Enzymatic Debridement Reduces Pigment Load by Over 90% in Injuries

Traumatic tattoos—persistent discolorations resulting from the embedding of foreign particles into the skin—are an uncommon but challenging consequence of high-velocity abrasion and blast injuries. These injuries occur when materials such as asphalt, soil, glass, or metallic fragments penetrate the dermis with force, potentially resulting in permanent pigment deposition, cosmetic disfigurement, functional impairment, and increased susceptibility to inflammation or infection. Traditional management relies primarily on mechanical scrubbing and irrigation, approaches that may not fully remove deeply embedded debris and may inadvertently damage viable tissue.¹

A newly published prospective study in the Journal of Burn Care & Research evaluates whether enzymatic debridement with NexoBrid, a bromelain-based enzymatic agent traditionally used for eschar removal in burn care, can more effectively reduce pigment load in traumatic tattoos. This publication represents the first reported clinical series focused specifically on the use of enzymatic debridement for traumatic tattoo prevention.²

“In blast injuries and friction burns, where wound depth is highly irregular, NexoBrid provides the precision these cases demand,” said Josef Haik, MD, MPH, director of the department of plastic and reconstructive surgery and burn center at Sheba Medical Center, in a news release from MediWound.³ “We believe the effectiveness of NexoBrid is driven by its selective enzymatic action on damaged skin layers, which helps remove many of the particles embedded within them. In high-energy explosions, some debris may remain lodged in deeper tissues, yet NexoBrid consistently reveals a clean, well-defined wound bed, enabling clinicians to determine the most appropriate next steps.”

Study Design and Patient Population

The single-center study was conducted at Sheba Medical Center’s National Burn Center and enrolled 15 patients, aged 4 to 51 years, who sustained traumatic tattoos after friction injuries (e.g., road rash) or blast-related events. All patients underwent initial care consisting of standard mechanical scrubbing to remove loose superficial debris. After this step, the presence of residual pigmentation was documented photographically.

Within 24 hours after injury, each patient received NexoBrid treatment under procedural sedation. The enzymatic agent was applied in a 1–3 mm layer to the injured areas, covered under occlusion for 4 hours, and then removed. Gentle scrubbing was again performed following removal to assess the wound bed.

Outcome Measures and Methods of Assessment

The investigators quantified pigment reduction using ImageJ, an open-source software platform commonly used for medical image analysis. Photographs taken before and after enzymatic debridement were analyzed to determine the proportion of the wound area containing visible pigment.

The primary endpoint was the change in pigmented wound surface area following NexoBrid application. Secondary observations included patient tolerance, procedural feasibility, and the occurrence of immediate treatment-related adverse events.

Key Findings

Across the cohort, the mean area of pigmented tissue decreased from 37.5% after mechanical scrubbing to 2.1% after NexoBrid application, representing a 92.5% relative reduction in residual pigmentation. All patients demonstrated substantial clearance of foreign particles.

When stratified by mechanism of injury:

• Abrasive friction injuries: approximately 96% of visible pigment was removed on average.
• Blast injuries: pigment reduction averaged 84%, a lower but still substantial reduction, likely reflecting deeper and more irregular tissue damage characteristic of high-energy explosive mechanisms.

The treatment was reported to be well tolerated, and no treatment-related adverse events were observed in the early post-procedure period. Procedures were performed at bedside, suggesting logistical feasibility in acute trauma settings.

Clinical Interpretation

The study authors propose that the observed pigment reduction is related to NexoBrid’s selective action on devitalized tissue. By enzymatically removing damaged dermal layers where particles lodge, the agent may facilitate more complete clearance than mechanical scrubbing alone. The results also appeared to produce a cleaner and better-defined wound bed, potentially aiding subsequent clinical decision-making.

Commentary from the investigators notes that despite significant pigment clearance, deeper debris in high-energy blast wounds may persist. Enzymatic debridement may therefore be a beneficial adjunct rather than a definitive solution in some complex trauma cases.

Conclusion

This prospective study provides early evidence that bromelain-based enzymatic debridement may offer a promising adjunctive method for reducing residual pigmentation in traumatic tattoos following abrasion or blast injuries. While preliminary, the findings suggest that NexoBrid may enhance foreign-particle clearance and help clinicians achieve cleaner wound beds. Researchers noted further research is needed to confirm these results, assess long-term outcomes, and establish standardized protocols in the acute management of traumatic tattoos.

References

1. Al Alawi K, Al Khayarin A, Al Kalbani H, Al Shaqsi S. Acute treatment of traumatic tattooing with dermabrasion: A case report. Case Rep Dermatol Med. 2025 Aug 6;2025:4084268. doi: 10.1155/crdm/4084268.
2. Serror K, Tasigiorgos S, Levi J, et al. Enzymatic bromelain-based debridement with nexobrid®: A new treatment to effectively prevent traumatic tattoos after abrasive incidents and explosive events. J Burn Care Res. Published online November 27, 2025. doi:10.1093/jbcr/iraf220
3. MediWound reports new clinical data demonstrating NexoBrid®’s effectiveness in preventing traumatic tattoos after abrasion and blast injuries. News release. MediWound. Published December 10, 2025. Accessed December 10, 2025. https://www.globenewswire.com/news-release/2025/12/10/3203047/30505/en/MediWound-Reports-New-Clinical-Data-Demonstrating-NexoBrid-s-Effectiveness-in-Preventing-Traumatic-Tattoos-After-Abrasion-and-Blast-Injuries.html