Tuesday, March 24, 2009

RX for Road Rash

Hands-off, micro-porous, spray-on liquid bandage

Sooner or later we all get to that day when our luck runs out and we limp home with a bad case of road-rash. Even Lance Armstrong has those days. I have found a very effective way of treating road-rash as a by-product of learning to care for a friend with a severely impaired immune system.

The remedy has two parts. Cleaning with Hibiclens, and then shielding with a Curad Liquid Bandage. Hibiclens has fantastic property - it soaks into your skin and continues to kill pathogens for 6-8 hours when protected by a liquid bandage.  

Hibiclens (chlorhexidine gluconate) and the Triclosan used in anti-bacterial soaps both break down into ammonia compounds, so have complimentary chemistry, and doing the initial debriding with an antibacterial soap like Dial (lasts 45 min) gives Hibiclens a near sterile environment to start from. This insures that adequate amounts of ammonia are available to kill any residual pathogens should they emerge from deeper in the skin.

DO NOT USE with a lye-based soap such as Ivory Bar Soap. The lye will react with the ammonia and release all of it immediately - destroying Hibiclens' time-released properties.

Hibiclens is an excellent, non-irritating, pre-surgical wash, safe for hands and skin. It is sold at Wallgreens stores, and except for letting it sit on the skin for a few minutes to soak in, works like any other soap. It will NOT damage skin like peroxide or alcohol, which would almost certainly cause scaring. 

Debriding can be done with a surgical scrub brush, but I find those to be overkill for typical road rash. They are made for cleaning intact skin before surgery, not shredded flesh. It's important to get the wound clean, but not cause more damage, as this will delay healing and cause scaring.

Better is a microfiber cloth, usually sold as dish cloths at the supermarket, because both Triclosan and   Chlorhexidine Gluconate are mildly degraded by organic materials - like the cotton of a cotton washcloth. You might also try using the sleeve of a heavy fleece jacket. These will often brush the sand and grit off the skin, and will create a nice lather that will lift debris from the wound surface, all while being very kind to your skin.
When Hibiclens was sold by Regent they had a great web page link to Connecticut General Hospital which recommended that anyone about to undergo elective surgery shower with Hibiclens the night before and morning of the surgery. It is also very effective for acne, and I personally find it very helpful for ridding my scalp of sores that seem to crop up where the straps of my helmet attach to the hard plastic thing in back. One or two applications is sufficient. It is a liquid soap. Leave it on the wound a few minutes to maximize penetration.

CAVEATS: Since it penetrates and bonds with flesh far below the surface there are a few places it should NEVER go.
  1. Eyes
  2. Ears
  3. Girl parts (betadine is the go-to antimicrobial for this application)
  4. Boy parts with lots of nerve endings (need I say more?)
The Curad bandage sprays on as an aerosol, dries in about 5 seconds, and stays on for 2-3 days. Neosporin can be used to lube the surface for chaffing, but it will suffocate the skin under it and delay healing. Neosporin has some significant risks. Use intelligently and sparingly. It is now sold in a hands-free spray-on package. I carry one in my saddle bag.

In a pinch, 99% isopropyl or 70%+ ethyl alcohol mixed 50/50 with Ceapasol (cetylpyridinium chloride) mouthwash makes a good anti-microbial. Cetylpyridinium chloride was approved by the USDA for sterilizing meat and vegetables and showed 10-log kills 30 days after application, so it's very, very persistent. I just don't like the alcohol on raw skin.

The glycerin in the mouthwash buffers the alcohol very effectively to prevent burning, although it tends to dry just a bit sticky. Anything you can put in your mouth is going to be pretty gentle on rashes. Alcohol concentrations less than 50% are ineffective, so omit entirely below these concentrations. (all mouthwashes used to have 40-50% alcohol until a few years ago when concentrations above 20% were shown to cause an increase in mouth cancer)

A bit off topic, except perhaps for compound bone breaks, but for deep penetrating wounds honey is about as good as it gets for externally applied anti-microbials. Any veterinarian that cares for horses knows this. Certain kinds of honey are preferred for this use as bees add special compounds to the high sugar content - which adds to sugar's primary mechanism of high osmotic pressure in killing pathogens.

For Century riders and Triathletes, showering with Hibiclens the morning of the event seems like a good precaution and will give you a good level of embedded protection already in place should your luck run a little thin.

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