Road rash? Let's talk about road rash!

Accidents can happen to us at unexpected times, right? Sometimes we fall off our bikes, slip while running, or have a minor accident while scootering or roller skating. When this happens, it is normal to get scrapes and minor injuries. But sometimes this 'scratching' can be a deeper, more painful experience than we think. That's how we are going to talk about 'Road Rash', a special injury that occurs due to the skin rubbing hard on a road, concrete, or asphalt. To be precise, this is like a burn caused by friction.

What is Road Rash?

Simply put, road rash is the injury that occurs when you fall on a rough surface like a road, and the skin rubs against it quickly. Imagine, you fall off a bike, and you don't stop immediately, you just slide along the road for a while. At that moment, your skin rubs against the road, and the heat damages the skin. This can happen on asphalt, cement, or concrete.

Road rash is more serious the deeper the wound, and like other burns, it has several levels.

What are the main types of road rash?

Doctors classify these wounds by how deep the skin is damaged.

• Superficial wounds: These only affect the top layer of our skin, the epidermis . This is like a small scratch.
• Partial thickness wounds: In this case, both the top layer of the skin ( the epidermis ) and the layer underneath it, the dermis, are damaged.
• Superficial partial-thickness: In this, only the upper part of the dermis is damaged.
• Deep partial-thickness: In this, the damage extends all the way to the lower layer of the dermis.
• Full thickness wounds: This is a bit more serious because it damages not only the top and bottom layers of the skin, but also the fat layer underneath.

Remember, in some very severe cases, this road rash can penetrate the fat layer and damage the underlying muscles and bones. So this is not something to be taken lightly.

What are the symptoms of road rash?

If you develop road rash, you may experience symptoms like these:

• Pain: Superficial and partial-thickness wounds are very painful . Surprisingly, full-thickness wounds are painless. However, the surrounding tissues may be painful.
• Skin color changes:
• When a person with fair skin gets a superficial wound, the skin may turn a reddish-pink color.
• A person with dark skin may develop a reddish tinge to their skin. Sometimes, as the wound heals, the skin in that area may turn a little white.
• When a partial-thickness injury occurs, the skin of people with fair skin may appear dark red or reddish-brown.
• In full-thickness wounds, the skin may be dark, charred, gray, or gray-white.
• Blistering: Superficial partial-thickness road rash can cause blisters, similar to sunburn. These blisters are filled with a yellow fluid. It is normal for them to burst spontaneously.
• Debris embedding: Because road rash damages the surface of the skin, small objects like pebbles , dirt, and debris can become embedded in the burned skin.

How does road rash occur?

Simply put, this happens when you fall on a rough surface like a road while going fast. Here are a few examples:

• It's okay to run a little fast or jog.
• When riding a two-wheeled vehicle such as a motorcycle, bicycle, or moped.
• When using wheeled sports equipment such as skateboards, rollerblades, and scooters.

When you fall during an activity like this, you don't stop immediately. You're dragged along the road with your speed. That's when friction occurs between the skin and the road, causing this injury.

The reason road rash is more severe than you might think is because it takes a lot of force to slide across a rough surface like a road. The farther you slide along the road, or the faster you slide, the more severe the injury becomes.

What are the possible complications of road rash?

If the road rash injury is severe, various complications can occur.

Minor complications

• Infections: Due to the force required to cause road rash, dirt, soil, and germs can easily penetrate the skin. Therefore, road rash wounds can easily become infected.
• Traumatic tattooing: Foreign objects, such as dirt and stones, that have entered the wound may remain trapped under the skin even after the wound has healed. If these are visible under the skin even after the wound has healed well, it is called traumatic tattooing . It looks like a tattoo.
• Scarring: Road rash, especially full-thickness wounds, can cause significant tissue damage. Deep wounds take longer to heal, so they are more likely to cause scarring.

Severe/Life-threatening Complications

Like burns from fire or hot water, severe road rash injuries can put a lot of strain on your body's systems. Large partial-thickness and full-thickness injuries can lead to life-threatening complications, such as:

• Shock: This can be caused by fluid leaking from the wound, bleeding from the injury, or both.
• Hypothermia: When the skin is severely damaged, the body's internal temperature control system is disrupted, meaning the body's core temperature drops.
• Organ failure: The waste products left behind when tissues break down can put a lot of pressure on the kidneys, as the kidneys are the ones trying to filter and remove these waste products.

How do doctors diagnose road rash?

A doctor can diagnose road rash by looking at your injury and asking you how it happened. Often, people with road rash injuries are unconscious after the accident. In such cases, doctors will get information from the first responders or someone close to you who witnessed the accident.

If you have road rash, you may have various tests, including lab tests and imaging tests, to check for other related injuries or complications. Blood tests and urine tests can help detect any toxic effects of the burn before they affect internal organs. X-rays or CT scans can also be done to check for broken bones or internal injuries.

How to treat road rash?

Like all other burns, the treatment of road rash depends heavily on several factors:

• How serious is the injury?
• If it is serious, how much of your body surface is affected?
• What other injuries do you currently have?
• What is your previous health history?
• What is your personal preference?

Things you can do at home for minor scratches

Superficial road rash wounds do not require much treatment, or even any treatment at all. You can take care of these at home.

• Immediately after the injury , rinse the wound with cold water for a few minutes .
• Make sure there is no dirt, soil, or stones on the injured skin.
• Cover the wound with a sterile bandage or a clean cloth. But do not tie the bandage tightly . Doing so can affect the healing of the wound.
• For pain, you can use over-the-counter painkillers, such as acetaminophen (such as Panadol) . Ibuprofen (such as Advil® or Motrin®, or in Sri Lanka, ibuprofen) or naproxen (such as Aleve®) can help with both pain and swelling.

Major injuries and treatments that require medical advice

Partial-thickness road rash wounds, if they are small enough to cover with your hand , can be treated at home. However, if they are larger than your hand, you should definitely seek medical attention. Full-thickness wounds always require specialist medical attention. Treatment may include:

• Pain management: You may need prescription pain medications to control your pain.
• Cleaning and debridement: If dirt or debris gets inside the wound, it can become infected. To prevent complications, your wound may need to be thoroughly cleaned and debridement , which involves removing dead skin and dirt.
• Bandaging: Partial-thickness and full-thickness wounds damage your skin, which loses its ability to keep things like germs out of your body. Bandaging is a substitute for protecting your body when your skin can't do that job.
• Surgery: Deep wounds take a long time to heal without surgery. You may need surgery, such as skin grafting, to help the wound heal.

Your doctor is the best source of information about your specific condition. He or she can provide information and guidance specific to your situation.

What can you expect when you get road rash? How long does it take to heal?

The shallower the road rash, the shorter your recovery time should be. Superficial wounds should heal in two to three days. Deeper wounds can take weeks or longer to heal. Other factors can affect what you can expect and how long it will take to heal. Your doctor is the best source of information about what to expect and what to do if you get road rash. He or she can also give you advice on what to do to make your recovery as easy and quick as possible.

How to protect yourself from road rash?

There are several things you can do to prevent road rash or at least reduce the risk of it:

• Wear clothing that is appropriate for the activity: Some types of clothing are designed to protect motorcyclists from road rash and other injuries. For example, thick jackets and pants.
• Don't forget other safety gear: Wearing elbow pads, knee pads, and a helmet when doing things like rollerblading and skateboarding can help protect you from road rash. It's also a good idea to take care of these when young children are playing.
• Stay safe on the road: Driving at a safe speed, paying full attention to the road, and being aware of your surroundings can save you from serious injuries.

What should you do if you get road rash? Do you need to see a doctor?

If you have road rash, it's important to manage it properly. Superficial wounds, meaning scratches just above the skin, can be treated at home.

But if your injury is more serious than that, and you think it might be, don't think twice about seeking medical advice.

When to see a doctor:

• If your wound appears to be partial thickness or deeper, and it is too large to cover with your hand.
• If painkillers from the pharmacy are not enough to control the pain.
• If there is a lot of dirt or foreign matter inside the wound and it is difficult to remove it.
• If you've been treating the wound at home for two or three days, but it doesn't seem to be healing.

Situations requiring emergency treatment:

If you have a road rash friction burn, partial thickness or deeper, and you have any of the following , you need emergency medical attention:

• If the wound is on your head, face, ears, arms, legs, or in a sensitive area like your groin or buttocks.
• If the wound is too big to cover with your hand.
• If you see signs of infection; that is, if there is a change in color, a bad odor, if there is fluid or pus draining, or if you have a fever.
• If you are in severe pain, especially if the pain seems to be more severe than expected given the injury.

Important questions to ask the doctor

Here are some questions you can ask your doctor:

• What can I do to help my road rash heal?
• Can I treat this at home? Should I?
• Does my road rash need treatment? If so, what does the doctor recommend?
• How long will it take for my road rash to heal?
• What symptoms should I look out for that indicate I need emergency medical attention?

Finally, a few important points (Take-Home Message)

We all love the feeling of riding a bike on the road, but if you get a rash on your skin, that feeling can be ruined. Road rash is often painful, and it can also interfere with the work you have to do and the things you want to do.

The good news is that road rash is very treatable. If the wound is shallow and small, you can take care of it at home. Also, it is often preventable.

If you have road rash and want to know if it can be treated quickly and easily, talk to a doctor. Timely treatment can make a big difference in road rash injuries. That's what you need to get back on the road quickly. So, even if it's a minor scratch, don't be lazy to seek medical advice if you have any doubts about it. Your safety is the most important thing!

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