Whether cycling, rollerskiing, or apparently spring skate skiing, road rash is almost inevitable. Maybe more annoying than painful, but definitely damaging to the ego, road rash is not necessarily difficult to treat. Contrary to popular belief, it acts much more like a burn than an abrasion. Also, contrary to popular belief, treatment should not attempt to dry it out.
Step 1. Cleaning
Make sure your hands are clean or gloved. Clean the area with water. If there are a lot of gravel bits, you want to remove those as best as possible. Light scrubbing with a clean brush works well but be prepared for pain and cursing. Stay away from hydrogen peroxide as it actually breaks down epithelial tissue. If there is still a bit of dirt remaining after washing with water, betadine can help prevent infection.
Step 2. Dressing
The goals of the dressing are to keep the area moist and clean. First, apply an antibacterial ointment like Neosporin or Bacitracin. Then cover the wound. Gauze and road rash don’t play well together. Unless the wound is very superficial and dry, gauze will just stick to the wound and rip it open when removed. “Non-stick” gauze is a lie. Tegaderm is what the pros use. Our medical team at the Tour of Utah gives out Tegaderm like candy on Halloween. It does a great job of meeting our goals: moist and clean. On a broad, fairly static area like the side of a hip or a butt cheek, Tegaderm will often stay in place by itself. On a knee or elbow with a lot of movement, a piece of mesh stockinette will help keep it in place. It’s also waterproof so unless you are due to change it out, leave it on while showering.
Step 3. Patience
A Tegaderm dressing can go a couple of days without changing. But if you’re exercising and getting sweaty, it won’t hold up as well and should be changed once or twice a day. Keep dressing the wound with ointment and Tegaderm until the skin is dry to the touch. Even then, it’s likely worth keeping it dressed for another couple of days. Resist the temptation to blot it with a towel, blow on it with a hairdryer, or otherwise attempt to speed up the “drying” process. The skin has to heal from the inside out. Once dry and healed, keep in mind that the new skin will be more susceptible to sunburn. If concerned about scarring, lotion or vitamin E oil can help, although you’re unlikely to escape a battle mark completely.
It should go without saying that if you see scary things like bone, bleeding that doesn’t stop, odd colored liquid, or radiating redness around the wound, stop your DIY medicine and seek professional care.
Ned Dowling
Ned lives in Salt Lake City, UT where his motto has become, “Came for the powder skiing, stayed for the Nordic.” He is a Physical Therapist at the University of Utah and a member of the US Ski Team medical pool. He can be contacted at ned.dowling@hsc.utah.edu.
