What Dressing Is Used for Stage 1 and Stage 2 Pressure Ulcers?

Stage 1 and Stage 2 pressure ulcers require different care because the skin is still intact in Stage 1 but has partially opened in Stage 2. For Stage 1, the priorities are pressure relief, moisture control, skin protection, and frequent reassessment; a protective silicone foam or transparent film dressing may sometimes be used when friction or shear is a concern. Stage 2 generally requires a dressing that protects the exposed dermis and maintains a moist wound environment, with silicone foam, hydrocolloid, or transparent film selected according to drainage, location, and surrounding skin.

Pressure ulcers are also called pressure injuries, bedsores, pressure sores, or decubitus ulcers. They develop when prolonged pressure—or pressure combined with shear—damages the skin or underlying tissue, often over a bony area or beneath a medical device.

Important: A dressing is only one part of pressure injury care. Repositioning, pressure redistribution, moisture management, nutrition, and treatment of underlying medical conditions may also be necessary. A healthcare professional should assess the injury and confirm its stage before a treatment plan is selected.

Quick Answer: Which Dressing Is Used for Each Stage?

This table is a general overview, not a fixed prescription. Dressing choice should also consider exudate, pain, surrounding skin, incontinence, infection risk, the need for frequent inspection, and whether the dressing will remain secure at the affected body site.

What Is a Stage 1 Pressure Injury?

A Stage 1 pressure injury has intact skin. The affected area may show persistent, non-blanchable redness in lighter skin tones or a change from the person’s usual skin color in darker skin tones. Changes in temperature, firmness, softness, or sensation may also occur.

Stage 1 should not be described as an open wound. However, intact skin does not mean that the problem is minor. Tissue damage may already be developing beneath the surface.

Assessment should include both visual and tactile examination because pressure-related changes may look different across skin tones. The pressure injury staging resources for clinicians and caregivers published by the National Pressure Injury Advisory Panel include educational materials for recognizing and classifying pressure injuries in different skin tones.

Not every temporary red mark is a Stage 1 pressure injury. A qualified healthcare professional should determine whether the discoloration is pressure-related and distinguish it from conditions such as:

• Incontinence-associated dermatitis
• Moisture-associated skin damage
• Medical adhesive-related skin injury
• Bruising
• Friction injury
• Allergic or irritant dermatitis

What Is a Stage 2 Pressure Injury?

A Stage 2 pressure injury has partial-thickness skin loss with exposed dermis. It commonly appears as a shallow, moist, pink or red wound. It may also appear as an intact or ruptured blister.

A true Stage 2 pressure injury generally does not contain:

• Visible fat
• Granulation tissue
• Slough
• Eschar
• Exposed tendon, muscle, or bone

If deeper tissue, yellow or black material, undermining, or significant depth is visible, the wound may not be Stage 2 and should be professionally reassessed. Accurate staging requires training because pressure injuries must also be distinguished from skin tears, moisture damage, burns, and other wound types.

What Dressing Is Used for a Stage 1 Pressure Ulcer?

A Stage 1 pressure injury does not automatically require a wound dressing because the skin is still intact. The most important interventions are:

• Removing or redistributing pressure
• Repositioning the person
• Reducing friction and shear
• Keeping the skin clean and appropriately dry
• Managing incontinence and perspiration
• Inspecting the area frequently
• Correcting problems caused by mattresses, chairs, footwear, or medical devices

Pressure Relief Comes First

A dressing placed over a Stage 1 area will not remove the pressure that caused the tissue damage. The person may need a different mattress, seat cushion, heel-offloading device, repositioning plan, or adjustment to a medical device.

The affected area should not be massaged. Rubbing tissue that is already showing pressure damage may add mechanical stress.

When Might a Protective Dressing Be Considered?

A preventive dressing may be considered for individuals at high risk of pressure injury when intact but vulnerable skin is exposed to ongoing pressure, friction, or shear.

Current international guidance suggests considering a multilayered soft silicone foam dressing for the sacrum and heels of individuals assessed as being at high risk, where resources permit. Clinical studies have reported lower pressure injury rates when these dressings were added to a standard prevention plan. However, the certainty of the evidence remains limited, and most available research relates specifically to the sacrum and heels.

Two principles are especially important:

• A preventive dressing is an addition to repositioning, pressure-redistributing support surfaces, and offloading—not a replacement for them.
• The available evidence mainly applies to multilayered soft silicone foam dressings. It should not be assumed that every thin foam pad or adhesive dressing provides the same preventive effect.

A healthcare professional may consider a preventive dressing for:

• The sacrum
• The heels
• Other vulnerable bony prominences exposed to friction or shear
• Skin beneath or beside a medical device, when appropriate for the individual care plan

Multilayered Soft Silicone Foam Dressing

A multilayered soft silicone foam dressing may provide cushioning and help reduce direct friction against bedding, clothing, or equipment. When used on intact skin for pressure injury prevention, it should remain part of a broader prevention plan.

Several practical rules apply:

1. Continue pressure relief measures. Repositioning schedules, pressure-redistributing mattresses or cushions, and heel offloading should continue while the dressing is in place.
2. Inspect the skin underneath at least daily. The dressing should be lifted and resecured, or replaced, according to the care plan so the underlying skin can be assessed. Failure to inspect the area may delay recognition of worsening tissue changes.
3. Keep the dressing flat and secure. Wrinkles, curled edges, or bunching may create additional friction or localized pressure.
4. Replace the dressing when necessary. It should be replaced if it becomes loose, dislodged, excessively moist, soiled, or unable to remain flat.
5. Reassess if problems develop. The area should be reviewed if discoloration increases, the skin becomes irritated, moisture accumulates beneath the dressing, or the adhesive causes a reaction.

For the heel, a preventive dressing must not replace heel elevation or another appropriate offloading method. Even with a dressing in place, the heel should continue to be fully relieved from contact pressure according to the care plan.

Transparent Film Dressing

A transparent film may sometimes be considered when:

• The skin remains intact
• There is no wound drainage
• The primary goal is reducing superficial friction
• The clinician needs to continue observing the skin

Film dressings are thin and allow visual inspection, but they provide little cushioning and do not absorb meaningful amounts of fluid. They may not be suitable if the skin is very fragile, moist, or easily damaged by adhesive removal.

What Should Be Avoided for Stage 1?

Avoid:

• Continuing pressure on the area
• Massaging persistent discoloration
• Applying tight wraps
• Using donut-shaped rings that concentrate pressure around their edges
• Stacking several thick dressings
• Ignoring skin changes because the area is not open
• Assuming the dressing alone is sufficient

What Dressing Is Used for a Stage 2 Pressure Ulcer?

Stage 2 pressure injuries generally need a dressing that:

• Protects exposed dermis
• Maintains an appropriately moist wound environment
• Manages the expected amount of drainage
• Minimizes friction and shear
• Protects the surrounding skin
• Can be removed without unnecessary trauma

Current clinical recommendations for pressure ulcer care advise considering a dressing that supports a warm, moist wound environment for Category 2 and more advanced pressure ulcers. Dressing decisions should also take the ulcer’s location, amount of exudate, pain, tolerance, and expected change frequency into account.

No single dressing is best for every Stage 2 pressure injury. Selection should be based on the individual wound rather than a universal “best dressing” claim.

Silicone Foam Dressing

A bordered silicone foam dressing may be considered for some Stage 2 pressure injuries with low to moderate drainage.

It may be useful when the wound needs:

• Absorption of exudate
• Soft cushioning
• Protection from external friction
• A water-resistant outer layer
• Gentler adhesion to the surrounding skin
• A dressing that conforms to the affected body area

A typical silicone foam dressing contains a soft silicone contact layer, an absorbent foam core, and an outer protective film.

It may be particularly practical for areas exposed to repeated friction or movement, provided the dressing does not curl, bunch, or create a new pressure point.

A foam dressing may not be appropriate if:

• The wound is dry
• The dressing is too bulky for the location
• There is heavy drainage beyond its capacity
• The surrounding skin cannot tolerate adhesive
• Frequent direct inspection is required
• Infection or deeper tissue involvement is suspected

Hydrocolloid Dressing

A hydrocolloid dressing may sometimes be selected for a shallow Stage 2 pressure injury with low to moderate drainage and no suspected infection.

Hydrocolloids interact with wound fluid and form a gel beneath the dressing. This can help maintain a moist environment and provide extended coverage.

They may be less suitable when:

• Drainage is heavy
• Infection is suspected
• The wound needs frequent inspection
• The surrounding skin is very fragile
• The dressing is repeatedly exposed to stool, urine, or heavy perspiration
• Adhesive removal is likely to damage the skin

The gel produced beneath a hydrocolloid can look yellow or cream-colored and may be mistaken for pus. This does not automatically indicate infection, but any unusual odor, increased redness, warmth, swelling, or clinical deterioration should be assessed.

Transparent Film Dressing

A transparent film may be considered for a very shallow Stage 2 injury with minimal drainage when continued visual inspection is helpful.

Film dressings:

• Protect against external contamination
• Reduce direct surface friction
• Allow the wound to remain visible
• Are thin and flexible

However, they do not provide substantial absorption or cushioning. A film is usually inappropriate if the wound is producing enough drainage to collect beneath it or damage the surrounding skin.

Non-Adherent Contact Layer with a Secondary Dressing

A non-adherent contact layer may be considered when the exposed wound surface is delicate and there is concern about the primary dressing sticking during removal.

Drainage passes through the contact layer into a secondary absorbent dressing. This approach may be helpful when the wound bed needs protection but absorption requirements exceed what a simple contact layer can provide.

Dressing Choice Depends on More Than the Stage

Pressure injury stage describes the depth and tissue involvement, but it does not provide all the information needed to select a dressing.

A warm, moist environment can support wound management, but too much retained fluid can cause maceration. The goal is moisture balance—not allowing the wound to dry out completely and not trapping more fluid than the dressing can handle.

For additional context on foam, hydrocolloid, film, alginate, antimicrobial, and other options, review a broader overview of dressing options and selection factors.

Does the Location Change the Dressing Choice?

Yes. The affected body site can influence dressing shape, thickness, adhesive border, and the required pressure-relief strategy.

Sacral Pressure Injuries

The sacral area is exposed to:

• Pressure from lying or sitting
• Shear when sliding in bed
• Perspiration
• Urine or stool
• Dressing movement during repositioning

A sacral-shaped silicone foam dressing may conform better to the anatomy than a standard square dressing. Its shape may help reduce gaps, wrinkles, and premature lifting.

However, a sacral foam dressing does not replace:

• Regular repositioning
• A suitable mattress
• Safe transfer techniques
• Incontinence management
• Skin cleansing and protection

Heel Pressure Injuries

Heel pressure injuries require special attention because simply covering the heel does not remove contact pressure.

The heel may need to be fully offloaded or “floated” using an appropriate device or positioning method. The dressing and offloading device should be checked to ensure that straps, seams, or edges are not creating new pressure.

Pressure Injuries Near Joints

Elbows, knees, ankles, and other moving areas can cause dressing edges to roll or lift. The dressing should:

• Conform to the body contour
• Remain flat during movement
• Avoid restricting circulation
• Not create a raised ridge beneath clothing or equipment
• Be inspected after repositioning

Pressure Relief Is Essential at Every Stage

Stage 1 and Stage 2 pressure injuries will remain exposed to damage if the underlying mechanical force is not corrected.

Pressure management may involve:

• Repositioning in bed
• Weight shifting when seated
• A pressure-redistributing mattress
• A suitable wheelchair cushion
• Heel-offloading devices
• Reducing time spent on the injured area
• Reviewing mobility and transfer techniques
• Checking oxygen tubing, braces, masks, splints, and other devices
• Correcting sliding or slumping in bed or a chair

The appropriate repositioning schedule should be individualized. It should consider the person’s mobility, skin condition, support surface, comfort, medical condition, and ability to reposition independently.

Do not use a dressing as permission to continue loading the affected area.

How Often Should the Dressing Be Changed?

There is no single dressing-change schedule for every Stage 1 or Stage 2 pressure injury.

Change frequency depends on:

• Dressing type
• Drainage amount
• Wound location
• Adhesive condition
• Exposure to moisture or incontinence
• Surrounding skin
• Manufacturer’s instructions
• The clinical care plan

A dressing should be assessed or changed earlier if:

• Drainage reaches the absorbent border
• Fluid leaks from the edges
• The dressing becomes loose
• The dressing curls, folds, or moves
• It becomes contaminated with urine or stool
• The surrounding skin becomes white, soft, or irritated
• A new odor develops
• Redness or swelling increases
• The wound appears deeper
• The dressing is causing pressure

Do not leave a saturated or contaminated dressing in place simply because the maximum suggested wear time has not been reached.

Stage 1 areas covered by a preventive dressing still need regular skin assessment. The dressing may need to be lifted or changed according to the care plan so the tissue beneath it can be examined.

When to Contact a Healthcare Professional

Contact a healthcare professional when a pressure injury is first suspected, particularly if the person has limited mobility, diabetes, vascular disease, reduced sensation, poor nutrition, incontinence, or a serious underlying illness.

Seek prompt or urgent assessment if:

• Stage 1 discoloration persists or worsens after pressure is removed
• A blister opens or the wound becomes larger
• Yellow, brown, or black tissue appears
• Fat, tendon, muscle, or bone becomes visible
• Redness or warmth spreads
• Swelling increases
• Pus or cloudy drainage appears
• A strong or unusual odor develops
• The person has fever, chills, or feels unwell
• Pain suddenly increases
• The skin becomes purple, maroon, blue, or black
• The wound is beneath a medical device
• The injury cannot be clearly staged
• The current dressing repeatedly leaks or damages the skin

A Stage 2 classification describes wound depth; it does not mean that the wound is infected. Infection must be evaluated using the full clinical picture.

Can FRESINIDER Silicone Foam Dressing Be Used for a Stage 2 Pressure Injury?

When a healthcare professional recommends a bordered absorbent foam dressing, FRESINIDER may be considered for some Stage 2 pressure injuries with low to moderate drainage. You can review the available bordered foam dressing sizes and construction before discussing suitability with a wound care professional.

The dressing combines:

• A soft silicone contact layer
• An absorbent foam core
• A breathable, water-resistant outer film
• An adhesive border for fixation
• Multiple size options

The absorbent pad should completely cover the open area, while the adhesive border should rest on intact surrounding skin. The dressing should lie flat without wrinkles, stretched edges, or excessive bulk.

A silicone foam dressing does not replace:

• Wound assessment
• Accurate pressure injury staging
• Repositioning
• Pressure redistribution
• Infection treatment
• Nutrition assessment
• Incontinence management
• Appropriate support surfaces

For a sacral injury, a dressing designed to follow the sacral contour may be more practical than a square dressing. Dressing shape and size should be selected according to the wound location and care plan.

Frequently Asked Questions

Does a Stage 1 pressure ulcer need a dressing?

Not always. Because Stage 1 skin remains intact, pressure relief, moisture control, friction reduction, and close monitoring are the priorities. A protective silicone foam or transparent film dressing may sometimes be considered if friction or shear remains a concern.

Is a silicone foam dressing suitable for a Stage 2 pressure ulcer?

It may be suitable for some Stage 2 wounds with low to moderate drainage, especially when absorption, cushioning, and gentle adhesion are needed. Suitability depends on the wound location, drainage, surrounding skin, and overall pressure-relief plan.

Can a hydrocolloid be used on a Stage 2 pressure ulcer?

A hydrocolloid may be used for certain shallow Stage 2 injuries with low to moderate drainage and no suspected infection. It may not be appropriate for heavy drainage, fragile skin, frequent inspection, or suspected infection.

Can transparent film be used on a Stage 2 pressure injury?

Transparent film may be considered for a very shallow injury with minimal drainage. It does not absorb much fluid, so it is not suitable when exudate is collecting beneath the dressing.

Should a Stage 1 pressure injury be left open to air?

The goal is not simply to expose the skin to air. The area needs pressure relief, protection from friction and moisture, and regular assessment. Whether a protective covering is used depends on the person’s skin and risk factors.

Can You Massage a Stage 1 Pressure Injury?

Massaging an area with persistent pressure-related discoloration is generally not recommended because rubbing may add mechanical stress to already vulnerable tissue.

Is Every Stage 2 Pressure Ulcer Infected?

No. Stage 2 refers to the depth of tissue loss, not infection status. Infection must be assessed separately based on clinical findings.

How Quickly Can Stage 1 Become Stage 2?

There is no fixed timeframe. Progression depends on the intensity and duration of pressure, shear, circulation, skin condition, mobility, nutrition, and overall health. Continued pressure can lead to further damage, so early action is important.

Final Thoughts

Stage 1 and Stage 2 pressure ulcers should not be managed with a one-size-fits-all dressing rule.

For Stage 1, the skin remains intact, so removing pressure, controlling moisture, reducing friction, and monitoring the tissue are the main priorities. A silicone foam or transparent film dressing may sometimes be added for protection, but the dressing cannot replace pressure redistribution.

For Stage 2, the skin is partially open. A dressing that protects exposed dermis and maintains moisture balance is usually needed. Silicone foam, hydrocolloid, transparent film, or a non-adherent contact layer may be considered according to drainage, wound location, and surrounding skin.

The right dressing supports the care plan, but repositioning and pressure relief remain essential at every stage.

Medical Disclaimer

This content is intended for general educational purposes only and does not constitute medical advice, diagnosis, or treatment. Pressure injuries can worsen even when they appear shallow or cause little pain. A qualified healthcare professional should assess the wound, confirm the stage, select the dressing, and create an individualized pressure-relief plan. Seek prompt medical care for spreading redness, warmth, swelling, pus, foul odor, fever, darkened tissue, visible deeper structures, or rapid deterioration.

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