Road Rash: Symptoms, Diagnosis, Causes, and Treatment

Road rash is an area on the body where the skin has been scraped off (skin abrasion). The injury is most likely to happen with outdoor activities that are done on tarred surfaces, like skateboarding.

Road rash on the skin looks raw and may bleed a little. The injury can be very painful but typically heals in a couple of weeks with at-home treatment. However, if the injury is deep and has caused damage to the nerve cells, medical attention might be necessary. 

This article will go over how road rash happens, how to treat road rash at home, and when to see a provider for road rash. You’ll also learn some tips for preventing road rash.

How Road Rash Happens

Road rash commonly happens after a fall or getting dragged against pavement or dirt—for example, in a biking accident or when playing a sport. 

When a person's body comes in contact with the ground, any areas of exposed skin can be easily scraped across the rough surface. For example, if a person falls or drags their arm across the tar, the abrasiveness causes the top layer of skin to get peeled away. 

Road rash injuries are more common in the spring and summer, as people are doing more outdoor activities in the warmer months of the year. People also tend to wear less and lighter clothing when they’re doing outdoor activities in hot weather, so their skin is less protected. 

Common Road Rash vs. Traumatic Tattoos

Road rash can leave discoloration called traumatic tattooing. This happens when pigmented debris is not washed out of the wound.

Symptoms of Road Rash

Road rash on the skin will look red, raw, and inflamed. Bleeding is also common. Pain and swelling are felt right away and these symptoms may last for several days.

It's not uncommon to have no pain at the deepest part of the injured area. However, the skin around the edges of the rash can be extremely painful.

As with any injury that breaks the barrier of the skin, road rash can lead to infection.

Signs of a wound infection include:

• Increased pain after the first day
• Swelling and increased redness
• Warmth
• Pus or fluid draining
• Foul-smelling drainage

Flu-like symptoms, such as fever, chills, and body aches. In rare cases, road rash may cause blood poisoning, a severe infection that spreads through the bloodstream. 

Septic shock (a potentially life-threatening condition that causes dangerously low blood pressure and organ failure) needs immediate medical attention to prevent complications—including death.

Treatment

Mild cases can be treated on the playing field, on the road, at home, or wherever the injury occurred. Severe cases of road rash need to be treated by a healthcare provider.

If the wound is not bleeding a lot and the pain is tolerable, you can probably handle road rash on your own at home. 

A standard first aid kit has the tools you'll need to treat road rash at home. 

First Aid

While road rash can look severe and cause quite a bit of pain, it is usually not serious and rarely life-threatening. 

However, you still need to consider the situation where the injury happened to decide if you can safely treat it on your own or if you need help. 

Here are the steps to follow after someone gets road rash:

1. Make sure everyone is safe. Make sure the injured person is breathing and awake (conscious). If the hurt person is not awake and responding to you, (unconscious), do not move them unless it would be unsafe to leave them where they are. Decide if the risk of not moving them is bigger than the risk of moving them. 
2. Treat life-threatening injuries first.  Usually, road rash oozes rather than gushes blood. However, if the injured person is bleeding and the blood is bright red or spurts from a wound, you need to stop it as fast as you can. 
3. Stop bleeding. A little pressure with a bandage or any clean cloth should be enough to control the bleeding.

If the injury is not serious enough to call 911, continue with the next steps (some of which might be given to you by a 911 dispatcher). 

Rinse the Affected Area

Rinse the road rash with soapy water to flush any dirt and debris out of the wound. It may help to soak the wound in soapy water before trying to remove any debris.

You may need to gently brush any foreign material from the skin. It’s not likely, but there is a chance that the debris will have to be taken out with sterile tweezers—but ideally, this should only be done by a medical professional.

Cover the Wound

Put gauze on the wound and wrap it to hold it in place. Dry dressings work fine, but you may want to moisten the first layer with saline solution or sterile water. If you use a layer of moistened dressings, cover it with dry gauze before wrapping.

Tetanus Shot

If the injured person has not recently had a tetanus shot, they might need to get medical attention. Tetanus is a serious bacterial infection that affects the nervous system and can be life-threatening.

The person's provider or an ER provider can give them a booster shot for tetanus.

Care and Healing

As road rash heals, the pain will get better—although the area can still be tender for a while. 

For mild road rash, an over-the-counter (OTC) pain reliever like Tylenol is likely enough. If the abrasion is at or near a part of the body that bends, like an elbow or knee, the joint may feel stiff and sore.

If the road rash is severe or there is also a more serious injury (like a broken bone), a provider may prescribe pain medication.

Road rash usually heals well on its own and does not cause much, if any, scarring. Still, you should keep an eye on the abrasion as it heals. After the first day, you can put antibacterial ointment such as Neosporin on your wound when you dress it. Be careful about ointment that’s not recommended for burns such as Bactroban. As the wound heals, you can use vitamin E cream to help restore the skin.

Take off the old dressing and replace it with a new one at least once a day. While you’re healing, look for signs of infection, such as increased redness and pain or a fever. If you have these signs, call your provider. 

If you get a road rash infection, you will probably need to see your provider for an antibiotic. Untreated skin infections can lead to serious health complications that can even be life-threatening.

Complications

Road rash is usually a simple skin injury that does not need medical treatment and does not cause long-term problems. As long as you take care of the wound and keep it clean and dry, it should heal on its own within two weeks.

However, if you have a more serious case of road rash, the injury could be in deeper layers of the skin. If road rash takes longer than two weeks to heal, you should see your provider.

Road rash can scar and look similar to those left by burns. As with burn scars, the worse the road rash is, the more likely it is to scar.

Severe Cases

It’s rare for road rash to be severe enough for a lot of medical treatment. However, severe road rash injuries may need to be treated like a burn from a heat source.

One possibility is surgery. Skin grafting uses healthy skin from another part of the body to cover the injured part. The skin is usually taken from an area that’s hidden by clothing, such as the buttock or the inside of the thigh.

The graft of healthy skin is transplanted onto the injured area and kept in place with gentle pressure and padded dressing, staples, or stitches. As it heals, new blood vessels grow to help new skin cells form and heal the wound.

How to Prevent Road Rash

The key to preventing road rash is to make sure you protect your skin while doing activities that put you at risk for it. 

The same steps you’d take to avoid any injury while doing these activities will help prevent road rash—for example, avoiding reckless behavior while on a bike or skateboard and following the rules for playing a sport. 

For example, making sure you wear long-sleeved shirts and pants when you’re doing activities on the tar, wearing the protective right gear (e.g., helmets, knee pads), and watching your surroundings for obstacles (e.g., potholes that throw you off your bike) can all help you avoid road rash.

When to See a Healthcare Provider

You should seek medical care for road rash if:

• The wound is more than three times bigger than the palm of your hand.
• The wound is on your face, hands, feet, or genitals.
• Muscles or bones are visible.
• Foreign objects, such as glass or small rocks, are embedded in the affected area.
• There is excessive bleeding.
• You notice signs of infection.
  

If you go to see your provider for road rash, they will look at the wound to see how serious it is. 

After a bad accident or injury—especially one that does not seem to be healing or is causing a lot of pain—your provider may want t do X-rays and other imaging to check for other injuries, like a broken bone or a foreign object under your skin.

In rare cases where there could be an infection or more serious complications, your provider may want to do blood tests and check your vital signs, such as your heart rate, pulse, and oxygen levels.

Summary

Road rash is a common injury, especially during the warmer months of the year when people are doing outdoor activities. Most cases of road rash, while painful, are not serious and can be managed at home.

However, if the road rash is severe, not getting better, or looks infected, you should see your provider for treatment.