Road rash from a cycling crash may not be the most severe injury that can result, but it can bleed and, as anyone who’s ever crashed a bike can confirm, it is definitely painful. Road rash occurs due to friction between the skin and the pavement, and can range from superficial skin scraping, to full thickness abrasions with embedded debris. They are considered to be a form of a burn injury. If the abrasion is large and/or deep, see a doctor, as some injuries may require oral or IV antibiotics, or other advanced treatments. Otherwise, treat it at home with these tactics.
How to Treat Road Rash
Abrasions like road rash are loaded with dirt from whatever surface it was that you dragged yourself across. Embedded dirt, gravel, and stones can easily become infection sources, so make sure that all debris is removed. Infection from debris leads to prolonged inflammation, which is a factor in scar formation. Use tweezers to remove any gravel, then clean the area with a mild soap and water. Scrub gently—you don’t want to cause any more damage. If you can’t scrub it because it hurts too much, try pouring water over it. Avoid using caustic solutions such as rubbing alcohol or hydrogen peroxide-while these kill bacteria, they also make the wound burn- water is adequate. Oh, and take an NSAID like ibuprofen or naproxen to help with the throbbing, because this will hurt. Over-the-counter lidocaine creams may also help with pain. If pain prevents proper cleaning, seek medical attention.
An ideal wound healing environment is clean, moist, and protected. A moist environment promotes healing factors, and decreases pain. Dressings should be non-adherent and able to absorb any wound exudates, while protecting the wound from the environment. A topical triple-antibiotic ointment (like Neosporin) may be applied if tolerated, and no allergic reactions are present. An antibiotic-containing mesh dressing, such as Tegaderm AG mesh dressing with silver, can also be used as a first layer to reduce infection risk. These dressings use antimicrobial agents such as silver or iodine, and come in various shapes and sizes to fit the road rash area.
A layer of petroleum jelly can be helpful in preventing the bandage from sticking to the flesh, keeping the wound moist, and decreasing pain. Cover the whole area with a sterile non-stick gauze pad and tape. An elastic tubular dressing such as Surgilast may be useful as a top layer to hold the dressing in place over limbs and joints. Change the dressing daily, unless using a bandage designed to stay on longer. It will be gooey and ooze, which is nasty but normal. If the bandage sticks to the wound, don’t try to pull it loose. Soak it in the bathtub for about 20 minutes and it should come off easily.
Hydrocolloid dressings may be used in cases where the road rash is drier and not draining (fresh, oozy wounds will need a more absorbent dressing), or beginning to scab over. Hydrocolloid dressings protect the wound from outside contamination, and create a moist environment that enhances the body’s healing mechanisms. They are designed to be left on for up to a week. Big abrasions like road rash usually heal from the deeper layers of the skin outward, and also from the edges toward the center.
If you see redness around the wound, red streaks, or if the wound feels hot or secretes yellow or green pus, your road rash could be infected. Some pain, swelling, and redness are normal parts of the healing process, but should decrease over the course of several days; increases might indicate infection. If left untreated, more severe, systemic signs of infection, such as fever, malaise, or movement loss. See a doctor if signs of infection arise. Otherwise, proper cleaning and care will minimize scarring, and lead to full healing.
New York City sports medicine specialist Jordan D. Metzl, M.D. is a 33-time marathon finisher and 13-time Ironman. His book, The Athlete’s Book of Home Remedies, has more than 1,000 tips to fix all types of injuries and medical conditions.