Infected knee scrapes suck.

June 3, 2011 4:38 PM

Infected scrapes on my knees -- advice for proper treatment?

Well, I fell down on some grizzled asphalt while skating down a ramp Tuesday night and scraped both of my knees pretty badly. The wounds aren't deep, thankfully, but they are fairly big.

Here's a picture of one of my knee scrapes, which as you can see, is infected: http://i54.tinypic.com/fleyvb.jpg

I didn't do a good job at all properly cleaning my scrape after the injury, and didn't apply antiseptic (I used New-Skin Liquid Bandage) over the entire wound until more than 24 hours later. What's worse is that I put the solution on without having removed all of the grit and dirt from my knee (I know for a fact that there is nothing stuck inside the wound, though), and that I didn't allow my wounds to properly air out. Very stupid of me, but hey, you live and you learn.

I thoroughly soaped and washed my wounds, then applied a layer of Neosporin over them before heading to bed. I woke up this morning feeling less pain than I did the previous couple days, but have noticed pain resurface and pus emanate from the wounds occasionally throughout the afternoon -- I'm assuming this is just my immune system fighting the bacteria in the wound. The pain is enough to cause me some grief walking and sitting down.

I know it's only been a few days since the accident, and I'm not freaking out, but I would like to take the proper measures to treat my wounds to prevent any serious infection or risk of illness, and to speed up the recovery process if possible.

Am I handling my wounds properly? I haven't used any hydrogen peroxide to clean my wounds, as I've read that it irritates the skin and kills white blood cells that help fight infection. Right now, all I plan on doing is washing my wounds night and day with soap and water, and applying Neosporin afterwards, wiping off the occasional seeping of pus with a paper towel. Should I just continue to do that and sit & wait over the next few days? Do you have other recommendations for treating my wounds? Also, can I avoid having to make a trip to the doctor, without the infection getting too bad?

Suggestions and help much appreciated!

Thanks!

posted by matticulate to health & fitness (31 answers total)

Try coating one with raw (unpasteurized) honey.
posted by zia at 4:46 PM on June 3, 2011

I don't know if this is the best way to go about it--it certainly isn't the most comfortable--but it was how our wounds were treated growing up, and despite being a pair of rambunctious, clumsy, injury-prone kids, my brother and I are healthy and relatively scar-free adults.

Whenever we had a wound that looked like that (and usually it was my brother, since he was the one rolling around in dirt and grit), we'd get scrubbed on with a hot, soapy washcloth and then douse with hydrogen peroxide. That part suuuuucks, but it does get the wound clean. You may want to grab an extra washcloth to bite down on. Then just put on a nice coating of neosporin (with a q-tip or very clean finger) and cover with gauze (taped down only at the edges so it can "breathe). As time goes on, just continue putting on neosporin and changing the gauze.
posted by phunniemee at 4:49 PM on June 3, 2011 [1 favorite]

Hydrogen peroxide kills healthy tissue. Use salt water instead.
posted by Specklet at 5:04 PM on June 3, 2011

You say the wounds are infected, what evidence is there for this? Heat is what you should be wary of, around the wound. That is infection.
posted by fire&wings at 5:09 PM on June 3, 2011

All antiseptics kill indiscriminately, although hydrogen peroxide does seem to be worse than the rest. Bottom line, you will be killing your white blood cells, but you have more, and you'll be making short work of everything they've been fighting.
Soap+water+neosporin is always a good combination, don't forget to disinfect your hands before cleaning the wound.
Lastly what are you using to cover the wound? I'm pretty sure New Skin is meant more for smaller wounds and for closing deep ones, for something like this you'd be better off with gauze.
posted by marakesh at 5:24 PM on June 3, 2011

Tegaderm did wonders for my recent raw oozing sunburn. It was recommended by folks who've used it very succesfully on scrapes.
posted by mollymayhem at 5:26 PM on June 3, 2011

I would take a shower and wash the injuries thoroughly then apply triple antibiotic ointment rather than just Neosporin. Keep the wounds bandaged - latest studies show that keeping injuries like that covered with antibiotic ointment and a sterile dressing will heal quickest, cleanest. Watch for red streaks or heat - signs that you might need more treatment. I'd use big bandaids not new skin or gauze.
posted by leslies at 5:27 PM on June 3, 2011

Yeah, there is definitely heat around the wound. It's a different kind of pain (it's "hotter") than I'm used to from almost every other scrape I've had in recent memory (I've had quite a few, though not as big as the one pictured in the image). A number of my friends also tell me that they think the wounds are infected, based on looking at them and on my description of the symptoms, so I'm going to plan my treatment as though the wounds are infected.

I just washed my wounds again with soap & water and will be applying some Neosporin, then tape sterile gauze over them.
posted by matticulate at 5:31 PM on June 3, 2011

Scrub it with a clean washcloth and a new bar of soap, liberally apply triple antibiotic ointment and cover with clean gauze. Depending upon how pussy it gets, change the gauze either once or twice a day. If it doesn't start to get better in a couple of days, you should go to the doctor, there's some nasty bugs out there.
posted by The Light Fantastic at 5:32 PM on June 3, 2011

Soak your knees in the warmest water you can stand at least once a day for the next several days. Soaking in a hot bath would be just the ticket for this. Then let the wound get some air when possible. Germs like to grow in moist places, so keeping it covered with a band-aid all the time will slow healing. If it's getting irritated, you can keep it covered during the day, uncovered while you sleep. Fire&wings is right, the real concern would be if the skin around the wound was getting hot, with redness spreading away from the wound. If you see this happen, see a doctor sooner than later.
posted by goggie at 5:53 PM on June 3, 2011

I think you are doing fine with a twice a day gentle wash and liberal applications of neosporin/ bacitracin/polymixin/whatever antibiotic ointment. I think that all the white on the wound will eventually turn to scab if you give it a chance to dry out. Don't keep it too wet.

And don't don't don't use peroxide. That is old stuff, no longer recommended for wound cleaning.
posted by SLC Mom at 5:55 PM on June 3, 2011

If it's oozing pus 2-3 days after the injury that sure sounds infected to me, but IANAD. (Assuming it's pus and not that almost-clear oozing that abrasions sometimes do?)
posted by hattifattener at 6:00 PM on June 3, 2011

IANAD. I got a nasty infected cut on my foot in college - it looked bad enough to scare me a little. I scrubbed it down with soap and hot water twice daily, cleaned it with hydrogen peroxide afterward (but as per comments, perhaps you should use salt water), coated it liberally in neosporin and bandaged it up. The main thing was that the first time I scrubbed it out, I basically scrubbed off a lot of the scabbing/dead skin/ick/feeble beginnings of new skin and it got kind of raw again, but that was okay. I started to see improvement in 24 hours and it cleared up on its own.
posted by Frowner at 6:02 PM on June 3, 2011

I'm not sure how hard it would be to find hydrocolloid bandages large enough, and they wouldn't be cheap, but they're an incredible advance over band-aids. Immediate relief and quick healing. They're one of those products that I can't believe it took me so long to try.
posted by daisyace at 6:04 PM on June 3, 2011 [1 favorite]

Why wouldn't you go see a doctor? If it is really infected, you are risking your leg, and your life. I know, it is not likely that you will, but don't risk it. Go see your GP and have a nurse clean it and get a prescription for generic antibiotics.

This happened to me in high school, a little more deep than yours, but a trip to the emergency room taught me to never mess around with this stuff.
posted by TheBones at 6:11 PM on June 3, 2011 [1 favorite]

Scrub it with a clean washcloth and a new bar of soap, liberally apply triple antibiotic ointment and cover with clean gauze. Depending upon how pussy it gets, change the gauze either once or twice a day. If it doesn't start to get better in a couple of days, you should go to the doctor, there's some nasty bugs out there.

I did exactly this and ended up in the emergency room where they had to cut away the necrotic tissue and give me cipro. They said I could have lost my leg if it hadn't been caught by then.

My situation is different than yours, this is just anecdata.
posted by TheBones at 6:13 PM on June 3, 2011 [1 favorite]

keeping it covered with a band-aid all the time will slow healing.

This is, to my understanding, the exact opposite of the truth. Wounds heal fastest when moist and covered.
posted by Justinian at 6:23 PM on June 3, 2011 [2 favorites]

If you haven't scrubbed the New-skin bandage stuff off already, please do so. It is inadvertently keeping all the awfulness inside.

I had a similar scrape, and it wasn't healing particularly well. A day spent in a lake brought it right around.

(I wouldn't, however, soak in a tub. Don't want to spread the bacteria around. If it is something noxious, you don't want it getting up into your business, or other wounds. Take a hot shower, scrub with soap(*), apply neosporin, put on a bandage. Take off bandage after a few hours, take another shower, repeat. If it doesn't start getting better after another couple of days, seek medical attention. Immediately if it starts to get worse.)

(*) Don't use anti-bacterial soap. Some people (lots of people) have issues with the Triclosan in there, causes skin irritation. You don't want skin that is trying to heal to be irritated.
posted by gjc at 6:30 PM on June 3, 2011

keeping it covered with a band-aid all the time will slow healing.

This is, to my understanding, the exact opposite of the truth. Wounds heal fastest when moist and covered.

More art than science, I think. You for sure don't want to keep the same bandage on for very long. Once the skin has closed up, you can basically do what you want. Let a scab build, or keep it moist and no scab, but slower healing. (I think.)
posted by gjc at 6:32 PM on June 3, 2011

Well, yes, you don't want to keep the same bandage on a moist wound for a long time.

OP, I'm big on avoiding doctors when possible and think many people use them too often. But make sure you don't screw around with infections of shallow-but-wide skin abrasions. That's like MRSA heaven.
posted by Justinian at 7:01 PM on June 3, 2011

Four words: MRSA
Methicillin-resistant Staphylococcus aureus

Treat it like a normal infection with all the good advice given above, but if it gets more painful, hotter, nastier--get thee to an ER. Check out pics here
posted by BlueHorse at 7:18 PM on June 3, 2011

From the photo, the wound looks terribly wet. Wet is more comfortable (a dry wound will be tighter and harder to bend), but if it's wet like that from being covered you should probably let it get some air.

I would say that I play moderately fast and loose with wounds and if that happened on Tuesday and it didn't look dramatically better by 10am tomorrow I'd go to urgent care and get oral antibiotics and maybe a tooth-clenching debridement if they deem it necessary (ask for a round of Vicodin first).

But, if you let it dry out, AND don't let it be irritated (so wear shorts and not jeans or pants), and wash it now and in 6 hours with soap maybe with triclosan if you think it's not causing irritation, you could play it by ear a little longer. If there is a definable red margin around the edges, use a fine-point pen (Sharpie if you've got it) to dot or draw around the edge of the red. If it recedes between now and start of business hours, you're probably on top of it. If it crawls past the margins, go ahead and get it looked at. You don't want to push it to Sunday, when it's harder to get non-ER treatment, if it's getting worse.
posted by Lyn Never at 11:37 PM on June 3, 2011

Dude, you will be just fine. I think you should dry it out a bit..
posted by kuatto at 11:40 PM on June 3, 2011

After a good cleaning by a method described above, I'd give it another 24 hours before going to urgent care. If the infection gets worse it could be cellulitis (Im on a phone so no link, but you can get an eyeful at Google images) which often requires IV antibiotics. Ask me how I know.
posted by ImproviseOrDie at 12:38 AM on June 4, 2011

Umm, these are not my knees, but they do not look infected to me. That looks like healthy healing tissue. You'll be looking at low-level infection when you get a layer of green pus over the top. Tasty! Even that can be treated with a gentle hydrogen peroxide wash.

The fact they are hot doesn't indicate anything other than healing to me. However, I think what is throwing you is that you are looking at this as a normal cut/scrape and are confused as to why it isn't healing like one; that's because what you actually have is road rash - it's a burn wound.

I know this because I had an injury exactly like that photo after an accident, with the pleasant addition of my snapped collar bone sticking out through the wound. The scarring was horrendous. Because it's on a moving joint, the healing time is approximately forever. The heat pours off it. Walking hurts like a bitch. I don't know what to tell you; it just sucks. Here is some good info on treatment. In my case, treatment was Tegaderm over a clean wound with neosporin to keep it moist. IT MUST STAY MOIST. Under no circumstance do you want to be peeling healing skin off when it gets sticky. Just really, really trust me on this.
posted by DarlingBri at 3:44 AM on June 4, 2011

I sure as hell ain't your or anyone's doctor. That said, DarlingBri is right on the money here. Moist good, pretty much vital on a joint like the knee. If the wound is allowed to dry it will crack open every time you flex your knee and stay open for much much longer, simply prolonging your exposure to infection. Big bummer that you didn't clean it out right away - that is of true concern and most likely the cause of the pus. If you have insurance and can afford it, there's really no reason not to go to a doctor and get the wound cleaned properly right now.

If you plan to clean a wound that's only this size yourself, a good product for that is HibiClens instead of soap. In fact, do not use soap on the wound if you're using HibiClens because the soap will neutralize the cationic surfactant in it that has the antimicrobial action. It should be in the drugstore first aid section in a green box.

Once the wound is clean, Neosporin not only is a good topical triple antibiotic, it helps with the moistness. A wet bandage product called Second Skin is a wonderful thing. I think it's what daisyace is talking about above. Coupled with a clean wound and neosporin, these get put on for a day or two at a time and speed healing and seriously reduce scarring. You may need to shop around for this. First aid section again, blue box.

The redness you display and the heat seems normal. The moment you see any tendrils of redness radiating away from the wound, get thee to a hospital as fast as you can. Needless to lose your leg or life for a scraped knee.

If you don't know exactly when you've had a tetanus shot you really need one. Good luck.
posted by buzzv at 5:22 AM on June 4, 2011

This article on road rash is aimed primarily at competitive cyclists, but it offers outstanding advice for treating nasty skin abrasions even if you're not in the middle of a race. I dug this article out last weekend after getting a bit of road rash myself. I followed the low-budget instructions and have been rewarded with nice, pink, healthy, granulating tissue.
posted by timeo danaos at 7:51 AM on June 4, 2011

I'm not a doc, so the following statement could be wrong (corrections invited): if it is infected, no amount of cleansing or self-treatment is going to help. Instead, you need anti-biotics. The danger is that the infection can end up in your bloodstream.

I had an infected elbow, with the redness and swelling working its way down my arm. Went to "urgent care" where the doc had me on an intraevenous anti-bio inside of 20 minutes, followed by pills at home. Problem solved.

So watch this closely for signs of infection. In addition to other indicators, take your temp periodically. Don't mean to be alarmist since most scrapes and cuts seem to take care of themselves, especially if properly treated from the start. But it is a potentially dangerous situation.
posted by Kevin S at 1:47 PM on June 4, 2011

Kevin S: "I'm not a doc, so the following statement could be wrong (corrections invited): if it is infected, no amount of cleansing or self-treatment is going to help. Instead, you need anti-biotics."

This is absolutely not correct. The human body is fully capable of fighting off bacterial infections. Were it not, we'd all be dead. Your body is squirming with bacteria; it is kept in check, and (when necessary) fought off by your immune system. That is what it is there for. Sometimes it is not sufficient and you do need antibiotics, but not nearly as often as they are given out.
posted by DarlingBri at 2:45 PM on June 4, 2011

Wow, this thread received more responses than I had ever envisioned. Thanks to all of you kind folk for your advice, and thank you for caring!

I have learned a ton about wounds, infections, MRSA, and treatment from reading and further researching the answers in this thread. I will definitely refer back to the information in this thread the next time I suffer a similar injury.

DarlingBri, while these aren't your knees, you described the symptoms I had to a tee, as though you were actually me! Thank you for your input and for clarifying that my injury is more a case of road rash (I didn't know there was a specific term for this kind of injury!) than infected scraping. Your response assuaged a lot of my worrying.

Here's an update on the status of my scrapes: my knee abrasions have been healing just fine. Soap & warm water, plus liberal applications of Neosporin with a Q-tip after showering, twice a day seem to have done the trick. The pain in my wounds has subsided pretty substantially and I can actually walk without limping now. Also, the abrasions aren't oozing pus anymore, there are no signs of streaking or heat, and they are starting to scab with a more normal-looking color.

I guess my scrapes weren't infected after all, or maybe at the time I posted the question, they were beginning to get slightly infected, until I started to actually clean and take care of them properly.

Thanks again to everyone for your help!
posted by matticulate at 9:24 PM on June 4, 2011

You are very welcome! Glad you are healing! Other things I know about road rash that may be useful:

1) This visual healing chart is superlative. If around Day 18 you get crust and pus coming from the crater in the middle, it's still OK - the wound is chucking out the deeply embedded dirt and cruft you think isn't there but is. Unless it reverts to red tissue, treat it with diluted hydrogen peroxide and don't worry about it just because it's weeping.

2) Once the wound is healed over (like the Day 21 photo) treat it daily with pure Vitamin E, the stuff you can pour out of the capsules from the health food store. This will help reduce scarring* and much more importantly help keep the tissue supple so you don't end up with a constant tugging sensation whenever you, you know, walk.

3) Even after the skin is healed, you must protect it from direct sunlight. I had to swim with a t-shirt for 4 years and couldn't wear anything strapless - not out of vanity but because the scar tissues sunburns like a motherfucker in the weakest of sunshine. The pain of that is not to be toyed with. SPF, long pants, knee pads when biking/boarding, the big assed Ultra Strip bandaids when in shorts - these should probably be your new temporary best friends, even if they are not cool. Burned scar tissue is WAY LESS COOL.

*Or maybe not, (there are competing studies) but if you don't get contact dermatitis from it, it isn't going to hurt. Test it on your arm!
posted by DarlingBri at 4:20 AM on June 5, 2011 [2 favorites]