Use of infrared thermography in the early detection of pressure ulcers: a narrative review
Keywords:
pressure ulcers, infrared thermography, nursing, early detection, CareAbstract
Background:
Pressure ulcers constitute a significant public health concern and remain a key indicator of the quality and safety of nursing care. Early identification of tissue damage is essential for effective prevention strategies; however, visual skin assessment is often insufficient, particularly in early-stage lesions and in individuals with higher skin phototypes. Infrared thermography (IRT) has emerged as a non-invasive imaging technique capable of detecting subclinical microvascular and inflammatory changes prior to the onset of visible skin alterations.
Objective:
To synthesise the available evidence on the use of infrared thermography for the early detection, prevention and monitoring of pressure ulcers, with a specific focus on its applicability within nursing practice.
Methods:
A narrative review of the literature was conducted through a structured search of PubMed, CINAHL Complete and Scopus. Original studies published between 2016 and 2025 that examined the application of infrared thermography in patients at risk of, or diagnosed with, pressure ulcers were included. The study identification and selection process was described in accordance with the PRISMA 2020 recommendations.
Results:
Twenty-two studies, predominantly observational in design, were included. The evidence consistently indicated that infrared thermography enables the identification of thermal alterations in intact skin before the appearance of clinically observable signs of pressure-related tissue damage. Additionally, infrared thermography demonstrated utility in monitoring lesion progression and prognosis. Studies evaluating the influence of skin tone reported that thermal patterns were largely independent of skin phototype, highlighting the potential of infrared thermography to mitigate diagnostic inequities associated with visual assessment alone.
Conclusions:
Infrared thermography represents a promising adjunct to conventional nursing assessment for the early detection and management of pressure ulcers. Nonetheless, methodological heterogeneity and the lack of standardised clinical protocols underscore the need for further prospective, multicentre studies to support its widespread clinical implementation.
Downloads
References
European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline. Emily Haesler. EPUAP/NPIAP/PPPIA: 2019.
Li Z, Lin F, Thalib L, Chaboyer W. Global prevalence and incidence of pressure injuries in hospitalised adult patients: A systematic review and meta-analysis. Int J Nurs Stud. 2020 May;105:103546. doi: 10.1016/j.ijnurstu.2020.103546. Epub 2020 Jan 31. PMID: 32113142.
Gorecki C, Brown JM, Nelson EA, Briggs M, Schoonhoven L, Dealey C, Defloor T, Nixon J; European Quality of Life Pressure Ulcer Project group. Impact of pressure ulcers on quality of life in older patients: a systematic review. J Am Geriatr Soc. 2009 Jul;57(7):1175-83. doi: 10.1111/j.1532-5415.2009.02307.x. Epub 2009 May 21. PMID: 19486198.
Coleman S, Gorecki C, Nelson EA, Closs SJ, Defloor T, Halfens R, Farrin A, Brown J, Schoonhoven L, Nixon J. Patient risk factors for pressure ulcer development: systematic review. Int J Nurs Stud. 2013 Jul;50(7):974-1003. doi: 10.1016/j.ijnurstu.2012.11.019. Epub 2013 Feb 1. PMID: 23375662.
Bennett G, Dealey C, Posnett J. The cost of pressure ulcers in the UK. Age Ageing. 2004 May;33(3):230-5. doi: 10.1093/ageing/afh086. PMID: 15082426.
Demarré L, Van Lancker A, Van Hecke A, Verhaeghe S, Grypdonck M, Lemey J, Annemans L, Beeckman D. The cost of prevention and treatment of pressure ulcers: A systematic review. Int J Nurs Stud. 2015 Nov;52(11):1754-74. doi: 10.1016/j.ijnurstu.2015.06.006. Epub 2015 Jun 25. PMID: 26231383.
Díaz-Herrera MÁ, González-Durán M, Rodríguez-Martínez FJ, Tujillo-Flores G, Tuset-Mateu N, Verdú-Soriano J, Gea-Caballero V, Sanllorente-Melenchón A, Almeda-Ortega J, Cunillera-Puértolas O, Acedo-Anta M, Martínez-Riera JR. The financial burden of chronic wounds in primary care: A real-world data analysis on cost and prevalence. Int J Nurs Stud Adv. 2025 Feb 14;8:100313. doi: 10.1016/j.ijnsa.2025.100313. PMID: 40535786; PMCID: PMC12175658.
Bergstrom N, Braden BJ, Laguzza A, Holman V. The Braden Scale for Predicting Pressure Sore Risk. Nurs Res. 1987 Jul-Aug;36(4):205-10. PMID: 3299278.
Norton D, McLaren R, Exton-Smith AN. An Investigation of Geriatric Nursing Problems in Hospital. London: Churchill Livingstone; 1962.
Fuentelsaz Gallego C. Validación de la Escala EMINA: un instrumento de valoración del riesgo de desarrollar úlceras por presión en pacientes hospitalizados. Enfermería Clínica 2001; 11 (3 ): 97-103.
Dhoonmoon L, Nair HKR, Abbas Z, Andrews E, McConnie S, Pearson J, Waheed M, Wijeyaratne M. Wound care and skin tone: Signs, symptoms and terminology for all skin tones. International Consensus Document. London: Wounds International; 2023.
Ring EF, Ammer K. Infrared thermal imaging in medicine. Physiol Meas. 2012 Mar;33(3):R33-46. doi: 10.1088/0967-3334/33/3/R33. Epub 2012 Feb 28. PMID: 22370242.
Nakagami G, Sanada H, Iizaka S, Kadono T, Higashino T, Koyanagi H, Haga N. Predicting delayed pressure ulcer healing using thermography: a prospective cohort study. J Wound Care. 2010 Nov;19(11):465-6, 468, 470 passim. doi: 10.12968/jowc.2010.19.11.79695. PMID: 21135794.
Kesztyüs, D.; Brucher, S.; Wilson, C.; Kesztyüs, T. Use of Infrared Thermography in Medical Diagnosis, Screening, and Disease Monitoring: A Scoping Review. Medicina 2023, 59, 2139. https:// doi.org/10.3390/medicina59122139
Fitzpatrick TB. The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol. 1988;124(6):869–871.
Jiang X, Wang Y, Wang Y, Zhou M, Huang P, Yang Y, Peng F, Wang H, Li X, Zhang L, Cai F. Application of an infrared thermography-based model to detect pressure injuries: a prospective cohort study. Br J Dermatol. 2022 Oct;187(4):571-579. doi: 10.1111/bjd.21665. Epub 2022 Jun 13. PMID: 35560229.
Cai F, Jiang X, Hou X, Wang D, Wang Y, Deng H, Guo H, Wang H, Li X. Application of infrared thermography in the early warning of pressure injury: A prospective observational study. J Clin Nurs. 2021 Feb;30(3-4):559-571. doi: 10.1111/jocn.15576. Epub 2021 Jan 26. PMID: 33258199.
Simman R, Angel C. Early Identification of Deep-Tissue Pressure Injury Using Long-Wave Infrared Thermography: A Blinded Prospective Cohort Study. Adv Skin Wound Care. 2022 Feb 1;35(2):95-101. doi: 10.1097/01.ASW.0000790448.22423.b0. PMID: 34469910.
Aloweni FAB, Ang SY, Chang YY, Ng XP, Teo KY, Choh ACL, Goh IHQ, Lim SH. Evaluation of infrared technology to detect category I and suspected deep tissue injury in hospitalised patients. J Wound Care. 2019 Dec 1;28(Sup12):S9-S16. doi: 10.12968/jowc.2019.28.Sup12.S9. PMID: 31825768.
Xu Y, Xu M, Huang P, Zhu Q, Jiang X, Cai F. Infrared thermography for assessing skin temperature characteristics of postoperative blanching erythema and stage 1 pressure injuries. J Tissue Viability. 2025 Nov;34(4):100963. doi: 10.1016/j.jtv.2025.100963. Epub 2025 Oct 30. PMID: 41207079.
Bilska A, Stangret A, Pyzlak M, Wojdasiewicz P, Szukiewicz D. Skin surface infrared thermography in pressure ulcer outcome prognosis. J Wound Care. 2020 Dec 2;29(12):707-718. doi: 10.12968/jowc.2020.29.12.707. PMID: 33320753.
Koerner S, Adams D, Harper SL, Black JM, Langemo DK. Use of Thermal Imaging to Identify Deep-Tissue Pressure Injury on Admission Reduces Clinical and Financial Burdens of Hospital-Acquired Pressure Injuries. Adv Skin Wound Care. 2019 Jul;32(7):312-320. doi: 10.1097/01.ASW.0000559613.83195.f9. PMID: 31192867; PMCID: PMC6716560.
Lin YH, Chen YC, Cheng KS, Yu PJ, Wang JL, Ko NY. Higher Periwound Temperature Associated with Wound Healing of Pressure Ulcers Detected by Infrared Thermography. J Clin Med. 2021 Jun 29;10(13):2883. doi: 10.3390/jcm10132883. PMID: 34209633; PMCID: PMC8269037.
Lin L, Zhuang D, Guo H, Zheng M, Zhu Q, Xu Y, Jiang X, Cai F. Application of infrared thermography for predicting pressure injury healing: A prospective study. J Tissue Viability. 2025 May;34(2):100857. doi: 10.1016/j.jtv.2025.100857. Epub 2025 Jan 9. PMID: 39826281.
Kanazawa T, Kitamura A, Nakagami G, Goto T, Miyagaki T, Hayashi A, Sasaki S, Mugita Y, Iizaka S, Sanada H. Lower temperature at the wound edge detected by thermography predicts undermining development in pressure ulcers: a pilot study. Int Wound J. 2016 Aug;13(4):454-60. doi: 10.1111/iwj.12454. Epub 2015 Jul 24. PMID: 26212623; PMCID: PMC7949717.
Cox J, Kaes L, Martinez M, Moles D. A Prospective, Observational Study to Assess the Use of Thermography to Predict Progression of Discolored Intact Skin to Necrosis Among Patients in Skilled Nursing Facilities. Ostomy Wound Manage. 2016 Oct;62(10):14-33. PMID: 27768578.
Oohashi F, Ogai K, Takahashi N, Arisandi D, Urai T, Sugama J, Oe M. Increased temperature at the healed area detected by thermography predicts recurrent pressure ulcers. Wound Repair Regen. 2022 Mar;30(2):190-197. doi: 10.1111/wrr.12999. Epub 2022 Feb 18. PMID: 35180332.
Çor O, İlçe AÖ, Demiraran Y. Evaluation of surgery-related pressure injury with infrared thermal camera in the postoperative intensive care unit. J Tissue Viability. 2025 Nov;34(4):100944. doi: 10.1016/j.jtv.2025.100944. Epub 2025 Jul 22. PMID: 40714414.
Miao A, Lin C, Ni Y, Yin S, Lv C, Huang H, Jiang X, Zhou H. Effectiveness of skin interface pressure and temperature monitoring for pressure injury prevention in paraplegic patients: a comparative study. Front Public Health. 2025 Oct 7;13:1521948. doi: 10.3389/fpubh.2025.1521948. PMID: 41127593; PMCID: PMC12537892.
Cwajda-Białasik J, Filipska-Blejder K, Mościcka P. Medical thermography in the diagnosis of pressure ulcers: a narrative review. Journal of Wound Management. 2025;26(2):100-110.
Bates-Jensen BM, Jordan K, Jewell W, Sonenblum SE. Thermal measurement of erythema across skin tones: Implications for clinical identification of early pressure injury. J Tissue Viability. 2024 Nov;33(4):745-752. doi: 10.1016/j.jtv.2024.08.002. Epub 2024 Aug 22. PMID: 39214728.
Jordan K, John GT, Chung A, Asare-Baiden M, Hertzberg VS, Ho JC, Sonenblum SE. Impact of skin tone and cupping on erythema and thermal imaging measurements. Sci Rep. 2025 Nov 27;15(1):42575. doi: 10.1038/s41598-025-24823-w. PMID: 41309734; PMCID: PMC12663286.
Sonenblum SE, Jordan K, John GT, Chung A, Asare-Baiden M, Pelkmans J, Gichoya JW, Hertzberg VS, Ho JC. Impact of skin tone, environmental, and technical factors on thermal imaging. PLoS One. 2025 Sep 10;20(9):e0325091. doi: 10.1371/journal.pone.0325091. PMID: 40929141; PMCID: PMC12422453.
Asare-Baiden M, Sonenblum SE, Jordan K, Chung A, Gichoya JW, Hertzberg VS, Ho JC. A Feasibility Study of Thermography for Detecting Pressure Injuries Across Diverse Skin Tones. medRxiv [Preprint]. 2024 Oct 16:2024.10.14.24315465. doi: 10.1101/2024.10.14.24315465. PMID: 39484234; PMCID: PMC11527050.
Burke OM, Kirsner RS, Elman SA. Retrospective analysis of thermographic imaging in early detection of pressure injuries. Wound Repair Regen. 2025 Jan-Feb;33(1):e70003. doi: 10.1111/wrr.70003. PMID: 39949176.
Burke OM, Bilik SM, Restrepo A, Garcia J, Frischholz ZJ, Pire C, Sepulveda M, Zuniga SV, Zincone LL, Gonzalez G, Cahill J, Guo S, Thichava J, Elman SA. Prospective Evaluation of Thermographic Imaging for Early Detection of Pressure Injuries: A Follow-Up Study. Wound Repair Regen. 2025 Nov-Dec;33(6):e70119. doi: 10.1111/wrr.70119. PMID: 41366606; PMCID: PMC12689484.
Wilson HJE, Patton D, Budri AMV, Boland F, O'Connor T, McDonnell CO, Rai H, Moore ZEH. The correlation between sub-epidermal moisture assessment and other early indicators of pressure ulcer development: A prospective cohort observational study. Part 2. The correlation between sub-epidermal moisture assessment, temperature, epidermal hydration and pain. Int Wound J. 2024 Oct;21(10):e70058. doi: 10.1111/iwj.70058. PMID: 39379178; PMCID: PMC11461043.
Carpenito LJ. Nursing diagnosis: Application to clinical practice. 14th. ed. Philadelphia: Lippincott-Willians & Wilkins; 2013.
NNNConsult. Herramienta online para la consulta y diseño de planes de cuidados de enfermería [Internet]. Elsevier; [cited 2026 Jan 07]. Available from: https://www-nnnconsult-com.mergullador.sergas.es/
Published
Versions
- 2026-04-23 (2)
- 2026-03-31 (1)
How to Cite
Issue
Section
License
Copyright (c) 2026 Revista Enfermeir@s
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
When publishing in the journal Enfermeir@s, the author transfers all exploitation rights of their article to the Illustrious Official College of Nursing of Lugo, which, under the conditions and limitations established by intellectual property legislation, holds the copyright.
Unless otherwise indicated, all content is distributed under an international Creative Commons BY-NC-ND 4.0 license. Any form of reproduction, distribution, public communication, or transformation of this work not included in the Creative Commons BY-NC-ND 4.0 license may only be carried out with the express authorization of the copyright holders, unless an exception is provided by law. You can access the full text of the license at this link: https://creativecommons.org/licenses/by-nc-nd/4.0/deed.gl.
Privacy Policy
Right to Information
For the purposes of Regulation (EU) 2016/679 of April 27, 2016 (GDPR), regarding the protection of individuals concerning the processing of personal data and the free movement of such data, and Organic Law 3/2018 of December 5, on the protection of personal data and guarantee of digital rights (LOPDGDD), the user is informed of the existence of an automated processing system for personal data created by the Official College of Nursing of Lugo and under its responsibility, using the personal data provided during navigation on our website, either at the time of registration or when sending an email message.
Data Controller:
- Legal Name: Official College of Nursing of Lugo
- CIF: Q2766003D
- Address: Avenida de la Coruña 104, Entresuelo B, 27003 - Lugo (Lugo)
- Phone: 982242450
- Email for Communications: colexio@enfermerialugo.org
- Data Protection Officer Contacts:
- Phone: 984283532
- Email: delegadoprotecciondatos@prodasva.org
Purpose of Data Processing:
The purpose of processing your data is described in each of the forms provided on the website where you provide your data.
Legal Basis:
Article 6.1.a) of the GDPR: The data subject has given their consent to the processing of their personal data for one or more specific purposes.
Data Retention and Processing:
Your data will be retained as long as necessary to address your request unless you exercise your right to deletion or until the obligations arising from the purpose for which the data was collected are fulfilled. If necessary, the Official College of Nursing of Lugo will cancel or rectify data that is inaccurate, incomplete, or no longer needed for its purpose, in accordance with current legislation on Personal Data Protection.
Unless otherwise communicated, it is understood that your data has not been modified, that you commit to notifying us of any changes, and that we have your consent to use it to strengthen the relationship between the parties.
The data provided will not be transferred to third parties unless there is a legal obligation.
The Official College of Nursing of Lugo will not create any type of "profile" based on the information provided. No automated decisions will be made based on profiles.
In compliance with Law 34/2002 on Services of the Information Society and Electronic Commerce, Article 21, we will request your consent to send advertising communications that we believe may be of interest to you, via email or other equivalent electronic communication methods.
You have the right to object to and/or withdraw consent for the processing of the aforementioned data at any time without affecting the lawfulness of processing based on consent before its withdrawal, by notifying the data controller at the addresses provided.
Technical and Organizational Measures:
The Official College of Nursing of Lugo adopts technical measures, controls, and procedures of a physical, organizational, and technological nature that are reasonably reliable and effective to preserve the integrity and security of your data and ensure your privacy. However, it assumes no responsibility for damages caused by third-party alterations to users' computer systems, electronic documents, or files.
Additionally, all personnel with access to personal data has been trained and is aware of their obligations concerning personal data processing.
Contracts with our suppliers include clauses requiring them to maintain confidentiality regarding personal data accessed due to the tasks performed. They must also implement the necessary technical and organizational security measures to ensure the confidentiality, integrity, availability, and resilience of personal data processing systems and services.
These security measures are periodically reviewed to ensure their adequacy and effectiveness.
Rights:
Users may exercise their rights of access, rectification, deletion, objection, restriction of processing, data portability, and not being subject to automated individual decisions concerning the data processed, by contacting the data controller at the aforementioned address or via email at colexio@enfermerialugo.org, attaching a copy of their ID or equivalent document. Alternatively, they may contact the Data Protection Officer directly.
If satisfaction is not achieved in exercising their rights, users may file a complaint with the competent Data Protection Authority, which is the Spanish Data Protection Agency. Contact details are available at https://sedeagpd.gob.es/sede-electronica-web/vistas/formNuevaReclamacion/reclamacion.jsf.
BY-NC-ND 4.0