From Pineapple Fields to Burn Units: How a Kitchen Enzyme Rewrote Parts of Modern Medicine

A knife made from fruit

In December 2022, the U.S. FDA approved NexoBrid, a bromelain-based biologic, to remove dead burn tissue in adults—a job traditionally done with a surgical blade. The label later expanded to pediatric patients in 2024. In pivotal trials, enzymatic debridement achieved complete eschar removal faster, reduced the need for surgery, and matched standard care on wound closure, while preserving more viable tissue. ^[13][16]

At the bedside, the explanation is visceral. "This enzyme eats away damaged and dead tissue at a cellular level without damaging the living tissue that's left... It's very precise; much more precise than surgery using human eyes and hands," said burn surgeon Steven Kahn, MD. ^[15]

Across systematic reviews and meta-analyses, this pineapple-derived protease repeatedly showed selective debridement, less blood loss, and in many series fewer grafts—especially in delicate areas like the hand and face. ^{[16][18][23][25]} The surprise isn't just that it works; it's that it does so by reading biology's fine print—snipping proteins that hold dead eschar together while sparing the still-breathing layers beneath. ^[16]

How can a protein from a fruit act in your body?

Bromelain is a family of protein-cutting enzymes concentrated in pineapple stem and fruit. Indigenous traditions in Central and South America used pineapple for digestion and wound care long before Western labs had names for its components. Chemists first isolated "bromelin" in the 1890s; a century later, bromelain remains the collective term. ^[1][14]

The mind-bender came in 1997, when researchers fed volunteers bromelain and then found intact, active enzyme in their blood, hitchhiking with carrier proteins. In short: a sliver of this large protein slips past the gut's security, keeps some activity, and circulates for hours. ^[3] ENT surgeons have even detected bromelain moving from blood into sinonasal tissue—one reason it's been tested for sinus problems. ^[4]

What it can—and can't—do by mouth

Clinical evidence by mouth is most convincing for short-term inflammation and swelling.

• Acute sinusitis: A systematic review found that adding bromelain to standard care improved some symptoms in acute rhinosinusitis. Later meta-analyses of clinical trials broadly echoed benefit signals, though study quality varied. ^[10][5]
• Dental surgery: Multiple randomized trials around wisdom tooth extraction reported less pain and better function with bromelain versus placebo, sometimes comparable to diclofenac. A meta-analysis showed modest but statistically significant reductions in pain, swelling, and trismus. ^[8][9]
• Osteoarthritis: Findings are mixed. A 12-week placebo-controlled pilot in knee OA didn't clearly separate from placebo, while an active-controlled pilot showed similar short-term improvements to diclofenac and better tolerability for some patients. Overall, effects appear possible but inconsistent. ^[6][7]
• Mechanistic bridge: In a 2024 crossover trial of an oral enzyme combination containing bromelain, investigators observed reductions in systemic inflammation markers and cartilage breakdown products in knee OA, offering a biologic rationale for the symptomatic reports. ^[12]

The big picture from a 2023 systematic review: oral bromelain may help with sinusitis and pain, while evidence for cardiovascular use is not supportive. Safety was generally favorable in studied doses. ^[5]

The bleeding question

Because bromelain can keep platelets from clumping in lab systems, people often worry about bleeding. The reality is subtler. In vitro, bromelain can reduce aggregation and prolong clotting times, but animal data show paradoxes, and clinical burn literature advises caution rather than alarm—especially for those with coagulopathies or on anticoagulants. In short: respect interactions, monitor where risk is high, but don't overgeneralize lab results to every scenario. ^[11][19][24]

Authoritative guidance echoes this. The U.S. National Center for Complementary and Integrative Health notes bromelain's promotion for sinusitis, post–wisdom tooth recovery, and osteoarthritis, and flags its prescription, bromelain-based use in serious burns. It also underscores the limited size and quality of many oral studies and the need to consider drug interactions. ^[14]

Practical ways people weave it in

• For short, inflammatory flares (e.g., after dental surgery), clinical trials used anywhere from 40 mg every 6 hours for 6 days to 4×250 mg daily perioperatively; products vary widely. Always match the regimen to the studied context, not to marketing copy. ^[9][22]
• For sinus support, trials often used adjunctive dosing for days to a few weeks, with benefits beginning within the first week when present. ^[10][5]
• For chronic joint symptoms, studies range from 4 to 16 weeks; responses are inconsistent. Consider it a monitored trial with clear goals and a stop date. ^[6][7]
• Watch interactions: anticoagulants/antiplatelets, upcoming surgery, and potential increases in tetracycline antibiotic absorption are the main specifics to discuss with a clinician. ^[19]

Why this story matters

Bromelain's arc mirrors medicine's best surprises: cultural practice prompts curiosity; biochemistry offers a mechanism; and, in the burn unit, a fruit enzyme becomes a precise tool. Even as oral uses continue to be mapped with mixed results, the surgical application is already reshaping care. Or as one industry leader put it when FDA approval arrived: there's "a considerable unmet need for non-surgical eschar removal," and this enzyme helps meet it. ^[13]

The next horizon explores where selectivity matters most—hands, faces, and wounds where millimeters decide outcomes—and whether measured, standardized oral preparations can consistently translate lab promise into everyday relief. ^[18][12]