Treating Road Rash

The 2016 Olympic women’s and men’s road races were completed in Rio this past weekend.  It turned out to be a grueling race with several riders crashing on the descent of the final climb.

Assessing the Severity of Road Rash

Treating Road RashFalling onto the pavement at high speeds is obviously a traumatic experience for both professional and novice riders alike.  After ensuring there are no severe injuries or broken bones, the next thing to evaluate is the severity of skin damage or road rash.  The level of skin injury can be classified into three degrees.

  • First Degree – Only the outer layer of skin (epidermis) is affected.  The skin will appear red but typically will not require extensive treatment.
  • Second Degree – The outer and portions of the inner layer (dermis) are affected.  The skin will appear discolored and moist.  Medical attention is required if the bleeding won’t stop, if there is a deep cut that requires stitches, or if any debris remains deeply embedded within the skin.
  • Third Degree – This is the most severe and affects all layers of the skin.  The loss of skin reveals underlying fat and connective tissue.  This level of injury requires immediate medical attention and may require a skin graft to heal properly.

Cleaning Road Rash

Road rash should be cleaned as quickly and thoroughly as possible to prevent infection.  This can be accomplished with a large amount of water or with a saline wound wash under moderate pressure.  Mild antibacterial soap may be used, but avoid hydrogen peroxide or rubbing alcohol as they may harm the skin and delay the healing process.  Use a clean washcloth or gauze to gently remove any dirt or debris.  Do not scrub vigorously as this may further damage the skin.  Once the wound has been cleaned and dried, it needs to be properly dressed.  Many over the counter wound care products are available.

Dressing Road Rash with Ointment and Bandages

A traditional dressing is comprised of a thin layer of antibiotic ointment (Neosporin or Bacitracin) with a nonstick gauze pad (Telfa).  This may be applied and changed at least once a day for one week or until a scab forms.  To avoid scarring, avoid prematurely removing any scabs.

Dressings that promote a moist environment improve the rate of healing and avoid the formation of a scab.  A semipermeable dressing (Tegaderm or Opsite) or a hydrocolloid dressing (DuoDerm) may be placed directly onto the wound without any ointment necessary.  These dressings may be changed every couple days depending on how much the wound drains.

Monitor Healing

During the healing process, inspect the wound daily.  Once the skin heals, use sunscreen and keep the area covered for at least a month.  New skin is sensitive to the sun and may permanently darken.

When your skin meets the road, a thin layer of clothing offers little protection and some damage to your skin is unavoidable.  Proper treatment of road rash will prevent infections and repair the skin allowing you to get back on the bike faster.  If your skin does not appear to be healing properly or if you have any concerns, consult your doctor.

Melanoma of the Foot

With summer officially here, many of us will be excited to spend more time outdoors under the sun while wearing sandals or open-toed shoes.  While some people routinely use sunscreen when outside, how many of us think about protecting our feet from the sun?

Melanoma of the Foot

Inspect Your FeetSkin cancer is the most common form of all cancers diagnosed in the US, and approximately 1 in 5 Americans will develop some type of skin cancer.  The foot is susceptible to all forms of skin cancer, including melanoma, basal cell carcinoma, and squamous cell carcinoma.  The most serious form of skin cancer is melanoma; it is responsible for 75% of all skin cancer deaths.  Melanoma is a tumor of melanocytes, which are cells responsible for the color of your skin.  Studies have shown that prolonged exposure to UV radiation from the sun increases your risk of getting melanoma.

Inspect Your Feet

Check your skin regularly for any new or abnormal looking moles or freckles.  Don’t forget to inspect the bottoms of your feet and in between your toes as well.  Early detection is critical for the treatment of skin cancer.  When checking your feet, look for the ABCDE warning signs of melanoma.

          Asymmetry – the lesion is asymmetric; one half is different from the other half
          Border – the borders are irregular and jagged
          Color – the color is uneven with different shades of brown and/or black
          Diameter – the diameter is greater than 5 mm (about the size of a pencil eraser)
          Evolving – the lesion evolves in appearance over time

If you notice any new or changing areas of pigmentation that display any of these warning signs, see your doctor as soon as possible.  Any suspicious skin lesion should be biopsied.  A biopsy is a quick office procedure that can be done by your podiatrist.  It can help determine if a lesion is skin cancer.

Protect Your Feet

Summer is a great time to enjoy the outdoors as long as you take a few steps to protect your skin.  Prevention of skin cancer requires minimizing exposure to ultraviolet rays.  Avoid sun exposure during the peak daytime hours.  Wear sun-protective clothing.  And of course, apply sunscreen to exposed skin including your feet.

Hubert Lee, DPM, FACFAOM is a podiatrist at CarePlus Foot and Ankle Specialists in Bellevue, Washington.  If you have any questions or would like to schedule an appointment, please call (425) 455-0936 or visit bellevuefootdoctor.com.

A Possible Mechanical Risk for Melanoma of the Foot

Can walking or running increase the risk of the skin cancer melanoma on your feet?

ANew England Journal of Medicine recent study out of Japan suggests that repetitive mechanical stress and pressure on our feet might increase the risk of melanoma.  They found a higher number of cases of melanoma in areas of more pressure such as the heel and the ball of the foot and a lower number of cases in areas of less pressure such as the arch.  This was published last week in the New England Journal of Medicine.

This is a good reminder to inspect your feet during routine skin cancer exams.