| Agent | Enzyme source | Advantages | Disadvantages | Precautions |
| Collagenase | Strain of Clostridium histolyticum | - Approved by the US FDA for the debridement of chronic wounds and burns
- Selective for collagen
- Generally pain-free delivery
- May be combined with a variety of other topical dressings
| - Effectiveness compared with other forms of debridement may be questionable
- Prescription based on wound area
- High cost
- Relatively slow acting
| - Moist wound environment required for activation
- Topical silver dressings significantly inhibit collagenase activity
|
| Papain | Papaya | - Provides relatively "aggressive" enzymatic debridement
- Generally pain-free delivery
- May be combined with a variety of other topical dressings
| - Not readily available in the United States
- Nonselective (ie, will cleave any protein containing cysteine)
- Relatively slow acting
| - Agent is often combined with a chlorophyll complex that causes green wound discoloration following application
- Need to avoid adjacent healthy tissues
|
| Bromelain | Pineapple | - Relatively rapid acting
- Selective for nonviable tissue
| - Removal from base of wound required after several hours
- Inhibits platelet function but is reversible
| - Evidence of efficacy is based on acute wounds or burns, not chronic wounds
|
