What is the best treatment approach for a patient with a minor abrasion?

Treatment for Abrasion

After thoroughly irrigating the abrasion with tap water until clean, apply a topical antibiotic ointment and cover with an occlusive dressing to maintain a moist wound environment.

Initial Wound Cleaning

• Irrigate the abrasion with running tap water or sterile saline until all debris and foreign matter is removed 1, 2
• Tap water is as effective as sterile saline and superior to antiseptic agents like povidone-iodine for wound cleansing 1, 2
• Use higher volumes (100-1000 mL range) rather than lower volumes for more effective cleaning 1
• Room temperature or warm water is acceptable and more comfortable than cold water 3
• Continue irrigation until the wound bed is visibly clean 2

Topical Antibiotic Application

• Apply petroleum-based antibiotic ointment (such as bacitracin, polymyxin B, or triple antibiotic) after cleaning 2, 4
• The American Heart Association specifically recommends this as standard of care for superficial wounds and abrasions 2
• Apply a small amount (equal to the surface area of a fingertip) 1 to 3 times daily 4
• Topical antibiotics significantly reduce clinical infection rates in minor wounds from 12.5% to 1.6% 5
• In children at risk for streptococcal infection, topical antibiotics reduce pyoderma incidence from 47% to 15% 6

Occlusive Dressing Coverage

• Cover the wound with a clean occlusive dressing after applying ointment 1, 2
• Occlusive dressings demonstrate significantly shorter healing times compared to leaving wounds exposed to air 1
• This combination approach maintains a moist wound environment that accelerates healing and reduces infection risk 2, 7
• The dressing prevents crust formation and promotes organized tissue repair, minimizing scar formation 2
• May be covered with a sterile bandage 4

Special Circumstances Requiring Different Management

Corneal Abrasions

• Prescribe broad-spectrum topical antibiotics for any corneal abrasion following trauma 1
• Do NOT patch the eye or use therapeutic contact lenses due to increased risk of bacterial keratitis 1
• Prophylactic antibiotics started within 24 hours prevent ulceration 1

Contact Lens-Associated Abrasions

• Topical antibiotics should be prescribed for contact lens wearers presenting with corneal abrasion 1
• Patching or therapeutic contact lens use is contraindicated due to secondary bacterial keratitis risk 1

Bite Wounds or Saliva Contamination

• Seek immediate medical evaluation regardless of wound appearance 2, 8
• These require professional assessment and likely systemic antibiotics 2
• Irrigation with large volumes of tap water or saline is still the first step 8

Monitoring for Complications

• Watch for signs requiring medical evaluation: increasing redness, swelling, foul-smelling drainage, increased pain, and fever 2
• If any develop, remove the dressing, inspect the wound, and seek medical care immediately 2
• Stripes of redness extending from the wound indicate spreading infection 8

Common Pitfalls to Avoid

• Do NOT use antiseptic agents like povidone-iodine for initial irrigation as they provide no benefit over tap water and may delay healing 1, 3
• Do NOT leave superficial abrasions uncovered and dry as this significantly prolongs healing time 1, 7
• Do NOT apply ice directly to abrasions as this can cause tissue ischemia 3
• Do NOT skip antibiotic ointment despite concerns about resistance, as the infection prevention benefit outweighs theoretical risks in acute traumatic wounds 5, 6