Evidence supporting the use of: Protease
For the health condition: Ulcerations (external)

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Synopsis

Source of validity: Scientific
Rating (out of 5): 3

Proteases are enzymes that break down proteins and have been used in the management of external ulcerations, such as chronic wounds and ulcers, primarily due to their debriding properties. Scientific studies and clinical experience support the use of proteolytic enzymes, including those derived from microorganisms (like subtilisin) or plants (such as papain and bromelain), in wound care. Their primary role is to aid in the removal of necrotic tissue (debridement), which is essential for preparing the wound bed and promoting healing. Enzymatic debridement is especially valuable when surgical or autolytic debridement is not feasible or when a selective, less invasive approach is needed. Proteases help by digesting devitalized tissue without damaging viable cells, potentially reducing infection risk and supporting granulation.

Several studies and clinical guidelines acknowledge the benefits of topical protease preparations in wound management, and products containing proteolytic enzymes are widely used in clinical practice for treating pressure ulcers, venous leg ulcers, and diabetic foot ulcers. However, the overall strength and quality of evidence vary, and while many reports and case series describe positive outcomes, there remains a need for more high-quality randomized controlled trials to firmly establish efficacy and optimal usage protocols. Nonetheless, the scientific rationale and clinical experience justify their use, particularly in cases where other debridement methods are contraindicated.

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