.
- Robusta coffee is reported to have greater antioxidant properties than Arabica coffee and is reported to be the preferred coffee species for traditional wound treatment4.
- In the research above, the coffee powder was ground from Robusta or Arabica beans (i.e., not instant coffee powder), purchased locally from coffee shops3. The process for grinding and the fineness of the powder were not reported, nor was any sterilization.
In the case studies above, coffee powder was used in a volume of approximately 80—100 g (enough to fill the wound bed). The coffee powder was secured in place with dry gauze and tape. When changing the coffee powder dressing, cleansing was avoided, any loose coffee was removed, leaving the layer of coffee in contact with the wound bed undisturbed. Fresh coffee powder was added3. In contrast, the treatment regimen in the quasi-experiment included saline cleansing when changing the coffee powder dressing, which necessitated more frequent dressing changes4.
No adverse events were reported in any of the research included in this evidence summary and no potential adverse effects were discussed in the literature.
Conflicts of interest
The author declares no conflicts of interest in accordance with International Committee of Medical Journal Editors (ICMJE) standards.
About WHAM evidence summaries
WHAM evidence summaries are consistent with methodology published in Munn Z, Lockwood C, Moola S. The development and use of evidence summaries for point of care information systems: A streamlined rapid review approach, Worldviews Evid Based Nurs. 2015;12(3):131-8. Methods are outlined in resources published by the Joanna Briggs Institute6-8 and on the WHAM Collaborative website: http://WHAMwounds.com. The WHAM evidence summaries undergo peer-review by a 20-member international, multidisciplinary Expert Reference Group (available on the website). WHAM evidence summaries provide a summary of the best available evidence on specific topics and make suggestions that can be used to inform clinical practice. Evidence contained within this summary should be evaluated by appropriately trained professionals with expertise in wound prevention and management, and the evidence should be considered in the context of the individual, the professional, the clinical setting and other relevant clinical information.
Copyright © 2023 Wound Healing and Management Collaboration, Curtin University
DOI: https://doi.org/10.33235/wcet.43.3 .36-39
在资源匮乏和资源中等的社区，特别是在印度尼西亚，咖啡粉是一种传统的伤口愈合方法1, 2。据称，其具有抗菌、抗炎和抗氧化作用，可促进新组织的生长1-4。其可能带来的其他获益包括吸收伤口渗出液和掩盖伤口恶臭。然而，咖啡粉用于愈合人体伤口的证据非常有限。2级4和3级2证据报告称，接受咖啡粉治疗的糖尿病足溃疡（DFU）在12周内实现伤口完全愈合，且无不良反应。上述情况得到了4级证据1, 3, 5的支持。不过，所有研究均存在较高的偏倚风险，需对使用咖啡粉的效果和影响进行进一步研究，然后才能就这种用于治疗伤口的干预措施提出建议。
据介绍，咖啡粉是一种传统的伤口治疗方法，特别是在印度尼西亚。有报告称，咖啡粉具有抗氧化、抗菌和抗炎作用3, 4。实验室研究表明，这些特性可能源于咖啡的化学成分，包括5-羟甲基糠醛（5-HMF）9、多酚（例如，咖啡酸和绿原酸）10, 11和生长因子12。一些实验室研究报告了接受咖啡粉治疗动物的伤口愈合速度加快13-16。其他实验室研究对咖啡浸渍伤口敷料材料进行了探索，但文献检索并未发现这些产品在人体中进行过任何临床试验10, 11。
将咖啡粉应用于伤口床时，其与伤口渗出液混合，产生高渗溶液，对耐甲氧西林金黄色葡萄球菌1-3, 5、链球菌属和革兰氏阴性菌5的最低抑菌浓度较低。咖啡粉可吸收伤口渗出液4, 5，其香气特征可掩盖伤口恶臭1-4。文献中所述的咖啡粉可能带来的另一个获益是保护伤口床1-3。直接涂抹在伤口上时，咖啡粉会附着在伤口床表面。更换咖啡粉敷料时，无需清洁伤口，与伤口床接触的咖啡层保持原样。这使得上皮组织的发育不受干扰1, 3。
一项偏倚风险较高的比较研究2报告了在基线伤口直径为3 cm-5 cm的DFU中，使用纱布将咖啡粉保持在原位（n=82）与生理盐水浸湿的纱布
在上述病例研究中，咖啡粉用量约为80 g-100 g（足以填充伤口床）。用干纱布和胶带将咖啡粉固定在适当位置。更换咖啡粉敷料时，无需清洁，去除任何松散的咖啡，与伤口床接触的咖啡层保持原样。加入新鲜咖啡粉3。相比之下，准实验中的治疗方案包括更换咖啡粉敷料时使用生理盐水进行清洁，这需要更频繁地更换敷料4。
WHAM证据总结采用的方法与以下文献中发表的方法一致：Munn Z, Lockwood C, Moola S. The development and use of evidence summaries for point of care information systems: A streamlined rapid review approach, Worldviews Evid Based Nurs. 2015;12(3):131-8。乔安娜·布里格斯研究所6-8和WHAM合作网站（http://WHAMwounds.com）发布的资源列出了这些方法。WHAM证据总结由20名成员组成的国际多学科专家参考小组进行同行评审（可在网站上查阅）。WHAM证据总结提供了关于特定主题的最佳可用证据的总结，并提出了可用于指导临床实践的建议。本总结中包含的证据应由经过适当培训的具有伤口预防和管理专业知识的专业人士进行评价，并应根据个人、专业人士、临床环境以及其他相关临床信息考虑证据。
PhD P Grad Dip Adv Nurs (Gerontics) BN FWA
Adjunct Professor, Curtin University, Curtin Health Innovation Research Institute, Wound Healing and Management (WHAM) Collaborative
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