1. Please describe why the 84-day cutoff period was chosen.

Response: The choice of 84 days is based on a recent study by Rai et al [5], which suggests that 80% of leprosy ulcers were healed within 84 days following standard practice. This has been mentioned under the heading “Sample size.”

2. The flow chart is a bit small and thus hard to read.

Response: We have attached a full page of the flow chart as a supplementary material to make it easier for readers to understand.

3. Usually, overlapping inclusion and exclusion criteria are not mentioned.

Response: This is noted.

4. It is not clear why hepatitis B or C were added in the exclusion criteria list.

Response: We have considered that hepatitis B and C are not important confounders to the outcome of this study. We have now expunged the statement from the revised protocol.

5. It is not clear for me if patients are clinically admitted or not, and if so, why? For how long? Is this routine care? And what are the discharge criteria?

Response: All the study participants are hospitalized for up to 84 days or discharged when healing occurs before the 84-day period. Those whose ulcers are not healed after the 84-day period will continue with treatment but outside this study depending on the clinicians’ advice.

6. If diabetes is excluded, it may be good to also exclude other known reasons for peripheral neuropathy (eg, vitamin B deficiencies).

Response: This is an important suggestion. However, the study is already on course, and we have not considered vitamin B deficiencies from the inception. This is noted for future studies.

7. Are signs of infection also monitored, assessed, or outcome measures?

Response: Yes, the ulcers are beings observed for any sign of infection during the dressing changes. We report any serious adverse event throughout the study.

8. Please explain more on the swabs: what kind of swab is it and what is tested, if this is not part of the research project? In general, it is better to take a routine swab to test for infection (bacterial growth) prior to inclusion instead of prior to randomization, as infection is an exclusion criteria. Also, address this under the heading about “biological specimens.”

Response: Thank you for pointing this out. We have now addressed it to clearly show that wound swabs would be taken from the participants to screen for bacterial infections before recruitment. We have also reflected this in the section under “biological specimens.”

9. Explain why the video recording is taking place. It may be interesting to also do it with the last 5 patients if it is performed for monitoring reasons.

Response: The video recording is only for the purpose of quality control. The aim is for the independent assessors to verify that the protocol for the wound dressing is carefully followed. We also envisaged that this was only necessary at the start of the study.

10. Why are assessors from Nepal used and not contextual assessors from Nigeria itself (also, is it because of skin color differences of participants in both countries)?

Response: This is part of a multicountry study with India and Nepal. The plan was to send specimens across the countries to be examined by other researchers who understands the study but are completely blinded from the dressing allocation. For each ulcer, the measurement is carried out by 2 separate assessors, in which the measurements are later collated and harmonized by the data monitoring committee. We believe that, by doing so, the risk of bias will be greatly reduced.

11. Please explain why early analysis is taking place after the inclusion of the first three-eighths of participants.

Response: The purpose is to ensure that quality data are recorded throughout the study.

12. I missed the argument in the discussion that mentioned that honey is often relatively cheap and better available than many advanced wound care products.

Response: We have now mentioned that honey is cheaper and a readily available alternative to many wound care products.

13. Include some information about how long data will be stored (number of years), where it will be stored in a secure way, and if it will be shared (pseudonymized) if requested (eg, for reproducibility).

Response: The information is included under “Data management” and “Confidentiality.”

14. Write numbers up to 9 in text.

Response: Noted.

15. Check abbreviations.

Response: All abbreviations checked.

16. Update reference list, include authors, URLs, and “assessed on [date]” in references to websites and online documents.

Response: Noted.

17. Explain the camera used for photography.

Response: The camera used is the Samsung Galaxy Tab S7 (13Mp) as mentioned in the protocol.

18. Please add 2 more references in the discussion.

Response: Noted.

19. Explain more about the pedometer usage.

Response: The pedometers are worn on the nonaffected foot of the participant to monitor their daily step counts. This might show if the level of activity or weight bearing has any impact on the healing rate of the ulcers.