Definition

Vulnus excoriatum, also known as an abrasion, occurs when the skin is rubbed against rough surfaces, resulting in open wounds. Most abrasions can heal without leaving significant scars, especially if they only affect the superficial layer of the skin, known as the epidermis. However, scarring may occur during the healing process if the abrasion penetrates deeper into the dermis.

Causes

Abrasions are classified into three primary types:

• Linear or line-shaped abrasions

These abrasions are characterized by scratches that disrupt the epidermal layer of the skin. Typically simple, the abrasions tend to heal without leaving scars. From a legal standpoint, these abrasions assume significance when located on certain anatomical regions such as the neck, and inner thighs, and in proximity to the genital area. Linear or semicircular patterns are often attributed to nail-induced abrasions. Notably, abrasions near the genital may signify instances of sexual assault, whereas the presence of such wounds on the neck could suggest strangulation.

• Grazed abrasions

This type of abrasion is characterized by variations in shape, typically resulting from frictions with broad and coarse surfaces, such as road asphalt. Primarily prevalent in scenarios like traffic collisions and sports-related incidents, these injuries manifest due to the abrasive interaction between bodily tissues and coarse surfaces, elevating the epidermal layer. The extent of injury depth depends upon factors including the surface's irregularity and the velocity of bodily motion during contact with the abrasive object.

• Patterned abrasions

This abrasion typically arises from a perpendicular force acting upon the epidermis, effectively "tracing" the contours of an object in contact with the skin. This type of injury can be further categorized based on the duration of contact with the object's surface, they are pressure abrasions and impact abrasions. Pressure abrasions occur due to prolonged yet relatively minor pressure exerted on the epidermis. For instance, abrasions observed on the neck after self-hanging tend to mirror the rope or object utilized. Conversely, impact abrasions resulting from sudden collisions are usually involving substantial forces. Instances of such injuries are commonly encountered in motorcycle accidents involving automobiles and pedestrians.

Risk factor

Abrasions can affect individuals irrespective of age or gender. Typically stemming from accidents, the injuries could occur either intentionally or unintentionally. Intentional abrasions may result from acts of physical violence, while unintentional injuries are often associated with sports-related activities and falls.

Symptoms

Abrasions, a type of skin tissue injury, are typically classified into three degrees:

1. First degree

Characterized by damage limited to the outermost layer of the skin (epidermis). Typically devoid of bleeding, first-degree abrasions are often termed erosions or scrapes by medical professionals.

2. Second degree

Involves injury extending through both the outer and the deeper layer of the skin (epidermis and dermis). Light bleeding may occur, and second-degree abrasions are commonly known as excoriations.

3. Third degree

Represents the most severe form of abrasions, encompassing damage extending beyond the dermis into deeper tissue layers. These injuries typically result in bleeding and necessitate comprehensive medical intervention. Third-degree abrasion is also referred to as avulsions.

Diagnosis

In diagnosing abrasions, the doctors would inquire about the mechanism and circumstances surrounding the injury, including the timing, cause, and manner of occurrence. Additionally, they may assess the tetanus immunization status of the individual, which may encompass vaccination status such as DT, Td, TT, or Tdap. In cases of trauma, clinicians may conduct a comprehensive examination to identify potential injuries to other body regions, particularly in incidents involving falls. Certain indicators, such as the wounds in areas concealed by clothing or close to the genital area, may heighten suspicion of violence. Moreover, doctors typically evaluate the location, shape, color, and dimensions of the abrasions, along with the presence of any foreign bodies within the wound.

Management

You can typically treat abrasions at home with the following first-aid measures:

• Wash your hands

This step helps minimize the risk of infection.

• Stop the bleeding

Bleeding from abrasions generally ceases spontaneously. If necessary, applying gentle pressure with a bandage or clean cloth and elevating the affected limb or body part can aid in stopping the bleeding.

• Cleansing the wounds

Rinsing the abrasion with water is recommended. Alternatively, flushing the wound with running water helps reduce the risk of infection. Subsequently, cleaning the surrounding area with soap is advisable, take care to avoid direct contact with the wound. It is recommended to avoid substances like hydrogen peroxide or iodine due to their potential to irritate. If the abrasion contains debris, prompt medical attention should be sought at the nearest emergency facility.

• Antibiotics

The application of antibiotic ointment serves to maintain skin moisture and prevent scar formation. Bacitracin is an example of an antibiotic ointment suitable for this purpose. However, discontinuation is warranted if a rash develops at the application site.

• Closure of the wound

Covering the abrasion with a sterile adhesive bandage aids in maintaining cleanliness. In cases where the injury is minimal, leaving the wound exposed may be permissible.

• Changing wound dressing

It is advisable to replace the wound dressing daily or as needed, particularly when the bandage or plaster appears soiled or damp.

• Tetanus vaccination

Individuals should receive a tetanus vaccination if their last immunization was more than five years ago or if the wound appears contaminated or deep.

• Monitoring for signs of infection

Vigilance for indications of infection is crucial. Symptoms such as purulent discharge, erythema, escalating pain, and fever warrant prompt medical attention.

Complications

Abrasions typically could heal fairly quickly, yet the potential for infection or scarring remains a possibility. To prevent these risks, prompt wound management is crucial following the injury. It is strongly recommended to maintain the cleanliness of the wounds and refrain from disturbing the healing process by avoiding scratching or scraping the affected area. 

One of the concerning complications associated with abrasions is infection. Signs suggestive of infection may include:

• Prolonged non-healing of wounds
• Sensations of soreness or irritation in the affected area
• Presence of smelly pus discharge from the abrasions
• Pus discharge exhibiting hues of green, yellow, or brown
• Persistent fever lasting more than four hours
• Formation of a painful lump in the armpit or groin

Prevention

Preventing abrasions could be done by using suitable personal protective gear during physical activities and occupational tasks. Moreover, mitigating the risk of falls, particularly among children and the elderly, involves implementing various safety measures. For instance, installing handrails at home can aid in fall prevention. Child safety can be enhanced through the installation of stair fences, restricting access to staircases. Similarly, measures such as the provision of grab bars and mobility aids like crutches offer support and stability to the elderly, reducing their risk of falls.

When to see a doctor?

Abrasions typically do not require immediate medical intervention. However, seeking urgent medical attention is advisable under the following circumstances:

• Persistent bleeding despite applying pressure to the wounds for five minutes
• Profuse and heavy bleeding
• Injuries resulting from acts of violence or trauma, such as those sustained in a traffic accident

Furthermore, consulting a doctor is recommended if there is suspicion of wound infection. Untreated infections can potentially escalate into more severe medical complications by spreading to other body regions. In such cases, medical intervention may involve wound cleansing, dressing, and prescription of oral or topical antibiotics to facilitate healing. Additionally, suturing of open wounds or debridement of infected or necrotic tissue may be necessary as per the doctor's assessment.

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