Summary of the new 2025 NPIAP/EPUAP guidelines for Preventive Skin Care

Version date: 14 September 2025

Preventive Skin Care

Maintaining skin integrity in all healthcare settings is crucial to prevent infections, pain, and serious complications like chronic wounds, sepsis, or pressure ulcers. As the primary barrier against environmental hazards, intact skin ensures comfort, mobility, and overall quality of life, which is particularly important for older adults or those with reduced mobility. 

Changes to the skin, whether due to ageing, co-morbidities or other factors such as moisture, shear or pressure, make it fragile and easier to damage. It is too late to initiate a structured preventative programme when the damage is already in place, therefore it is vital that we identify issues and risks early and have a consistent skin care regime that uses targeted emollients and barrier products to maintain and protect the skin (Fletcher et al, 2025).  

The Best Practice Statement on Managing Ageing Skin and Maintaining Skin Integrity (2025) highlights how a moisturising /emollient-based skincare regime is key to preventing skin damage and complications which are distressing for patients and challenging for clinicians. Implementing such a regime early in the patient’s care journey can improve patient outcomes and quality of life.

NPIAP and EPUAP (2025) have updated their clinical practice guidelines for preventative skin care and below is a short summary of these guidelines

Promoting skin health is a fundamental component of pressure ulcer (PU) prevention and treatment. Preventative skin care aims to maintain skin integrity, reduce vulnerability to mechanical stress, and enhance comfort and dignity for individuals at risk. Core strategies include structured skin care regimens, optimisation of nutrition, hydration and mobility, and effective prevention and treatment of co-existing skin conditions such as incontinence-associated dermatitis (IAD) or intertriginous dermatitis (use these links to previous clinical articles on Moisture Related Damage 2024). Regular skin care also provides opportunities for quality skin and tissue assessment, enabling early identification of high-risk areas and promoting timely changes to PU prevention plans (Kottner, 2025; Dissemond et al., 2021).

Structured skin care regimes

Regular skin assessment and the introduction of structured skin care regimens are regarded as good practice in pressure ulcer prevention. Targeted skin care supports skin resilience by reducing dryness, inflammation and maceration, thereby improving tolerance to pressure, friction and shear forces (Kottner, 2025). Gentle cleansing and drying, combined with appropriate moisturisation when indicated, are key components of maintaining skin integrity. Skin inspection should occur during routine care delivery and repositioning, with findings documented using standardised terminology to support accurate diagnosis and interprofessional communication (Dissemond et al., 2021). Cleansing frequency should be individualised, as excessive washing may contribute to skin dryness and barrier disruption.

Preventive dressings

Preventive dressings are applied to intact skin to reduce sustained mechanical loading and tissue deformation. The strongest evidence relates to the use of multi-layered soft silicone foam dressings, particularly on the sacrum and heels, in individuals assessed as being at high risk of pressure injuries. Clinical trial evidence demonstrates a reduction in pressure injury incidence compared with no preventive dressing, although certainty of the evidence remains very low (Beeckman et al., 2021). Preventive dressings should be integrated with other prevention strategies such as repositioning and appropriate support surfaces and should be discussed with your Tissue Viability Service as there will be a cost involved. If using preventative dressings, clinicians need to consider some of the reported undesirable effects such as skin itching / irritation due to increased heat under the dressings, reduced opportunities for regular skin assessment due to coverage of the area, increased risk of rucking of dressings causing skin shearing, or epidermal stripping.

Low friction fabrics

Low friction fabrics are designed to reduce shear forces at the skin–support surface interface and improve moisture management. Evidence suggests that their use may be associated with a lower incidence of pressure ulcers in individuals unable to reposition independently; however, the certainty of this evidence is very low (Patton et al., 2024). Potential risks, especially with the use of low friction bootees, including increased fall risk in ambulatory individuals, must be considered and a comprehensive falls risk assessment undertaken prior to their use.

Leave-on topical skin products solely for pressure ulcer prevention

Leave-on topical skin products include oils, creams and emulsions. While meta-analytic evidence suggests a possible reduction in pressure ulcer incidence, the certainty of evidence is very low, and mechanisms of action remain unclear (Patton et al., 2024). Dermatological evidence indicates that some plant-based oils may disrupt the skin barrier, particularly in individuals with impaired skin integrity (Kottner, 2025). As a result, routine use solely for pressure ulcer prevention is not recommended. When applying any skin products, clinicians should avoid massaging / rubbing the skin vigorously as this can cause shear and friction to fragile skin.

The future

The evidence base for preventive skin care interventions is limited by methodological challenges and low certainty. Priority areas for future research include effectiveness of preventive dressings beyond the sacrum and heels, long-term cost-effectiveness, outcomes in specific populations, and improved classification and mechanistic understanding of topical skin products. Greater inclusion of patients’ perspectives and patient-reported outcome measures is also required (Patton et al., 2024).

References 

• Beeckman D, Fourie A, Raepsaet C, et al. (2021). Silicone adhesive multilayer foam dressings as adjuvant prophylactic therapy to prevent hospital-acquired pressure ulcers. British Journal of Dermatology, 185(1), 52–61.
• Wounds-UK (2025) Best practice statement in Managing ageing skin and maintaining skin integrity. Available at https://wounds-uk.com/wp-content/uploads/2025/11/ALI25_BPS_Ageing-Skin-WEB.pdf (Accessed 30.01.26)
• Dissemond J, Assenheimer B, Gerber V, et al. (2021). Moisture-associated skin damage (MASD): A best practice recommendation from Wund-D.A.CH. Journal der Deutschen Dermatologischen Gesellschaft, 19(6), 815–825.
• Fletcher, J. et al (2025). Best Practice Statement. Managing ageing skin and maintaining skin integrity. Wounds-uk. Available at https://wounds-uk.com/best-practice-statements/managing-ageing-skin-and-maintaining-skin-integrity/
• Kottner J. (2025). Skin care products to prevent pressure ulceration? International Journal of Nursing Studies, 167, 105075.
• National Pressure Injury Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Preventive Skin Care. In: Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline: Fourth Edition. Emily Haesler (Ed.). 2025. Available from: https://internationalguideline.com.
• Patton D, Moore ZEH, Boland F, et al. (2024). Dressings and topical agents for preventing pressure ulcers. Cochrane Database of Systematic Reviews, CD009362.