Road Rash Treatment
Last Updated 07/11/08

See A Report By A Couple of Users Of Our Recipe 

Like many other things in this modern age, change has hit here too. We've said before that most road rash can be healed in a week if you go about it right. Let it stay dirty, or get infected, or let it dry out and scab over, and it may take a long, long time and leave an unsightly stain when it is finally healed. That much is still true; but our past recommendation to scrub well, cleanse with hydrogen peroxide and cover with antibiotic ointment is now revised. [Click the photo to see Steve's rash up close. The raw parts are what need the care described here.]

R. S. Basler, MD, Garcia, M.A. and Gooding, K.S reviewed the subject in Vol 29, No. 4, April 2001, THE PHYSICIAN And SPORTSMEDICINE. The gist of their recommendations is given below. Here's what it boils down to for us:

First, you need some supplies. And it would pay you to get them now, before grief comes your way. Make a small rash-aid package for your medicine chest. You can get this stuff at a full-service pharmacy like Glenbyrne in Toledo, OH - call ahead; neighborhood pharmacies won't have the dressings. Find a new spray bottle at the Dollar Store to prevent accidental contamination from an old one you may find around the house.]:

• 0.9% sodium chloride solution
• Spray bottle
• 4" X 4" gauze pads
• Johnson & Johnson Bioclusive Dressing, or Spenco 2nd Skin, or 3M Tegaderm. Prefer the Tegaderm.
• Paper Tape

      

To deal with fresh rash: Get your post-ride shower (ouch!), not scrubbing the abrasions. Then, use the spray bottle of sodium chloride solution to clean up the abrasions, only gently scrubbing with the gauze pad if absolutely needed to remove visible gravel, etc. 
The rash needs to be CLEAN - if it's not you're going to have to grit your teeth and make it clean with the gauze and salt solution. Let the wound dry.
Place the semipermeable dressing over the wound, drying the surrounding area and attaching the film with adhesive tape on dry skin. If you are using sheets too small to cover the wound, Tegaderm, for instance, will adhere to itself and can be shingled over the wound area. The dressing can remain in place for a week, but it might be better to change the dressing after a few days. (The wound should not be allowed to dry out until it has healed.) For signs of infection or if you need a tetanus booster, see your doctor.
You may find yourself sweating under the dressing when you work hard on subsequent rides. Using paper tape to secure the edges of the dressing will keep it from falling off, and you may find you want to replace the dressing if it is particularly wet.
A thought: if you find yourself in the ER because you have trashed more than some skin, you might want to get pushy with whomever is about to clean up your road rash, hoping to get the treatment outlined here.

From Basler, et al.:

" ... Conventional treatment has consisted of cleansing the affected area with a mild soap and water or a mild antiseptic wash, such as hydrogen peroxide. This would then be followed with the application of antibiotic ointment along with a dry dressing. The problem with this approach lies in the fact that mechanical cleansing by scrubbing the wounds can produce increased trauma and a renewal of the inflammatory response. It has also been seen that the application of antiseptics, such as hydrogen peroxide or povidone-iodine, can actually cause harm to the tissue and interfere with function, which can further increase the injury and lengthen the healing process. Topical antimicrobials have been shown to be detrimental to fibroblasts and other cells needed for wound restoration.

In light of these findings, newer, improved methods for treating abrasions are recommended. The most advisable treatment for cleansing the wound is to flush it using a "pistol" syringe or bulb syringe containing a non-toxic surfactant, such as Shur-Clens (ConvaTec, Skillman, New Jersey) or a 0.9% sodium chloride solution, followed by the application of a hydrocolloid or semiocclusive hydrogel dressing.

A moist healing environment is provided by the dressing, which will promote cell migration, remove excess exudate, allow for gaseous exchange, and provide an impermeable barrier to bacteria and other contaminants. The moist environment provided by the proper dressing is important for optimal cell migration by preventing crust formation and allowing the wound to heal from the bottom as well as from the edges. Two basic options fulfill this requirement. One option is semipermeable film dressings, such as Bioclusive (Johnson & Johnson, New Brunswick, New Jersey) andTegaderm (3M Company, St Paul), in combination with semiocclusive hydrogels such as Spenco 2nd Skin (Spenco Medical Corp, Waco, Texas). These dressings are impermeable to water and bacteria but allow the exudate to evaporate.

Another option is the use of hydrocolloid dressings. These also offer a hospitable healing environment but differ from the semiocclusive hydrogels by absorbing the exudate rather than allowing for evaporation. In addition, the hydrocolloid dressing can remain in place for up to 7 days after being applied as can be done with the semipermiable films. Examples of hydrocolloidal dressings are Duoderm (ConvaTec, SkiUman, New Jersey) and Cutinova hydro (Beiersdorf, Inc, Norwalk, Connecticut). ... "

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