Treatment of Abrasions
After cleaning, superficial traumatic abrasions should be covered with a clean occlusive dressing and/or a topical antibiotic that keeps the wound moist and prevents drying. 1
Initial Wound Cleaning
The most critical first step is thorough irrigation to remove debris and reduce infection risk:
- Irrigate the wound with large volumes (100-1000 mL) of tap water or sterile saline until no visible debris or foreign matter remains 1
- Higher irrigation volumes are more effective than lower volumes for preventing infection 1
- Tap water is as effective as—or superior to—sterile saline and antiseptic agents like povidone-iodine for wound irrigation 1
- Body temperature water is more comfortable than cold water, though both are effective 1
- Soap and water may be more effective than saline alone for removing contaminants 1
The evidence strongly supports irrigation over antiseptics: multiple Level 1 clinical trials demonstrate that tap water reduces infection rates as effectively as any other solution, while being more accessible and cost-effective 1.
Wound Coverage and Moisture Management
Once cleaned, maintaining a moist wound environment accelerates healing:
- Apply a topical antibiotic ointment or cream to keep the wound moist 1
- Cover with a clean occlusive dressing 1
- Occlusive dressings (film, petrolatum, hydrogel, or cellulose/collagen) demonstrate significantly shorter healing times compared to leaving wounds exposed to air 1
- Evidence from Level 2 human trials and well-designed animal studies shows that any occlusive dressing or topical antibiotic is superior to no dressing 1
Apply antibiotic ointment 1 to 3 times daily and may cover with a sterile bandage 2. Common topical antibiotics include bacitracin, polymyxin B-bacitracin-neomycin combinations, which help prevent bacterial superinfection while maintaining wound moisture 1, 2, 3.
When to Seek Medical Evaluation
Certain abrasions require urgent professional assessment:
- Any wound caused by animal or human bite, or contaminated with animal/human saliva, requires immediate medical facility evaluation 1, 4
- Seek medical attention if signs of infection develop: redness, swelling, increased pain, foul-smelling drainage, or fever 1, 4
- Wounds with extensive contamination, deep tissue involvement, or covering large body areas should be professionally evaluated 5
Important Caveats
- Do not apply antibiotic ointment if the patient has known allergies to the antibiotic 1
- There is no evidence that antibiotic or antibacterial dressings improve healing or decrease infection rates in clean, simple wounds beyond maintaining moisture 1
- Eye patching is not recommended for corneal abrasions as it does not improve pain and may delay healing 6, 7
- For contact lens-related corneal abrasions, use antipseudomonal topical antibiotics specifically 6
Tetanus Prophylaxis
- Evaluate and update tetanus vaccination status for all traumatic wounds 4, 8
- Administer tetanus toxoid if vaccination is outdated (>10 years) or unknown, particularly for contaminated or penetrating wounds 8, 5
The American Heart Association and American Red Cross guidelines provide the strongest evidence base for this straightforward approach: clean thoroughly with tap water, apply topical antibiotic, and cover with an occlusive dressing 1.