# Road Rash Care Guide - How to Treat and Prevent Scars



## ivy (Aug 13, 2008)

Hi
I'm new to the sport of mountain biking and recently took a nasty spill in Tahoe. I broke my jaw and arm. In addition, I got quite a lot of road rash. I spoke with a dermatologist who is also an avid cyclist who helped me tremendously in understanding how best treat the rash and prevent scarring. I've put together what I hope is some useful information about how to treat it. If you have additional knowledge, let me know and I'll edit this guide.

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*Road Rash Care Guide - minimize scars and be less ugly  *

Road rash is a fairly inevitable part of biking. Some day, some how, you will likely come off your bike. If you're reading this, you've had road rash, currently have it or you're going to have it. Road rash is something like going to the spa and getting a deep exfoliating treatment&#8230;for free! Actually it's not like that at all. It hurts, it bleeds, it weeps, and, depending on how you take care of it, it SCARS!

So, let's minimize that scarring with some knowledge:

*Degrees of Road Rash*

Like burns and murder, road rash has different degrees:

*First: * Probably looks like a really bad sunburn. The surface of the skin is red, but not bleeding. The skin is not broken. Treatment isn't really required here, though you'll want to clean it just to be safe.

*Second: * Skin is broken and bleeding. People flinch when they look at you. However, the deep layer of skin is intact. How do you know if the deep layer is there? See below. This guide is for second degree road rash.

*Third:* Skin is gone daddy gone. You can see fat layers and tissue. When I called my dermatologist friend about my road rash, this was the first thing he asked: "Can you see fat?" If you can, head straight to the ER; damage like this can mean grafting.

*A note about prevention: *

Let's pretend you don't already have road rash, and are blissfully unaware of how icky it is. To prevent joining the club, protective pads and covering up exposed skin with a decent layer of clothing are key. However, even if you're all covered up, it's unlikely unless you're in a face mask that your face is protected, which is one place you probably would like to minimize scars the most.

Now, let's say you really meant to wear protective clothing (I did! I really did!) but it was just so hot and you weren't planning on falling. The first step is any wound care is cleaning. There are a number of things you want to avoid, like infection and tattooing. Tattooing is when you rash your face and embed dirt or street grit in your face. You want that gone or it will heal with the stain of the dirt underneath. This means scrubbing. It's unpleasant, but necessary to avoid both tattooing and infection. For bad road rash, you'll want to see a physician first, perhaps in the ER. They can clean it properly and scrape (I've had this done, it's unpleasant, but a doctor can numb you first) out the dirt. A note about hydrogen peroxide before I go on: There seems to be some debate about using hydrogen peroxide to clean the wound as it can damage tissue, however the dermatologist I saw about this assured me it was a very small amount.

*What to use to clean:*

*Iodine Scrubber. * You'll usually get some of these in the doctor's office. You might try a pharmacy as well. I don't know if these are generally available at drugstores, Iodosorb is the brand name. 
*
Shur-Clens or 0.9 sodium chloride:* Ideally, you want to irrigate the area to properly cleanse the area. If you've got a syringe handy, this will help give the liquid pressure which will help get the grit out. The area must be completely cleaned out. If necessary, use clean gauze to gently scrub the area. Do not scrub vigorously, as this can cause more tissue damage. Can't find either. Try an antiseptic wash like Band-Aid Antiseptic Wash. Soap and water will also work fine.

Gauze: No scrubber? Gauze is not only useful for covering but also for scrubbing. Use mild soap and water and scrub with a bit of pressure behind it. (Don't go overboard, you don't want to cause more tissue to the area.) 
*
Once everything is clean&#8230;*

Old wisdom about wounds like road rash, was to let things "dry out" and scab over. I actually heard this exact sentiment from my physician. My dermatologist set me straight: This is just plain wrong. Why?

•	We all know scabs crack, and cracking scabs hurt and itch. Why add more hurt to the mix? Scabs are your enemy here.

•	Scabbed areas are essentially dead areas, so they're not getting oxygen so take longer to heal properly.

What you want to do with a wound like this is keep it moist. Once a wound has scabbed over, you diminish the skin's ability to heal. It's that simple. So&#8230;

*Moist and covered: *

Keep the wounds moist with ointment. Stay away from Neosporin. The rate of people who are allergic to Neosporin is significant enough (about 20%) that you'll want to avoid it. Apparently the allergy appears very similar to poison oak. If you're a mountain biker treating your road rash (and using Neosporin) you may think, _oh great, poison oak too!?_ And now you're on something for the poison oak as well, when in fact it's the allergy to the Neosporin. You can also apparently develop an allergy to Neosporin even if you've never been allergic in the past.

I'm a fan of Aquaphor which I've heard referred to as "the dermatologist's duct tape". This will keep it moist, is unlikely to irritate and is a cheap over the counter solution sold in most drugstores. Aquaphor comes in a tube or a tub, you want the tube to minimize the chance of spreading bacteria every time you dip your fingers in the tub. You can cover with gauze, but this isn't critical. You will however want to clean off wound as it weeps which will happen for a couple of days. Then reapply Aquaphor. Keep it moist. Always, always keep it moist.

Second degree road rash generally takes about three weeks to heal. At that point the skin will still look strange, discolored and the texture may feel rough in places. You may want to get some silicone sheeting to place over the discolored and areas with more texture. Neosporin makes a very cheap one, but I am currently using Cica-Care by Smith & Nephew and really like it. I can reuse it over and over again and it doesn't come off when I sleep. This is supposed to help flatten scars and minimize your chances of keloid scarring which you want to avoid on your face. It also is supposed to help with discoloration. I'm currently trying this as I'm 6 weeks from the accident, so I'll have to report back on its effectiveness. But I have seen studies that show it helps. Some people advocate using things like Mederma at this point to help minimize scarring. You may also hear people recommend Vitamin E. Some other products on the market I've read about (with varying reviews):

Bio Oil
Prefer On
Scar Zone
Sudden Change
Palmer's Cocoa Butter

I personally have been using Bio-Oil. Whether or not it's doing anything I'm not sure, but it seems to keep the skin soft and it's cheap, and people seem to love it.

What I will say is that Vitamin E (either the serum or fresh from the capsule) has been proven to do&#8230;absolutely nothing. This is if you are a believer in randomized, placebo-controlled, double blind studies. If you are, like me, a believer in placebos, witchcraft and wishful thinking, go ahead and try it. It can't hurt and it encourages you to massage the area, which may be a good thing.

Other considerations:

Duoderm and Tegaderm and other Dressings

It's likely that parts of your road rash are worse than others. I had a particularly bad spot on my chin, that was very very deep. For that, you'll want something like Duoderm. Duoderm is a dressing generally used for leg ulcers and other wounds that are slow to heal. It's commonly used for wounds on diabetics. It's opaque and skin colored (if you are Malibu Barbie) and non breathable. In this way it helps keep the wound from drying out. It's similar to wearing a fake layer of skin, which, when you're missing a layer, is a much more comfortable feeling while healing is going on. Duoderm is treated with some kind of gooey adhesive which apparently helps skin heal. With something like Duoderm and Tegaderm, you don't need any ointment, in fact this will keep it from sticking. Tegaderm works much the same way as Duoderm. I've heard conflicting things about which is better. My own experience was that Duoderm worked shockingly well. I will caution you that Duoderm is both expensive and hard to find. Your regular drugstores might stock it in the pharmacy, but I did a pretty extensive search and was only able to find it online. A pack of ten 4x4 is $50-$60. You might also try getting it from a hospital pharmacy which is generally better stocked. Both these types of dressings come in pieces that can be cut to size. For larger areas of road rash, you'll find Duoderm treatment can get pretty expensive. I will say, I was enormously happy that I chose to use it on my face. You can shower in the Duoderm, wear clothes, sleep in it, whatever. Generally you'll want to put a new one on every couple of days. Peel SLOWLY, clean the wound and reapply another patch. Johnson & Johnson and Curad both make adhesive dressings that are decidedly cheaper. They are reviewed well, though I personally haven't tried them and they don't seem to be as revered by the dermatologists I spoke with as say, Duoderm.

Sunscreen:

You don't want to radiate the skin while it's healing. Stay out of the sun as much as you can, especially during the first weeks and months. Wear a hat. If you refuse to wear a hat, slather up with sunscreen, with a minimum SPF of 30. Reapply every two hours. Cautionary tale: I am currently healing from a bad bout of road rash and went to a county fair wearing SPF 45. It was a bright sunny day and even with the sunscreen, I noticed I've got some tiny white blisters on one area of my road rash. Sorta wish I'd worn the hat.

**If anyone has additional knowledge or suggestions feel free to let me know and I'll edit this guide. Safe cycling everyone!


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## seawind161 (May 1, 2008)

*Great Info*

That everyone will need, sooner or later...

Thanks!


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## madcatmini (Aug 3, 2008)

Prevent scarring? I wear mine with pride! Although I get no sympathy from the wife about it.


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## pbcrazyboy (Jun 13, 2008)

sticky


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## Call_me_Al (May 31, 2008)

pbcrazyboy said:


> sticky


+1

Good post, ivy, and heal fast.


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## EHCRain (Jun 23, 2008)

sorry to hear for the crash but thanks for the great information
heal up quick, ive had a broken jaw and thats not a fun experience


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## Datalogger (Jul 5, 2008)

madcatmini said:


> Prevent scarring? I wear mine with pride! Although I get no sympathy from the wife about it.


Ditto! I show mine to friends so they know what fun they're missing out on. Haha.

Great write up ivy!


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## tomsmoto (Oct 6, 2007)

good stuff! cleaning roadrash is quite a task, its certainly not fun.

i dont think i exactly believe that 20% of people develope a poison oak like rash from neosporin though.. that sounds like a gross exaggeration, ive never known anyone who had any reaction to it. neosporin also makes a "with pain" version that works fantastic and does relieve a lot of pain. if you dont have it, you should!


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## Rudster (Jun 25, 2008)

Chicks dig scars.....


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## Surestick Malone (Jan 24, 2004)

One thing I can suggest, from personal experience, is it's important to ensure that whatever you cover the road rash with it has something on it to prevent it from sticking. 
When I had road rash from a 60 kph crash on my road bike the emergency room (who thought I'd crashed a motorbike - LOL) cleaned the road rash and applied a cream with silver in it used to treat burns and prevent infection then wrapped it with gauze.
When I went back to have the dressings changed the clinic nurse was swearing at the emergency room nurses for not putting an anti-stick layer between the road rash and the gauze. She had to wet the bandage, peel a bit off, wet the next bit, peel it off, etc. 
With the replacement dressing she put a layer of anti-stick fabric on first and then the gauze. The anti-stick layer looked exactly like the fine plastic mesh you see on top of the gauze on Elastoplast bandages (it's probably exactly the same stuff).


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## formica (Jul 4, 2004)

you might check on the recommendation for iodine/betadine scrubbers. Last I heard, that recommended f has been changed for two reasons. One reason being is that some people have an iodine allergy, and two, iodine and betadyne kill all sorts of good healthy cells too and can slow down healing. 

The update would be to use good old soap and water with a washcloth. Plus those scrubbers aren't readily available to the general public.


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## savagemann (Jan 14, 2008)

Good info Ivy.
I saw your other thread about your crash. So sorry you got so thrashed. 
I've had some really bad crashes over the years.
One crash on pavement going about 25mph I slammed into the ground face first. I was wearing a leather jacket so the only thing that got messed up was my face/neck and hands. Going by your scale of damage degree, it was about a 2.5.
My top teeth went through my upper lip, and all 6 of my front bottom teeth went through my bottom lip. I had serious rash from my forehead, all along my right side of my face covering my cheek, ear, nose, chin and neck. My hands were just as bad.

Another time I was dragged by a car going 30mph and had varying degrees of rash from my shoulder down to my knee. The whole side of my body was litterly a huge 4 foot scab. Varying from a 2-2.5 on the scale you posted above.

My last bad crash left me with a hole the size of a red bull can right in my widows peak above my forehead. My skull was fractured in 3 spots.....and now the best part..............None of these crashes left me with any serious scars.
The head wound only left a tiny scar about the size of a pencil eraser.
Getting dragged by the car left no scars that I can find, and the face plant to cement at 25mph left only very thin scars where my teeth went through my lips.

Once you are healed and ready to ride, just try to clear your thoughts of your crash before you saddle up. It will take a little time, but you will soon be able to ride without having your previous crash effect your concentration. 
Get some good protective gear too. Knee/shin, elbow/forearm and maybe a full face helmet. Trust me, you will feel so much more confident with all this gear on, it will enable you to concentrate you what you are doing at that moment.......not what happened in the past.

I almost forgot to mention, I mostly just used neosporin and scrubs to treat all these wounds.......kept them moist and covered.


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## -Devil- (Feb 28, 2008)

Tea Tree Oil ... use it from the get go on a fresh scar or cut or anything ... helps it heal up a little differently ... and leaves less of a scar .. then some good lotions afterwards will help some with the scarring .. if all else fails .. take a dremel to the parts that still look a bit rough and smooth em down some.


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## docweedon (May 14, 2008)

"Chicks dig scars"

Be a man...scars are like trophies. Wear them with pride! 

On a serious note, good info for us that take a dirt sample from time to time.


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## GlennSter (Aug 22, 2008)

the one most important thing is...

don't scratch the scab off!


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## SammiH20 (May 6, 2009)

On the subject of Duoderm-- I actually had no problem finding it in my local drug store. It was at the pharmacy and they sold it per sheet (5bucks)! This was good news because the entire box is pretty expensive, so it's nice to just be able to buy what I needed and maybe just an extra sheet to have on-hand rather than breaking my bank acccount.


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## Kneescar (Feb 26, 2009)

savagemann said:


> Good info Ivy.
> I saw your other thread about your crash. So sorry you got so thrashed.
> I've had some really bad crashes over the years.
> One crash on pavement going about 25mph I slammed into the ground face first. I was wearing a leather jacket so the only thing that got messed up was my face/neck and hands. Going by your scale of damage degree, it was about a 2.5.
> ...


Lemme try and guess your MTB nickname.... Rasputin?


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## Wahoo23 (Mar 12, 2009)

ditto on the concerns about betadine/iodine. betadine sole usefulness is for skin sterilization prior to surgical procedures -- making an incision, sticking a needle somewhere, etc. -- and it doesn't even perform that function unless it is applied and then allowed to dry. often I see nurses, or even doctors, having people soak a wound in a bucket of water with betadine in it. This is absurd. betadine is not good for skin that is already injured, it performs no sterilization in this manner, and actually stagnant water soaks increase the bacterial load in wounds.

The best way to clean a wound is high pressure irrigation, surprisingly with simple tap water, which has been shown to decrease rate of infection even more than irrigation with sterilized saline. no one knows why. Road rash has the added complication of having dirt embedded in the skin, so gentle scrubbing is necessary of course. But for cleaning, the pressure from one of those massage shower heads with regular old tap water is actually a great way to irrigate wounds.

excellent write-up and spot-on description of long term wound care!


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## ZoSoSwiM (Dec 2, 2005)

My scars have scars but none from road rash yet... considering I ride over 150 miles a week right now on the road and over 200 a week later in the year I've been lucky so far.. (Knock on wood)

Good guide though!


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