An Unexpected Detrimental Effect on the Incidence of Heel Pressure Ulcers After Local 5% DMSO Cream Application: A Randomized, Double-blind Study in Patients at Risk for Pressure Ulcers

Abstract

Background. Ischemia-reperfusion injury and reactive oxygen species (ROS) are considered to play an important role in the pathogenesis of pressure ulcers (PU). Antioxidants may diminish the inflammation and damage of these ROS in pressure ulcer formation. Dimethyl sulfoxide (DMSO) is a hydroxyl antioxidant that inhibits leukocyte adherence. When used topically, DMSO is a safe and well-tolerated drug with excellent penetrating properties. In this prospective randomized study, the effect of topically applied DMSO on the prevention of PU formation is analyzed.

Methods: In a randomized double-blinded study, the effects of massage with or without DMSO creams were assessed against controls for 2 locations (ie, heel and buttocks) in 79 patients prone for development of PU.

Results: There was no difference in PU incidence between the 3 interventions on the buttocks. Surprisingly, the topical 5% DMSO cream group showed an increase in superficial pressure ulcers for the heel location.

Conclusion: This is the first study on the possible role of DMSO in the prevention of PU. The results suggest an adverse effect on PU incidence in heel, whereas on the buttocks the DMSO cream seems to have no effect. Possible explanations for this unexpected detrimental effect are discussed.