Abrasion: Medical Definition, Classification, and Initial Management

An abrasion is a superficial traumatic wound caused by mechanical friction that removes the outermost layers of the epidermis (stratum corneum and stratum spinosum). It is the most common type of skin injury.

Pathophysiology

• Shearing force scrapes off keratinized epithelium.
• Dermal papillae may be exposed but the basement membrane remains intact (distinguishes from partial-thickness burn/laceration).
• Capillary oozing and serosanguineous exudate are typical; nerve endings exposed → sharp, burning pain.

Classification by Depth

Grade	Depth	Clinical Appearance	Healing
1 (Superficial)	Stratum corneum only	Erythema, minimal bleeding	Hours–days; no scar
2 (Partial epidermal)	Into stratum spinosum/granulosum	Raw, shiny, pinpoint bleeding	Days–1 week; minimal scar
3 (Deep epidermal)	To basement membrane / papillary dermis	Significant bleeding, weeping	1–2 weeks; possible dyspigmentation

Common Causes

• Falls on rough surfaces (asphalt, gravel, carpet)
• Sports (sliding, turf burns)
• Motor vehicle crashes ("road rash")
• Industrial / occupational friction

Initial Management (Outpatient)

1. Irrigation: Copious normal saline or tap water; remove debris.
2. Debridement: Gentle removal of loose epidermis, foreign material.
3. Antiseptic: Dilute povidone-iodine or chlorhexidine; avoid hydrogen peroxide (cytotoxic).
4. Dressing: Non-adherent petrolatum gauze + absorbent secondary; or hydrocolloid/film for moist healing.
5. Tetanus: Update if >10 yr (clean) or >5 yr (contaminated).
6. Analgesia: Topical lidocaine 4% or oral NSAIDs/acetaminophen.

Red Flags for Referral

• Embedded foreign body (gravel, glass) not removable by irrigation
• Signs of infection (spreading erythema, purulence, fever)
• Large surface area (>10% BSA) or over joint
• Immunocompromised host, diabetes, vascular disease

Proper cleansing and moist wound healing minimize scarring and infection risk.