DEPARTMENTS: LETTER TO THE EDITOR
The prevalence of pressure injuries in patients hospitalized in general ICUs is estimated to be between 14% and 56%.1 Regular patient repositioning continues to be one of the main strategies for preventing pressure injuries. Along with this important intervention, several therapies may increase the blood flow to affected skin, including topical pentoxifylline.
Pentoxifylline is a methylxanthine derivative conventionally used for the treatment of intermittent claudication.2 Because pentoxifylline is a vasoactive agent, it can increase tissue perfusion. Pentoxifylline improves blood flow via several mechanisms of action such as increasing erythrocyte and leukocyte elasticity, preventing platelet aggregation, and modulating immunologic activity to produce cytokines (vasodilatory effect). In addition, it possesses anti-inflammatory and antioxidant properties.3 Based on this, topical pentoxifylline may have beneficial effects for patients who are critically ill, such as protecting peripheral vascular health and improving tissue perfusion.
In addition to therapeutic applications for peripheral vascular disease, limited recent studies have shown that this drug can be used locally for the treatment of pressure injury. In a preliminary study including 112 critically ill adult patients, topical pentoxifylline 5% was administered twice a day for 14 days. The results of the study indicated that the size and severity of pressure injuries were significantly decreased.4 By extrapolating these data, these authors hypothesize that topical pentoxifylline could prevent pressure injury, reduce the severity of existing injury, or accelerate the wound healing process.2
However, because of limited evidence, the efficacy of topical pentoxifylline has not been proven, and further research is needed. Further well-designed clinical trials are warranted to determine the effectiveness of topical pentoxifylline in preventing the occurrence of pressure injury among vulnerable populations such as individuals in the ICU. If the results of future studies confirm the effectiveness of the drug, this topical pharmacologic intervention could be an effective, inexpensive, innovative, and safe option for preventing or treating pressure injury.
Abbas Heydari, PhD
Hassan Sharifi, PhD
Ahmad Bagheri Moghaddam, MD, FCCM
Mashhad University of Medical Sciences, Mashhad, Iran
1. Cooper KL. Evidence-based prevention of pressure ulcers in the intensive care unit. Crit Care Nurs 2013;33:57–66.
2. Salhiyyah K, Forster R, Senanayake E, et al. Pentoxifylline for intermittent claudication. Cochrane Database Syst Rev 2015;9:CD005262.
3. McCarty MF, O'Keefe JH, DiNicolantonio JJ. Pentoxifylline for vascular health: a brief review of the literature. Open Heart 2016;3(1):e000365.
4. Najafi E, Ahmadi M, Mohammadi M, et al. Topical pentoxifylline for pressure ulcer treatment: a randomised, double-blind, placebo-controlled clinical trial. J Wound Care 2018;27:495–502.