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. My post is on the Passion forum. I'm currently recovering, slowly. Finally got my jaw unwired. In any case, in the first few days after the accident I consulted with lots of docs. among them a dermatologist and 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. Maybe a mod can make it a sticky?
Road Rash Care Guide Ė 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 youíre reading this, youíve had road rash, currently have it or youíre going to have it. Road rash is something like going to the spa and getting a deep exfoliating treatmentÖfor free! Actually itís not like that at all. It hurts, it bleeds, it weeps, and, depending on how you take care of it, it SCARS!
So, letís 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 isnít really required here, though youíll 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: ďCan you see fat?Ē If you can, head straight to the ER; damage like this can mean grafting.
A note about prevention:
Letís pretend you donít 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 youíre all covered up, itís unlikely unless youíre in a face mask that your face is protected, which is one place you probably would like to minimize scars the most.
Now, letís say you really meant to wear protective clothing (I did! I really did!) but it was just so hot and you werenít 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. Itís unpleasant, but necessary to avoid both tattooing and infection. For bad road rash, youíll want to see a physician first, perhaps in the ER. They can clean it properly and scrape (Iíve had this done, itís 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. Youíll usually get some of these in the doctorís office. You might try a pharmacy as well. I donít 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 youíve 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. (Donít go overboard, you donít want to cause more tissue to the area.)
Once everything is cleanÖ
Old wisdom about wounds like road rash, was to let things ďdry outĒ and scab over. I actually heard this exact sentiment from my physician. My dermatologist set me straight: This is just plain wrong. Why?
ē We all know scabs crack, and cracking scabs hurt and itch. Why add more hurt to the mix? Scabs are your enemy here.
ē Scabbed areas are essentially dead areas, so theyíre 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 skinís ability to heal. Itís that simple. SoÖ
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 youíll want to avoid it. Apparently the allergy appears very similar to poison oak. If youíre a mountain biker treating your road rash (and using Neosporin) you may think, oh great, poison oak too!? And now youíre on something for the poison oak as well, when in fact itís the allergy to the Neosporin. You can also apparently develop an allergy to Neosporin even if youíve never been allergic in the past.
Iím a fan of Aquaphor which Iíve heard referred to as ďthe dermatologistís duct tapeĒ. 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 isnít 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 Iíve read about (with varying reviews):
Palmerís Cocoa Butter
I personally have been using Bio-Oil. Whether or not itís doing anything Iím not sure, but it seems to keep the skin soft and itís 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 doÖabsolutely 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 canít hurt and it encourages you to massage the area, which may be a good thing.
Duoderm and Tegaderm and other Dressings
Itís 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, youíll want something like Duoderm. Duoderm is a dressing generally used for leg ulcers and other wounds that are slow to heal. Itís commonly used for wounds on diabetics. Itís opaque and skin colored (if you are Malibu Barbie) and non breathable. In this way it helps keep the wound from drying out. Itís similar to wearing a fake layer of skin, which, when youíre 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 donít need any ointment, in fact this will keep it from sticking. Tegaderm works much the same way as Duoderm. Iíve 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, youíll 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 youíll 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 havenít tried them and they donít seem to be as revered by the dermatologists I spoke with as say, Duoderm.
You donít want to radiate the skin while itís 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 Iíve got some tiny white blisters on one area of my road rash. Sorta wish Iíd 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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