A newly approved medicinal cream made from pineapples is revolutionizing the treatment of burn patients, according to doctors at Stony Brook Medicine's burn center in New York. The cream, called NexoBrid, became commercially available on September 20 and is being hailed as a "game changer" in burn treatment. Unlike the traditional method of surgical skin grafting, NexoBrid offers a less invasive and more effective approach.

Dr. Adam Singer, an emergency medicine physician at Stony Brook, explained that the standard treatment for deep burns has involved operating room procedures to remove the burned tissue. This process is likened to slicing cheese, where sequential slices of the burn tissue are cut until reaching normal, healthy tissue, upon which a skin graft is applied. However, this method often results in the unintentional removal of healthy tissue, indicating a lack of accuracy in distinguishing between different degrees of burns.

NexoBrid, on the other hand, contains an enzyme called bromelain derived from pineapple stems. When applied to the burn, the cream selectively dissolves the burn tissue within four hours, leaving healthy tissue untouched. This allows doctors to accurately determine the depth of the burn and whether a skin graft is necessary. In clinical trials, the use of NexoBrid reduced the need for surgery from 72% to just 4% of patients.

The cream also speeds up the diagnosis of burn depth, eliminating the need to wait up to a week for determination. This reduces the risk of infection and allows for immediate treatment. Furthermore, NexoBrid is a minimally invasive treatment, resulting in significantly less bleeding compared to surgical removal of tissue.

Stony Brook Medicine has been using NexoBrid on patients during clinical trials, but this month marked the first time the medication was used on regular patients. The results have been remarkable. In one case, a 53-year-old man with second-degree and third-degree burns to his legs saw significant progress within four hours of applying NexoBrid. The cream dissolved the dead tissue, allowing the healthy tissue to heal faster. Within two weeks, the patient was well enough to be discharged.

Dr. Steven Sandoval, a burn surgeon at Stony Brook, emphasized the speed and effectiveness of NexoBrid compared to other enzymatic debridement creams. While similar creams have been available since 2008, NexoBrid works much faster, removing dead tissue within hours instead of weeks. However, it is important to note that the cream may not eliminate the need for surgery in all cases, especially when there is a significant amount of dead tissue in critical areas.

NexoBrid was approved in Europe in 2014 but only received approval in the United States at the beginning of 2023. Currently, the medication is approved for use in adults with certain depth burns, excluding the face and genitalia. The only reported side effect is some degree of pain, which varies among patients.

Looking ahead, the doctors at Stony Brook are hopeful that NexoBrid will be approved for use in children and for other wounds with dead tissue, such as advanced bed sores. The cream has the potential to revolutionize wound care beyond burns, opening up new possibilities for treatment.