Proteolytic Enzyme Extract Debrides Severe Burn Wounds

A mixture of enzymes from the stem of the pineapple plant (Ananas comosus) enriched in bromelain add a new treatment option for severe burns.

NexoBrid is intended to remove burn eschar, the dried-out, thick, leathery, black necrotic tissue that covers severe burn wounds after a 4-hour application, providing an alternative to surgical removal means. The treatment is applied via a pack that includes a lyophilized sterile mixture of the enriched proteolytic enzymes and a sterile medical hydrating gel.


The mixture of both components is applied on the wound surface, and the dissolved eschar (in the form of a gelatinous mass) is wiped away, with no surgical or other special procedures, exposing the clean wound bed for visual assessment and treatment.

In second-degree burns, if a residual clean exposed dermis survives, the tissue may epithelialize and heal spontaneously. In full thickness third degree burns, devoid of any healing sources (viable dermis and epithelium), the skin will heal only if a living skin graft is harvested from healthy donor sites. NexoBrid is a product of MediWound (Yavne, Israel), and has received the European Community EC marking of approval. The US Food and Drug Administration has granted NexoBrid orphan drug status for the debridement of deep partial or full thickness burns in hospitalized patients.

Excisional debridement followed by autografting is the current standard of care for deep burns, but is associated with serious potential complications. On the other hand, conservative, nonsurgical and current enzymatic debridement methods are inefficiently slow, and may involve eschar and wound-handling complications; these include streptokinase, collagenase, papain/urea, and other combinations. Many of them are not in high demand for burn debridement due to relatively poor efficacy.

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