How to Treat Road Rash and Abrasions

Abrasions are common injuries among road athletes, typically caused by a fall or crash onto a hard surface. Cyclists will often refer to minor abrasions as "road rash," "friction burns," or "strawberries." In these scrapes, only the outermost layer of skin, called the epidermis, is affected. While there may be raw tissue and some minor bleeding, these injuries can often be treated sensibly with first aid.

By contrast, those that involve deeper layers of skin, called the dermis, are far more serious. They may require medical treatment to stop bleeding, suture the wound, and prevent infection.

When to Seek Treatment

There is often a fine line between an injury that you can treat on your own and those you should have tended to by a doctor. Oftentimes, in the midst of a race or training, we make the wrong judgment and try to push through the pain, only to find ourselves dealing with a serious infection later. Generally speaking, you should seek medical attention if:

• There is severe pain.
• It hurts to move the affected body part.
• There is a cut on the face larger than 1/4 inch.
• There is a cut on the body larger than 1/2 inch.
• Bleeding is difficult to stop, whatever the size of the wound.
• A gaping wound remains open when relaxed.
• You see fat globules in the exposed tissues.
• You have a head injury, were unconscious, or are experiencing confusion, a lack of coordination, or memory loss.

There are other injuries, such as cracked ribs, which may be less apparent but more serious. If in doubt, don't risk it. Stop what you are doing and either see a doctor or visit your nearest emergency care facility.

Self-Treatment

Many road injuries are treatable at the site of the accident and, afterward, at home. If the wound doesn't require medical care, you can treat it as follows:

1. Stop the bleeding. Road rash tends to ooze rather than actively bleed. Apply pressure with a bandage until the bleeding stops.
2. Wash your hands with soap and water. Do this prior to treating the wound. This reduces the risk of infection.
3. Rinse the wound. Place it under a stream of cold water to flush out debris. If needed, use a pair of tweezers to remove embedded grit. Take care not to leave any debris in the wound.
4. Wash the skin around the wound with soap and water. Do your best to keep soap away from the wound as it can cause irritation. Dab lightly to dry with sterile gauze. Avoid hydrogen peroxide, which doctors advise against for open wounds.
5. Use a topical antibiotic. Options include bacitracin and neomycin, available at drugstores. While triple antibiotic ointments like Neosporin may be used, they can cause allergy in some people. You may also consider using sterilized honey, which has considerable evidence for wound care. Use medical-grade honey, such as Medihoney, available over the counter and online, since there is a risk supermarket honey will contain bacterial spores.
6. Bandage the wound. You can do so with sterile gauze and some dressing tape. Alternately, you can use a semipermeable dressing such as Tegaderm, Bioclusive, or Second Skin to cover the wound.
7. Change the dressing daily. The goal is to keep the wound clean but slightly moist. This not only prevents infection, but improves tissue formation and reduces the risk of scarring.

Unless your doctor tells you otherwise, you can manage pain with Tylenol (ibuprofen) or a nonsteroidal anti-inflammatory drug (NSAID) like Advil (ibuprofen) or Aleve (naproxen).

Follow-Up Care

After an abrasion, you should consider getting a tetanus shot if you are unsure when you had your last one. Tetanus booster shots last for around 10 years. If you have had an injury where the epidermis is compromised, there is a chance that the spores of the tetanus bacteria (Clostridium tetani) may have entered the wound.

During healing, the damaged tissues will undergo repair from the lower layers up. As new skin cells develop, the outer edges of the wound may get hard and form scabs. Do not pick at them. Instead, continue applying the topical antibiotic for the first few days, and, as the oozing stops, switch to petroleum jelly to help keep the skin soft. Take care not to soak the wound in the shower or bath until fully healed.

When the wound is entirely closed, you can remove the bandage and use a normal skin moisturizer to aid in healing. Some plant oils may also offer benefits—there is evidence oils such as rose or rose hip, sea buckthorn, tamanu, sweet almond, and shea butter can help in wound healing and scar prevention. Look for cold-pressed or unrefined versions, which will provide the most beneficial nutrients for the skin.

Treating Infection

If, at any time, you experience signs of an infection, see a doctor. Symptoms include:

• Redness and swelling
• Pain and tenderness
• Warm or hot skin
• Oozing pus or fluid

Fever, chills, nausea, and generalized body aches may also accompany an infection. If you experience these, treatment should be sought immediately and will typically involve a short course of a broad-spectrum oral antibiotic. If left untreated, the infection can lead to a potentially serious condition known as cellulitis.