Is zinc oxide 12.8% (ZnO) an appropriate topical treatment for an elderly patient with pressure ulcers on the buttocks?

Zinc Oxide 12.8% for Pressure Ulcers on Buttocks

Zinc oxide 12.8% is not an appropriate treatment for pressure ulcers based on current evidence-based guidelines, which recommend hydrocolloid or foam dressings as first-line topical therapy for wound healing. 1

Why Standard Dressings Are Preferred

The American College of Physicians guidelines establish that hydrocolloid dressings are superior to gauze dressings for reducing wound size (low-quality evidence) and are equivalent to foam dressings for complete wound healing. 1, 2 These dressings should be the foundation of your topical management strategy for buttock pressure ulcers. 2

The Evidence Gap for Zinc Oxide 12.8%

While one recent pilot study (2025) examined 25% zinc oxide cream and found improved partial healing rates (83.34% vs 60%) and peri-wound erythema reduction (50% vs 9.5%) compared to silver dressings for Stage I-II pressure ulcers, this evidence has critical limitations: 3

• The concentration studied (25%) differs from your proposed 12.8% - we cannot extrapolate efficacy to lower concentrations 3
• This was a single small pilot trial (60 patients) requiring validation 3
• The FDA-approved zinc oxide formulation is 20%, not 12.8% 4
• No guideline-level evidence supports zinc oxide for pressure ulcers 1

Recommended Treatment Algorithm for Buttock Pressure Ulcers

Immediate Actions:

• Implement complete pressure offloading from the buttocks using air-fluidized beds (superior to standard hospital beds for reducing ulcer size) 1, 2
• Establish repositioning every 2-4 hours using the 30-degree tilt position rather than 90-degree lateral rotation 2, 5

Wound Management:

• Apply hydrocolloid or foam dressings as primary treatment 1, 2
• Clean wounds regularly with water or saline to remove debris 2
• Perform regular debridement with a scalpel to remove necrotic tissue 2
• Control exudate to maintain moist wound environment 2

Systemic Support:

• Provide protein or amino acid supplementation to reduce wound size, especially if nutritionally deficient 1, 2
• Assess for signs of infection (increasing pain, erythema, warmth, purulent drainage) 2

Adjunctive Therapy:

• Consider electrical stimulation for Stage 2-4 ulcers to accelerate wound healing (moderate-quality evidence), though be cautious in frail elderly patients who have higher adverse event rates 1, 2

Critical Pitfalls to Avoid

Skin irritation, inflammation, tissue damage and maceration are the most commonly reported harms for topical therapies (moderate-quality evidence), making it essential to monitor the peri-wound skin closely with any dressing choice. 1

For elderly patients specifically, frail status increases susceptibility to adverse events from various interventions, requiring closer monitoring regardless of treatment selected. 1

Clinical Bottom Line

Use evidence-based hydrocolloid or foam dressings rather than zinc oxide 12.8% for this elderly patient's buttock pressure ulcers. 1, 2 The concentration you're considering lacks supporting evidence, differs from both the studied concentration (25%) and FDA-approved formulation (20%), and is not mentioned in any pressure ulcer treatment guidelines. 1, 4, 3