Wound Assessments: Excoriation or Abrasion?

Both excoriation and abrasion are terms used for superficial partial-thickness wounds of the skin. Thorough assessment and correct documentation are critically important in communication of skin injury.  A detailed history to determine the causative factors is valuable information in the development of a plan of care. The clinician should ascertain when the injury developed, comorbid conditions, and other factors that may impact treatment and healing. Excoriation and abrasion are terms that may need clarification for appropriate terminology use in documentation.

What is skin excoriation? 

Excoriation describes skin damage from mechanical injury.  It may also be referred to as a scratch. Depth of excoriated tissue is typically superficial or partial thickness. It may reach into but not through the dermis. Excoriation presents as a well-defined injury with sharp or linear edges, most often located on the extremities. Excoriation may also be a sign of factitial dermatitis. Factitial dermatitis is a term for self-inflicted skin injury which is often identified as linear wounding that occurs in areas within reach such as the abdomen, anterior chest, face or extremities. 

What is an abrasion? 

Abrasion is the term used to describe skin erosions resulting from the tissue being abraded, meaning rubbed or scraped away by friction. It describes the loss of epidermis through a mechanical process, such as friction or trauma. An example of how an abrasion occurs is if you fall and ‘skin’ your knee – it is a superficial break in the skin that resulted from the friction between the skin and the pavement. 

How to treat excoriation and abrasion injuries to the skin

Excoriation treatment is first designed to address the underlying causative factor. If it is a rash that causes itching, the cause of the rash needs to be addressed along with the symptom of itching and the partial-thickness wound that occurred from the scratch. Dry skin can also be a factor related to excoriation from scratching. Keeping the skin cleansed and moisturized may prevent scratching and injury. If the injury is deemed to be self-imposed as a component of secondary gain, multidisciplinary collaboration with mental health professionals may need to be a component of the treatment plan. 

What is road rash?

In the event of an abrasion, note that these often occur as a result of falls or sports activities, in which preventative measures such as the wearing of knee and elbow pads may be a benefit. ‘Road rash’ is a common lay term for abrasions caused by injury with road surfaces, often as a consequence of cycling and motorcycling accidents. These may cover large body surface areas needing attention from a medical professional. 

What is the initial treatment of excoriated tissue and skin abrasions?

Initial treatment of excoriated tissue and skin abrasions should be treated by managing any bleeding with firm, direct pressure using a clean cloth or dressing, holding pressure steadily until bleeding is controlled. Skin excoriation and most abrasions are shallow and don’t cause a great deal of bleeding. Small scratches and abrasions usually stop bleeding on their own. Seek medical attention right away if the injury spurts blood or doesn’t stop bleeding. Note that abrasions and skin excoriation may be quite painful as superficial tissues have a dense nerve supply. 

How do you clean the injured site?

To clean the injured site, first wash your hands with soap and water. Then cleanse the wound with cool clean water or a gentle skin cleanser thoroughly to remove any dirt and debris. Once bleeding has stopped and the wound is cleansed, apply a clean bandage or dressing to cover and protect it. Change the dressing every 2-3 days or more often if it becomes wet or soiled. A dressing provides an appropriate environment that improves tissue formation and protects the area from infection and scarring. The protective environment of a non-adherent or moist wound dressing may also aid in pain management. When changing the dressing, watch for signs of infection such as nonhealing, redness, swelling or warmth, increased pain or drainage, or red streaks around the wound and notify your medical provider if they are observed.  

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