Health Library ScrapesFrom Healthwise

Scrapes (abrasions) are skin wounds that rub or tear off skin. Most scrapes are shallow and do not extend far into the skin, but some may remove several layers of skin. Usually there is little bleeding from a scrape, but it may ooze pinkish fluid. Most scrapes are minor, so home treatment is usually all that is needed to care for the wound.

Scrapes occur most often in warm weather or warm climates when the skin on the arms and legs is more exposed. They are most commonly caused by accidents or falls but can occur anytime the skin is rubbed against a hard surface, such as the ground, a sidewalk, a carpet, an artificial playing surface, or a road (road rash). School-age children ages 5 to 9 are most affected.

Scrapes can occur on any part of the body but usually affect bony areas, such as the hands, forearms, elbows, knees, or shins. Scrapes on the head or face may appear worse than they are and bleed a lot because of the ample blood supply to this area. Controlling the bleeding will allow you to determine the seriousness of the injury. Scrapes are usually more painful than cuts because scrapes tear a larger area of skin and expose more nerve endings.

How a scrape heals depends on the depth, size, and location of the scrape. Occasionally the injury that caused the scrape will also have caused a cut or several cuts that may need to be treated by a health professional. For more information, see the topic Cuts.

When you have a scrape:

• Stop the bleeding. For more information, see how to stop bleeding.
• Determine whether other tissues, such as blood vessels, nerves, tendons, ligaments, joints, bones, or internal organs, have been injured.
• Determine whether evaluation and treatment by a health professional is needed.
• Clean the wound and remove any dirt or debris to prevent infections (both bacterial skin infections and tetanus, or lockjaw), decrease scarring, and prevent "tattooing" of the skin. (If dirt or other debris is not removed from a scrape, the new skin heals over it. The dirt can then be seen through the skin and often looks like a tattoo.)
• Determine if you need a tetanus shot.

Review the Emergencies and Check Your Symptoms sections to determine if and when you need to see a health professional.

• Signs of shock occur:
  • In children.
  • In adults and older children.
• Severe bleeding does not slow during the first 15 minutes of steady direct pressure.

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

If you have the following symptom, evaluate it first.

• A cut that may need stitches, staples, or skin adhesives: Go to the topic Cuts.

	Yes	Do you have bleeding from a scrape?
When to See a Doctor See significance of bleeding from a scrape if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: For more information, see how to stop bleeding. Call your health professional immediately if you answer "Yes" to the following question. Yes Do you have moderate bleeding that has slowed but not stopped after applying steady, direct pressure for 15 minutes? Call your health professional today if you answer "Yes" to the following question. Yes Do you have mild bleeding that has slowed but not stopped after applying direct pressure 3 times for 15 minutes each (45 minutes total)? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Has a scrape removed all the layers of skin (avulsion injury)?
When to See a Doctor See significance of an avulsion injury if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Has the full tip of a finger or toe been scraped off, and bone is visible? Yes Have all the layers of the skin been removed in an area that is 1 in. (2.5 cm) or larger? Call your health professional today if you answer "Yes" to any of the following questions. Yes Have all the layers of skin of the tip of a finger or toe been removed in an area that is less than 1 in. (2.5 cm)? Yes Have all the layers of skin over a joint been removed? Yes Does the scrape increase in size with movement of the joint? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Are you unable to adequately clean a scrape using home treatment?
When to See a Doctor See significance of a scrape that cannot be adequately cleaned if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: For more information, see how to clean a wound. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Are you unable to adequately clean a scrape at home because it is large or deep? Yes Are you unable to adequately clean a scrape at home because cleaning causes too much pain? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you think you have an infection?
When to See a Doctor See significance of an infection if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have diabetes? Yes Do you have a scrape on your leg or foot and peripheral arterial disease? Yes Do you have a disease or take medicine that causes problems with your immune system? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have increased pain, swelling, redness, or warmth around the scrape? Yes Is the area around your scrape increasingly tender to the touch? Yes Do you have red streaks extending from the scrape? Yes Do you have pus in or around the scrape? Yes Do you think you have a fever? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Have you had mild pain and swelling with redness less than 1 in. (2.5 cm) around a scrape for 48 hours or longer? Yes Have you had swollen lymph nodes near the injured area for longer than 2 weeks? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have a scrape that may need stitches, staples, or skin adhesives?
When to See a Doctor See significance of scrapes that may need stitches, staples, or skin adhesives if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: Most wounds that require closure should be stitched, stapled, or closed with skin adhesives within 6 to 8 hours after the injury. Some wounds that require closure can be closed as long as 24 hours after the injury. For more information, see are stitches, staples, or skin adhesives necessary? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have a large or deep scrape that gapes open? Yes Do you have other skin cuts besides a scrape that may need stitches, staples, or skin adhesives? Yes Do you have a scrape on the face, eyelids, lips, or other area that you are worried may scar? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you know or think you need a tetanus shot?
When to See a Doctor See significance of getting a tetanus shot if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: If you need a tetanus shot, call your doctor to arrange for the shot as soon as possible. Your need for a tetanus shot depends on the seriousness of your wound and your tetanus shot history. Your doctor may be able to tell you over the telephone if you need a tetanus shot. Call your health professional today if you answer "Yes" to any of the following questions. Yes Were you cut by something clean and your last tetanus shot was longer than 10 years ago? Note: Something is clean if it does not have dirt, soil, spit, or feces on it. Examples include a broken water glass, a kitchen knife, or sewing scissors. Yes Were you cut by something dirty and your last tetanus shot was longer than 5 years ago? Note: Something is dirty if it has dirt, soil, spit, or feces on it. Examples include a garden tool, a dirty nail, or a piece of glass that has been buried in the dirt. Yes Are you not sure if you were cut by something clean or dirty and your last tetanus shot was longer than 5 years ago? Yes Are you not sure when you had your last tetanus shot? Yes Did you not get the first series of tetanus shots (primary vaccination series)? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have a scrape that is not healing?
When to See a Doctor See significance of a scrape not healing if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Do you have a scrape that does not look like it is healing after 1 week? Yes Do you have a scrape that has not healed after 2 weeks? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

Minor scrapes can be treated effectively at home. Home treatment can prevent infection and promote healing. If you do not have a high risk for infection, do not have other injuries, and do not need evaluation by a health professional or a tetanus shot, you can clean and bandage a scrape at home. How a scrape heals depends on the depth, size, and location of the scrape.

Bleeding

Stop the bleeding with direct pressure to the wound. For more information, see how to stop bleeding.

• Mild bleeding can almost always be stopped within 15 minutes by applying direct pressure.
• Moderate bleeding can usually be slowed or stopped by applying steady, direct pressure for 15 minutes.
• Severe bleeding cannot be slowed or stopped by applying steady, direct pressure for 15 minutes.

Nonprescription products can be applied to the skin to help stop mild bleeding of minor cuts, lacerations, or abrasions. Before you buy or use a nonprescription product, be sure to read the label carefully and follow the label's instructions when you apply the product.

After you have stopped the bleeding, use the Check Your Symptoms section to determine if and when you need to see your health professional.

A scrape may continue to ooze small amounts of blood for up to 24 hours and may ooze clear, yellowish, or blood-tinged fluid for several days.

Cleaning the wound

Clean the wound as soon as possible to reduce the chance of infection, scarring, and "tattooing." (If dirt or other debris is not removed from a scrape, the new skin will heal over it. The dirt can then be seen through the skin and may look like a tattoo.)

• Use a large amount of water under moderate pressure (faucet at least halfway open). Cool water may feel better than hot water on a wound. Washing the wound will remove as much dirt, debris, and bacteria as possible, which will reduce the risk of infection.
• If you have a water sprayer in your kitchen sink, try using the sprayer to wash the wound. This usually removes most of the dirt and other objects from the wound. Avoid getting any spray from the wound into your eyes. It may be easier to rinse a large, dirty scrape in the shower.
• Wash the wound for 5 minutes with large amounts of cool water and soap; mild dishwashing soap, such as Ivory, works well. For more information, see how to clean a wound. Some nonprescription products are available for wound cleaning that numb the area so cleaning does not hurt as much. Be sure to read the product label for correct use.
• Scrub gently with a washcloth. Moderate scrubbing may be needed if the wound is very dirty. Scrubbing your scrape will probably hurt and may increase bleeding, but it is necessary to clean the wound thoroughly.
• Do not use rubbing alcohol, hydrogen peroxide, iodine, or mercurochrome, which can harm the tissue and slow healing.
• For splinter removal, see removing splinters.

Stitches, staples, or skin adhesives (also called liquid stitches)

Determine whether your wound needs to be treated by a health professional. Scrapes usually do not need to be closed with stitches, staples, or skin adhesives. However, sometimes you will have a deep cut along with a scrape. For more information, see are stitches, staples, or skin adhesives necessary?

Consider applying a bandage

Most scrapes heal well and may not need a bandage. You may wish to protect the scrape from dirt or irritation. It is important to clean the scrape thoroughly before bandaging it to reduce the risk of infection occurring under the bandage. Scrapes may heal with or without forming a scab.

• Select the bandage carefully. There are many products available. Liquid skin bandages and moisture enhancing bandages are available with other first aid products. Before you buy or use one, be sure to read the label carefully and follow the label's instructions when you apply the bandage.
• If you use a cloth-like bandage, apply a clean bandage when your bandage gets wet or soiled to further help prevent infection. If a bandage is stuck to a scab, soak it in warm water to soften the scab and make the bandage easier to remove. If available, use a nonstick dressing. There are many bandage products available. Be sure to read the product label for correct use.
• Watch for signs of infection. If you have an infection under a bandage, a visit to your health professional may be needed.
• An antibiotic ointment, such as polymyxin B sulfate (for example, Polysporin) or bacitracin, will keep the bandage from sticking to the wound. Apply the ointment lightly to the wound. Antibiotic ointments have not been shown to improve healing. Be sure to read the product label about skin sensitivity. If you have a skin rash or itching under the bandage, stop using the ointment. The rash may be caused by an allergic reaction to the ointment.
• Use an adhesive strip to hold the edges of a wound together. Always put an adhesive strip across a wound to hold the edges together, not lengthwise. A butterfly bandage can be made at home or purchased and will help hold the skin edges together.

Tetanus

• Determine whether you need a tetanus shot.
• You may have a localized reaction to a tetanus shot. Symptoms include warmth, swelling, and redness at the injection site. A fever of up to 100 °F (37.8 °C) may occur. Home treatment can help reduce the discomfort.
  • Apply an ice pack to the injection site for 20 minutes, 3 or 4 times a day for the first 24 to 48 hours. After 48 hours, heat may feel better.
  • Take a nonprescription medication for pain and fever.

Swelling, bruising, and pain relief

An ice or cold pack may help reduce swelling and bruising. Never apply ice directly to a wound or the skin. This could cause tissue damage.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment.

• Signs of infection develop.
• The wound does not heal.
• Symptoms become more severe or more frequent.

Since most scrapes are caused by accidents or falls, it is difficult to prevent them. Some general safety tips may reduce your risk for injury.

• Pay close attention to what you are doing.
• Know how to use objects properly.
• Have good lighting so you can see what you are doing.
• Prevent falls in your home by removing hazards that might cause a fall.
• Wear gloves whenever possible to protect your hands.
• Wear other safety gear, such as glasses or boots, as appropriate.
• Wear protective gear, such as hand, wrist, elbow, or knee pads and helmets, during sports or recreation activities.
• Store dangerous objects in secure places away from children.
• Teach children about safety, and be a good role model.

To prepare for your appointment, see the topic Making the Most of Your Appointment

You can help your health professional diagnose and treat your condition by being prepared to answer the following questions:

• What are your main symptoms? How long have you had your symptoms?
• How and when did the injury occur? Have you had any injuries in the past to the same area? Do you have any continuing problems because of the previous injury?
• Did other injuries occur at the same time?
• What home treatment measures have you tried? Did they help? Be sure to include any nonprescription medications you have taken or used. Did they help?
• When was your last tetanus shot?
• Do you have any health risks?

• Animal and Human Bites
• Cuts
• Puncture Wounds
• Shock
• Snake and Lizard Bites

Author:	Sydney Youngerman-Cole, RN, BSN, RNC	Last Updated: June 30, 2006
Medical Review:	William M. Green, MD - Emergency Medicine H. Michael O'Connor, MD - Emergency Medicine
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