What is the best cream for managing bed sores (pressure ulcers)?

Best Cream for Managing Bed Sores (Pressure Ulcers)

Use hydrocolloid or foam dressings as your primary treatment approach for pressure ulcers, as these are specifically recommended by the American College of Physicians and are superior to traditional gauze dressings for reducing wound size. 1, 2

Primary Dressing Recommendations

Hydrocolloid dressings are the evidence-based first-line choice for pressure ulcer management:

• Hydrocolloid dressings reduce wound size more effectively than gauze dressings (low-quality evidence, but guideline-supported) 1, 3, 4
• Foam dressings are an equally acceptable alternative to hydrocolloid dressings for reducing wound size 1, 2
• Both options control exudate while maintaining the moist wound environment necessary for healing 2
• These dressings should be selected based on exudate control, patient comfort, and cost rather than brand-specific features 4

The evidence supporting hydrocolloid and foam dressings comes from the American College of Physicians' 2015 clinical practice guideline, which systematically reviewed all available treatments. While the quality of evidence is rated as "low," these are the only dressings with specific guideline recommendations. 1

Topical Agents with Limited Evidence

Several topical agents have been studied, but the evidence is generally insufficient to recommend them over standard dressings:

• Zinc oxide cream (25%) may promote healing in stage I and II ulcers based on one recent 2025 pilot study showing 83% partial healing at 14 days, but this requires confirmation in larger trials 5
• Protease-modulating dressings show uncertain benefit compared to saline gauze (RR 1.65,95% CI 0.92 to 2.94), meaning they might help but the evidence is not strong enough to recommend routinely 2
• Platelet-derived growth factor (becaplermin) has insufficient evidence to justify routine use and is more expensive than standard dressings 1, 2
• Silver-containing dressings and other antiseptic products have no data supporting their routine use in pressure ulcer management 1, 6

Essential Complementary Treatments (Not Creams, But Critical)

No cream works in isolation. You must implement these evidence-based interventions simultaneously:

• Complete pressure offloading from the affected area is absolutely essential—no dressing will heal an ulcer that continues to experience pressure 2, 3
• Regular sharp debridement with a scalpel to remove necrotic tissue, which prevents healing 2, 3
• Protein or amino acid supplementation to reduce wound size, particularly in nutritionally deficient patients 1, 2, 3
• Electrical stimulation as adjunctive therapy accelerates healing for stage 2-4 ulcers (moderate-quality evidence) 1, 2, 3

Wound Cleaning Protocol

• Clean the wound regularly with water or saline only—avoid harsh antiseptics that damage healing tissue 2, 3
• Perform cleaning before each dressing change to remove debris and create optimal healing environment 2

What NOT to Use

Avoid these approaches that add unnecessary cost without proven benefit:

• Advanced support surfaces like alternating-air and low-air-loss beds (limited evidence, high cost) 1, 3
• Topical antibiotics or antiseptics for uninfected ulcers (no clear benefit demonstrated) 6
• Povidone-iodine solutions, which may actually reduce healing rates compared to non-antimicrobial alternatives 6
• Bioengineered skin products (insufficient evidence to justify routine use) 1, 2

Critical Pitfalls to Avoid

• Do not rely on dressings alone—failure to address pressure offloading is the most common reason for treatment failure 2, 3
• Reassess at 6 weeks—if the ulcer shows no healing progress despite optimal management, evaluate for vascular compromise 2, 3
• Watch for infection signs: increasing pain, erythema, warmth, or purulent drainage require systemic antibiotics, not just topical treatment 2
• Do not use gauze dressings—they are inferior to hydrocolloid dressings for wound size reduction 1, 2

Clinical Algorithm

1. Immediately implement complete pressure offloading (air-fluidized bed if standard mattress insufficient) 2, 3
2. Apply hydrocolloid or foam dressing as primary treatment 1, 2, 3
3. Perform sharp debridement of any necrotic tissue 2, 3
4. Start protein supplementation if nutritionally deficient 1, 2, 3
5. Add electrical stimulation for stage 2-4 ulcers to accelerate healing 1, 2, 3
6. Clean with water/saline only at each dressing change 2, 3
7. Reassess at 6 weeks—if no improvement, investigate vascular compromise 2, 3