Recommended Creams and Dressings for Pressure Sores
Use hydrocolloid or foam dressings rather than traditional creams or ointments for pressure sore treatment, as these dressings are superior to gauze for reducing wound size. 1
Primary Dressing Recommendations
The American College of Physicians guideline provides clear direction on what to apply to pressure ulcers:
Hydrocolloid dressings are recommended as first-line treatment for reducing wound size in pressure ulcers, with evidence showing superiority over traditional gauze dressings 1
Foam dressings are an equivalent alternative to hydrocolloid dressings and can be used interchangeably based on wound characteristics, patient comfort, and cost 1, 2
Both hydrocolloid and foam dressings should be used in conjunction with standard pressure relief measures and nutritional support 1
Topical Agents with Limited Evidence
While the question asks about "creams," the evidence shows most topical creams have inferior or unclear benefit:
Avoid povidone iodine preparations, as they may actually impair healing compared to non-antimicrobial dressings and show fewer ulcers healing when compared to protease-modulating dressings or hydrogel 2, 3
Collagenase ointment has unclear benefit compared to saline gauze, with low-certainty evidence that does not establish clear superiority 4
Silver sulfadiazine cream lacks strong evidence for pressure ulcer healing, with very low-quality evidence available 3
Topical antimicrobials (iodine, honey, silver dressings) should only be used when infection is clinically present, not routinely, as the evidence shows no clear healing benefit and potential harm 2, 3
When Topical Agents May Be Considered
Collagen matrix dressings can be applied to reduce protease activity and promote fibroblast proliferation when excessive inflammation is present 2
Medical-grade honey or silver-containing dressings may be used specifically for infected wounds after debridement, but should not be routine first-line treatment 2
Critical Implementation Points
Dressing selection should prioritize exudate control, comfort, and cost rather than seeking a specific "healing cream" 5
Combine dressing therapy with protein supplementation (protein or amino acids) to reduce wound size, particularly in patients with nutritional deficiencies 1, 2
Add electrical stimulation as adjunctive therapy to accelerate wound healing (moderate-quality evidence supports this approach) 1, 2
Perform sharp debridement first to remove necrotic tissue and biofilm before applying any dressing or topical agent 2
Common Pitfalls to Avoid
Do not use dextranomer paste, as it is inferior to other dressings for reducing wound size 1
Do not culture wounds or apply antimicrobial creams without clinical signs of infection (increased exudate, erythema, warmth, new breakdown), as this leads to inappropriate treatment 2
Do not apply vitamin C cream or supplements, as no benefit has been demonstrated for pressure ulcer healing 1, 2
Avoid focusing solely on the wound itself—address underlying causes including pressure relief, repositioning, and nutritional status 6