Sajid Ali, Muhammad Tahir Naseem, Wajid Zaman
Deep partial-thickness and full-thickness thermal burns require timely eschar removal, but surgical excision can sacrifice viable dermis, cause blood loss, and consume operating-room resources. Anacaulase-bcdb is a standardised pineapple stem-derived proteolytic biologic approved for enzymatic eschar removal in eligible adult and paediatric thermal burns. This Drug Evaluation reviews the product's biological origin, composition, mechanism of action, regulatory status, administration, clinical efficacy, safety and place in therapy. A targeted review of peer-reviewed and regulatory evidence was undertaken, prioritising the phase 3 DETECT trial, the randomised paediatric CIDS trial, systematic reviews, consensus guidance, prescribing information, and postmarketing studies. Anacaulase-bcdb provides rapid eschar removal, reduces surgical excision and debridement-related blood loss, and preserves subsequent options for conservative healing or grafting. Procedural pain, hypersensitivity, strict eligibility criteria, and specialist-team requirements remain important limitations. Anacaulase-bcdb is a clinically meaningful, tissue-sparing adjunct rather than a replacement for burn surgery. Its greatest value is likely in eligible deep partial-thickness and selected full-thickness thermal burns treated within protocolized burn-center pathways. Future adoption will depend on comparative effectiveness, cost-effectiveness, real-world safety, optimal patient selection and evidence that reduced operative burden translates into improved clinical and health-system outcomes.