Iodine is an essential trace element required for normal thyroid hormone production and metabolic function. As the body cannot synthesise iodine, it must be obtained through dietary sources such as seafood, dairy products and fortified foods (Köhrle, 2023). In wound management, iodine-based products have been used for decades and continue to be valued for their broad-spectrum antimicrobial activity, low risk of resistance and established role in infection control (Nurudeen et al, 2025).

The role of povidone-iodine in modern wound care
PVP-I is an iodophor that enables the gradual, sustained release of free iodine into the wound environment, in contrast to the bolus release associated with earlier iodine formulations (Ibragimova et al, 2025; Sibbald et al, 2011). This provides sustained antimicrobial activity while reducing the toxicity associated with previous iodine preparations.

PVP-I acts across multiple microbial targets, including in the absence of wound fluid, making it suitable for use across a range of wound environments.

These characteristics make PVP-I a practical option for infection management and align with the principles of antimicrobial stewardship (AMS).

Inadine in wound care
Inadine is a non-adherent dressing impregnated with PVP-I, designed to deliver antimicrobial activity directly to the wound surface while protecting newly formed tissue (Solventum, 2025). Its role is to reduce bacterial burden in superficial wounds where infection is present or likely (Gryson et al, 2025). Inadine’s colour-change indicator shows when iodine is depleted and the dressing requires changing (Boothman et al, 2015). This supports appropriate dressing changes and helps avoid under- and over-treatment.

Inadine is most appropriately used in superficial wounds at risk of or showing early signs of infection, including:

• Minor burns
• Acute traumatic wounds
• Post-surgical wounds
• Superficial skin loss
• Some chronic wounds (Harun et al, 2024).

Early intervention can help prevent infection progression and support healing (Hurlow and Bowler, 2022). Inadine is not intended for indiscriminate or prolonged use. It should be used as part of a targeted, time-limited antimicrobial strategy, aligned with current principles of wound bed preparation and AMS (Nair et al, 2023).

The use of antimicrobial dressings on a ‘just in case’ basis, in the absence of clinical signs of infection, is generally not recommended and may contribute to unnecessary antimicrobial exposure. However, their use may be appropriate in wounds that are at increased risk of infection. Inappropriate or excessive use of antimicrobials and antibiotics is a key driver of antimicrobial resistance (AMR) and should be avoided (Fletcher et al, 2025). AMS principles emphasise the need for careful assessment, accurate diagnosis and regular review to ensure that antimicrobial interventions are used only when clinically indicated and discontinued when no longer required (Fletcher et al, 2025). This supports optimal wound healing while helping to preserve the effectiveness of antimicrobial therapies.

Patient selection and safety for Inadine
Current guidance emphasises selecting the right patient, product and timing for antimicrobial intervention based on holistic wound and patient assessment. Figure 1 provides a decision pathway for appropriate short-term use. Assessment should consider wound aetiology, signs of local or spreading infection, comorbidities, concurrent medications and overall patient wellbeing (Tickle, 2023). Recent updates to the IFU for Inadine reinforce the importance of appropriate patient selection, particularly where systemic absorption of iodine may be a consideration (Solventum, 2025). Although absorption from small wounds over short treatment periods is generally minimal, it may increase with larger wound areas, prolonged use and impaired renal function (Sibbald et al, 2011).

The updated IFU distinguishes between contraindications and situations requiring medical supervision:

• Contraindications: Iodine hypersensitivity, thyroid disorders, pregnancy, breastfeeding, patients undergoing radioiodine procedures and severe renal impairment (e.g. stage 4 or 5 chronic kidney disease)
• Situations requiring medical supervision: Patients receiving thyroxine replacement following thyroidectomy or thyroid ablation should be treated based on an individual risk–benefit assessment. Where clinically indicated, renal and thyroid function can be monitored using routine blood tests. Use in newborns and infants up to 6 months of age should be under medical supervision.

Recent updates to the IFU have strengthened guidance regarding the use of PVP-I in patients with severe renal impairment, where systemic absorption of iodine may be a consideration (Solventum, 2025). This includes patients with stage 4 or 5 chronic kidney disease (CKD), corresponding to an estimated glomerular filtration rate (eGFR) of 15–29mL/min/1.73m² and <15mL/min/1.73m², respectively.

Caution is also advised in patients with thyroid disorders because iodine may be absorbed through the skin. In some patients, such as those receiving thyroxine replacement following thyroidectomy or thyroid ablation, or those with treated hypothyroidism, a clinical risk–benefit assessment may be appropriate. Where there are concerns regarding systemic iodine exposure, renal and thyroid function can be monitored using routine blood tests. Additional caution is advised when using PVP-I in infants up to 6 months of age (Boothman et al, 2015). Use in this age group is a precaution requiring appropriate medical supervision rather than an absolute contraindication. As recommendations may vary between PVP-I formulations, clinicians should always refer to the IFU for the specific product.

Povidone-iodine: Addressing common concerns
Concerns around iodine, particularly regarding toxicity and delayed healing, continue to influence clinical decision-making (da Silva Lopes et al, 2024). However, these concerns are often based on historical or non-clinical data. 

Current evidence indicates that PVP-I can reduce bioburden without impairing healing and that slow-release formulations are well tolerated in vivo. Despite more than 150 years of clinical use, no acquired bacterial resistance or cross-resistance to iodine has been reported, in contrast to many other antiseptic and antimicrobial agents (Eggers, 2019). 

Using Inadine in wound care 

Inadine should be applied directly to the wound and covered with a suitable secondary dressing to manage exudate (Sibbald and Elliott, 2017). 

Unlike some antimicrobial dressings that require wound fluid to support antimicrobial activity, PVP-I remains active in low-exudate wounds. Consequently, Inadine may be particularly useful for low-exudate, sloughy, necrotic, ischaemic or dry gangrenous wounds, where antimicrobial activity is required but wound fluid is limited (Sibbald and Elliott, 2017). The non-adherent knitted viscose carrier helps minimise dressing trauma and is suitable for fragile, sloughy, necrotic and gangrenous wounds. Inadine is easy to apply and remove, with well-established antimicrobial efficacy in vitro, in vivo and in clinical practice (Schwarzer et al, 2024).

Dressing change frequency should be guided by:

• Exudate levels
• Infection status
• The colour-change indicator (Sibbald and Elliott, 2017).

In more heavily exuding or infected wounds, more frequent dressing changes may be required. As with all antimicrobial dressings, treatment should be regularly reviewed, time-limited and stepped down once infection is controlled (Pozniak et al, 2025).

Ongoing monitoring should include reassessment of wound characteristics, exudate, infection and patient tolerance, with treatment adjusted as needed to avoid unnecessary antimicrobial use (Clemett, 2025). Failure to progress within 10–14 days should prompt reassessment of the wound and management plan (Sibbald et al, 2011).

The role of Inadine in wound care

Despite the availability of newer antimicrobial technologies, Inadine continues to offer advantages:

• Broad-spectrum efficacy with low resistance risk
• Simplicity across care settings
• A clear visual indicator to guide dressing changes
• Good patient tolerability 
• Cost-effectiveness compared with many alternatives (Bigliardi et al, 2017).

There is a growing need for reliable, easy-to-use and cost-effective wound care products as wound prevalence, healthcare costs and resource pressures increase (Schneider and Himmelsbach, 2024). Products that are simple to apply and monitor help support efficient care delivery.

Conclusion

Inadine remains an effective option for managing local infection in superficial wounds. Updated IFU guidance reinforces appropriate patient selection rather than avoidance of iodine-based dressings. Although the IFU has evolved, the formulation is unchanged and has an established efficacy and safety profile following more than 30 years of clinical use. Used appropriately, Inadine remains a simple, cost-effective antimicrobial dressing with an important role in modern wound care.