How do I treat road rash?

November 21, 2009 1:59 PM

How should I treat my road rash so that it will heal quickly and not scar?

I had a bike accident last night and scraped and bruised my face fairly badly. It looks like a really bad rash with a small puncture. I cleaned it really well with anti-bacterial soap and Bactine and then doused it with Neosporin. Is there anything else that I should do? Would Arnica help or be bad since it's an abrasion?

posted by Raichle to health & fitness (23 comments total)

I think scaring is largely a genetic question but keeping the area clean and free of infection can't hurt. How to moisturize healing tissue is a tricky issue that nurses and doctors quibble about. (Obviously, you don't want bacteria-breeding moisture.)

Personally, I slap this old-school horse medicine on anything that I don't want to feel tight and dry while the new skin is growing. My derm told me that aloe vera can be the wrong choice for a wounds and scrapes but it's not clear if this was a medical opinion, or just his view.

Although I have a road rash scar on my shoulder that's more than 10 years old, there are places on my cheek and arm that are scar free despite having been pretty seriously peeled at one point thanks to Corona ointment. I'd guess any medicinal goo would do the same.

If you had a good wreck, you might want to see someone just in case you have some small factures. Also, make sure there's no grit or dirt in your eyes.
posted by Lesser Shrew at 2:16 PM on November 21, 2009

This was a bicycle accident, yeah?

I'd check motorcycle forums - these discuss road rash quite often. Also, a doctor ought to know something. ER doctors grow familiar with this type of stuff, though they are not experts. If you can talk to a plastic surgeon, they'll know.
posted by krilli at 2:17 PM on November 21, 2009

Yes, a bicycle accident. That corona stuff looks awesome but by the time it arrives I'll have healed (hopefully) :).

I'll try to go to Student Health on Monday when they open but I don't want to pay for the ER when nothing feels broken.

Thanks!
posted by Raichle at 2:23 PM on November 21, 2009

Bentonite clay is excellent for healing wounds and should speed up the process while easing the pain. You could spray with colloidal silver between clay applications. Highly recommended. Be well.
posted by watercarrier at 2:32 PM on November 21, 2009

I had a spectacular bike accident twenty years ago that, among other things, left me with no skin in a strip from wrist to elbow on the arm I landed on. Copious amounts of Polysporin later, the arm healed without so much as a scar.

I don't know if it's available in the USA, though: the website ends in .ca and I do not see an American site.
posted by ricochet biscuit at 2:34 PM on November 21, 2009

colliodal silver?! no...

i think polysporin is the same or similar as neosporin, which is widely available in US drugstores. it's what i use.
posted by rhizome at 2:35 PM on November 21, 2009

Best of luck.

Just to clarify my vague point: Even if you don't go to the ER, you might have an MD in your extended network somewhere. If you're lucky, they're ER or plastic. If one is casually approachable, it can't help to have a little chat. Buy them coffee, and show what interest you have in the medi-bio-physical regenerative stuff. Some might be happy to talk.
posted by krilli at 2:51 PM on November 21, 2009

Spenco 2nd Skin is pretty good stuff.
posted by box at 3:07 PM on November 21, 2009

Most important thing you can do: Keep the road rash moist. Keeping the wound wet will allow it to heal much faster. If you let it scab, it will scar much worse and the healing time will increase dramatically.

The best way to do this is to dress the wound with a burn bandage. Spenco makes a great product called Second Skin, a clear gel bandage. You can cut it to fit the rash. Expensive, but totally worth it. Change the dressing anywhere from once a day to every two or three days, depending on how much the wound is weeping to your personal discretion.

From my experience, doctors will just tell you to let it scab over. Don't listen to them, for the love of Pete.

I say this as a recreational cyclist, commuter, and bike racer who's tended to many of her own road rash and other wounds.
posted by computech_apolloniajames at 3:11 PM on November 21, 2009

[Whole bunch of comments removed. This is not the place for a general debate about pet treatments/peeves, please stop flooding this thread with that stuff.]
posted by cortex at 3:23 PM on November 21, 2009

OP, colloidal silver is ineffective for ANY medical treatment and can lead to a whole bunch of nasty problems. This is true regardless of the method of administration. Contrary to popular belief, silver compounds are not fungible: like sodium compounds, for instance, they vary widely in their effects. Sloan-Kettering covers it well here: http://www.mskcc.org/mskcc/html/69189.cfm

The takeaway is this: Silver compounds have been used as topical antiseptics but there are no scientific studies to support the oral use of colloidal silver for infection.
posted by Inspector.Gadget at 3:38 PM on November 21, 2009

Oh, and as far as external use: The Food and Drug Administration (FDA) is issuing a final rule establishing that all over-the-counter (OTC) drug products containing colloidal silver ingredients or silver salts for internal or external use are not generally recognized as safe and effective and are misbranded. FDA is issuing this final rule because many OTC drug products containing colloidal silver ingredients or silver salts are being marketed for numerous serious disease conditions and FDA is not aware of any substantial scientific evidence that supports the use of OTC colloidal silver ingredients or silver salts for these disease conditions.
posted by Inspector.Gadget at 3:40 PM on November 21, 2009

computech_apolloniajames has it pretty right. I am recently retired bike racer, I keep a first aid kit specifically for dealing with road rash.

Basic steps:

- get it clean. really clean. this hurts. use something like the Brave Soldier First Defense spray. cuts way down on the pain during cleaning.

- use some anti bacterial goop when you are dressing it.

- keep it moist, use "water" or hydrocolloid bandages, especially on the face. ugly, expensive but worth it. these bandages act as an artificial scab and keep the real scab from forming. it is the real scab that influences a lot of scarring.

- use post surgical netting or a tube cut from a pair of fishnet nylons or an old sock to hold bandages on any arm or leg joints. bandages on the face are a bit trickier to keep in place.

- keep bandages on the wound for a lot longer than you want to. it needs to heal completely or a scab will form and scar when it is exposed to air and dries out. this can take a long time. new skin will eventually form.

- if you get anything that seems like infection, see your doc, asap.

- once the tender new skin has formed, you need to protect it from the sun. wear very heavy sunscreen for a long time. this skin will be sensitive for a few seasons. I had a very fair teammate who spent an entire year with white zinc on her cheekbone after scraping most of the skin off one side of her face and cracking her skull. She did all of the above and has NO scarring.
posted by chuke at 3:47 PM on November 21, 2009 [2 favorites]

This article came up a few times when I was looking into RR treatments a couple of months ago. The bit about Duoderm was intriguing, but I'm not sure how easily you could apply it to the face. It's also said to be a bit pricey. My face rash healed pretty quickly - during the scabby phase, I tried to keep things moisturized (Eucerin) as they got pretty itchy and tight, especially around the mouth/lips.
posted by jquinby at 3:54 PM on November 21, 2009 [1 favorite]

Also, this article gives a very clear description of the above technique, and compares it to traditional wound healing. there are some good illustrating photos. Do it the new way, you will be really, really glad you did.
posted by chuke at 3:56 PM on November 21, 2009

Nthing keeping it moist while it heals— I've collected numerous scrapes from biking and whatnot, and that's the main thing that seems to determine whether the wound produces a lasting scar or not. Plus, it's the same advice that medical professionals always gave me.

Sounds like you've already done the first thing: clean the wound well, using plenty of water get it as clean as you can stand. After that, bandage, with some neosporin or similar to keep it reasonably moist, change the bandage once a day or so until you don't need it.

You mention "a small puncture", so if there's any chance that the puncture is deep enough to hold an infection, esp. scary anaerobic stuff like tetanus, get it looked at by a professional. I think it's OK to wait till Monday for that — assuming no symptoms of infection — but IANAD.

And my pet quack remedy: keep yourself, not just the wound, well-hydrated while you heal. Drink plenty of water, avoid too much caffeine or alcohol.
posted by hattifattener at 4:06 PM on November 21, 2009

Most important thing you can do: Keep the road rash moist. Keeping the wound wet will allow it to heal much faster. If you let it scab, it will scar much worse and the healing time will increase dramatically.

I used to research wound healing. This is good advice. It's difficult though, if it gets too wet the skin will become macerated (that white wrinkly stuff) which makes the skin more fragile, slows healing, and promotes infection. The gel type dressings do a good job because they remove the actual liquid from the wound while still keeping it wet, just make sure you change them often enough (basically if the dressing is overloaded and leaking or the skin starts to go white then change it). You also really want to avoid infection because that will slow healing and promote scarring too. Even subclinical infection can slow healing, the less bugs in there the better. The neosporin was a good move (make sure it's fairly new, moist antibacterial cream is generally only safe or useful for a couple of weeks after the tube's been opened) and a decent dressing will do the rest.

Avoiding infection or irritation is why I'd stay away from stuff like arnica or aloe vera. It's not going to help so don't take the risk, just stick to a good dressing and keeping it clean, moist and non-macerated. If the dressing doesn't work out for some reason then use a plain moisteriser to keep the skin supple, personally I just keep using the antibacterial cream since I know it's not going to screw anything up.
posted by shelleycat at 4:13 PM on November 21, 2009

i like calendula cream - my boyfriend says it helps heal faster than polysporin.
posted by bellbellbell at 4:32 PM on November 21, 2009

After it's healed completely, also remember use sunscreen regularly. The newly healed skin can burn/darken easier for awhile.
posted by ejaned8 at 4:40 PM on November 21, 2009

nthing keeping it moist. If you need OTC salve, Polysporin is my weapon of choice.

I crash a lot.

The last time I had particularly nasty spill and started to get a little infection, my doc prescribed Mupirocin / Bactroban and it healed large patches of road rash on both knees in what seemed like record time (4-5 days) with minimal scarring. This was in conjunction with keeping the area clean and washing, changing the dressings, applying more goo, etc a couple times a day, which I would highly recommend regardless of which medicine you use.
posted by sapo at 4:54 PM on November 21, 2009

Hattifattener, I'm not sure what "deep" is, but the puncture wound seems pretty shallow to me. It's about an 1/8" maybe?

Thanks everyone for the advice. I soaked in epsom salts, put Arnica on all my bruises and coated the road rash with neosporin. I appreciate all the input!
posted by Raichle at 7:07 PM on November 21, 2009

put Arnica on all my bruises

This is not a good idea. The most Arnica is going to do for you is cause minor skin irritation, see here. Arnica has no legitimate medical uses. The Wikipedia page, not surprisingly, has been taken over by alternative medicine "advocates" who make a habit of linking to disreputable sources not backed up by any scientific evidence.
posted by Inspector.Gadget at 9:09 AM on November 22, 2009

Arnica is for bruising. Centuries of use have proved it's efficacy. I would use essential oils in calendula cream (Helychrysum or immortelle, carrot seed, german chamomile and lavender - look up the chemical constituents to see why these work-Salvatore Battaglia and Dr. Penoel are excellent sources). My Dad got hit in the shin with a horseshoe (no longer attached to the horse). Despite treating the wound with polysporin (which is effective at preventing some infections but not a great healing agent-the oils do both), elevation, and a butterfly bandage it failed to heal. I made an ointment with the above ingredients and it healed beautifully. My Dad is in his seventies and has very brittle skin which heals poorly so I was impressed with the results. I am a trained aromatherapist and am consistently amazed at what I can acheive with essential oils.
posted by Wendy BD at 2:28 PM on November 28, 2009