An Overview of Road Rash

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Shoulder with road rash

Zoe/Flickr/CC BY 2.0 

Road rash is the common term used for a skin abrasion—an area on the body where the skin has been scraped off. The injury is most likely to occur in outdoor activities performed on tarred surfaces, like skateboarding.

With road rash, the affected area usually looks raw and may bleed a little. The injury can be very painful but typically heals in a couple of weeks with at-home treatment. However, if the injury is deep and has caused damage to the nerve cells, medical attention may be necessary.

Symptoms

The affected area of skin will appear red, raw, and inflamed. Bleeding is also common. Pain and swelling are immediately felt and may last for several days.

It's not uncommon to feel no pain at the deepest part of the injured area. However, the skin around the edges of the rash can be extremely painful.

As with any injury that breaks the barrier of the skin, road rash can lead to infection.

  • Increased pain after the first day
  • Swelling and increased redness
  • Warmth
  • Pus or fluid draining
  • Foul smelling drainage
  • Flu-like symptoms, such as fever, chills, and body aches

In rare cases, road rash may cause blood poisoning, a severe infection that spreads through the bloodstream. Septic shock, a potentially life-threatening condition that causes dangerously low blood pressure and organ failure, requires immediate medical attention to prevent complications—including death.

Causes

Road rash is usually the result of a fall or being dragged against pavement or dirt, as would happen in a biking accident or when playing a sport. When a person's body comes in contact with the ground, any areas of exposed skin are vulnerable to scraping across the rough surface.

If a person falls or drags their arm across the tar, for example, the abrasiveness results in the top layer of skin getting peeled away.

Road rash injuries are more common in the spring and summer, as the warmer weather encourages more outdoor activity. Moreover, because people tend to wear less and lighter clothing during these seasons and when participating in activities where they work up a sweat, they have less skin protection should an accident occur.

Diagnosis

Road rash is usually a superficial skin injury that doesn't require any professional treatment. As long as you take good care of the wound and keep it clean and dry, it should heal on its own within two weeks.

However, if you have a more serious case of road rash, the injury may include deeper layers of skin. If road rash takes longer than two weeks to heal, you should seek medical attention.

When Should You See a Doctor?

Seek medical attention for road rash if:

  • The wound is more than three times bigger than the palm of your hand
  • It is on the face, hands, feet, or genitals
  • Muscle or bone is visible
  • Foreign objects, such as glass or small rocks, are embedded in the affected area
  • There is excessive bleeding
  • You notice signs of infection

If you go to see your doctor for road rash, they will assess the severity by performing a simple physical exam of the affected area.

After a more serious accident or injury, especially one that doesn't seem to be healing or is causing a lot of pain, the doctor may also perform X-rays and other imaging to check for other injuries, like a broken bone or a foreign object under the skin.

In rare cases where infection or more serious complications are suspected, your doctor may also order blood tests and cultures, as well as monitor your vital signs, such as heart rate, pulse, and oxygen levels.

Treatment

Severe cases of road rash need to be treated by a doctor. However, most mild cases can be treated on the playing field, the road, or wherever the injury occurred.

If the wound is not bleeding excessively and the pain is tolerable, you may also be able to wait and treat the wound once you arrive home. A standard first aid kit likely contains all the tools you'll need to treat road rash.

However, when confronted with the injury, review steps 1, 2, and 3 below before making a decision to treat road rash on your own.

1. Stay safe: If a person is injured and becomes unconscious, do not move them. The only exception is if the area is unsafe and leaving them where they are would be a greater risk than moving them to a safer area.

2. Treat life-threatening injuries first: While road rash can look severe and cause quite a bit of pain, it is not usually life-threatening. Don't let the presence of raw, bleeding wounds distract you from assessing the injured person's state. Make sure they are breathing and conscious. Address any bleeding that is bright red or spurts from the injury, which needs to be stopped right away.

3. Stop bleeding: Usually, road rash oozes rather than gushes blood. A little pressure with a bandage or any clean cloth should adequately control the bleeding.

Stop and Assess

If the injured person is unconscious, has problems breathing, or is bleeding severely, call 911 immediately.

Follow the advice of the dispatcher before proceeding. He or she will instruct you on the best next steps to take while you wait for emergency medical services to arrive.

If the injury does not seem serious enough to call 911, continue with the next steps (some of which may or may not be offered by the dispatcher in the event you do need to call 911).

4. Rinse the affected area: Rinse the road rash with soapy water to help flush any dirt and debris out of the wound. It may help to soak the wound in soapy water before trying to remove any debris. To do this, you may need to gently brush any foreign material from the skin. In rare cases, it may be necessary to remove debris with sterile tweezers (if possible, this should be done by a medical professional).

5. Cover the wound: Put gauze on the wound and wrap it to hold it in place. Dry dressings work fine, but you may want to moisten the first layer with saline solution or sterile water. If you use a layer of moistened dressings, make sure to cover with dry gauze before wrapping.

Do not put antibiotic ointment on road rash.

If the injured person has not recently had a tetanus shot, you may need to seek medical care. The person's doctor or an emergency room physician can provide a booster shot for tetanus—a serious bacterial infection that affects the nervous system and can be life-threatening.

Care and Healing

As road rash heals, the pain will lessen—although the area may be tender. In severe cases, a doctor may prescribe pain medication. For mild cases, an over-the-counter pain reliever like Tylenol is likely sufficient to ease discomfort.

If the abrasion is at or near a part of the body that bends, like an elbow or knee, the joint may feel stiff and sore.

Road rash usually heals well and clears with minimal scarring, but it's a good idea to keep an eye on the abrasion as it heals. After the first day, you can begin using an antibacterial ointment or vitamin E oil to promote healing.

Remove the old dressing and replace with a new one at least once per day. Watch for signs of infection, such as increased redness and pain or a fever.

If an infection occurs, treatment usually requires an oral antibiotic. Untreated infections can lead to serious health complications that may be life-threatening.

Severe Cases

Severe road rash needs to be treated as a burn, which may mean reconstructive surgery is required.

Skin grafting uses healthy skin from another part of the body. The donor site is usually an area easily hidden by clothing, such as the buttock or at the inside of the thigh.

The graft of healthy skin is transplanted onto the injured area and kept in place with gentle pressure and padded dressing, staples, or stitches. As it heals, new blood vessels grow to help new skin cells form and heal the wound.

While most cases of road rash can be safely treated at home and will heal on their own, more serious injuries may occur. Any road rash injury that is not fully healed within two weeks needs to be evaluated by a doctor.

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