Dressings and topical agents for preventing pressure ulcers.

Systematic review of trials in adults and children at risk of pressure ulcers but without existing ulcers. Participants were mainly older, mobility-impaired patients in hospitals, nursing homes, long-term care, and other care settings.

Prophylactic dressings and topical skin agents were applied to intact skin at pressure-prone sites to prevent pressure ulcers. Active regimens included fatty-acid and hyperoxygenated fatty-acid preparations, silicone dressings, DMSO cream, and other protective lotions or dressings, compared with no dressing, standard care, placebo, or alternative topical controls.

Most trials found no clear benefit or harm overall, and the certainty of evidence was low to very low. Some individual fatty-acid trials suggested benefit, such as 12/164 vs 29/167 in Torra i Bou 2005, while Chiew 2010 found 9/54 vs 9/55. Several silicone dressing trials showed fewer pressure ulcers than no dressing, including 8/177 vs 28/182 in Forni 2018, 1/184 vs 7/182 in Kalowes 2016, 0/45 vs 6/35 in Saab 2015, 7/161 vs 27/152 in Santamaria 2015, and 2/37 vs 11/37 in Nakagami 2007. More high-quality research is needed before firm conclusions can be made.

Evidence was low to very low certainty, with small and heterogeneous trials testing many different products, comparators, and care settings. Outcome definitions, follow-up, and reporting of adverse events varied, and several studies were underpowered or incompletely reported. Generalizability is limited because the evidence base was dominated by older, high-risk patients in institutional care.