Children's Hospital Colorado

Skin Injury

  • Injuries to the skin anywhere on the body surface
  • Includes cuts, scratches, scrapes, bruises and swelling

Types of Skin Injury

  • Cuts, lacerations, gashes and tears. These are wounds that go through the skin to the fat tissue. Caused by a sharp object.
  • Scrapes, abrasions, scratches and floor burns. These are surface wounds that don't go all the way through the skin. Scrapes are common on the knees, elbows and palms.
  • Bruises. These are bleeding into the skin from damaged blood vessels. Caused by a blunt object. They can occur without a cut or scrape.

When Sutures (Stitches) are Needed for Cuts

  • Any cut that is split open or gaping needs sutures.
  • Cuts longer than ½ inch (12 mm) usually need sutures.
  • On the face, cuts longer than ¼ inch (6 mm) usually need to be seen. They usually need closure with sutures or skin glue.
  • Any open wound that may need sutures should be seen as soon as possible. Ideally, they should be checked and closed within 6 hours. Reason: To prevent wound infections. There is no cutoff, however, for treating open wounds.

Cuts Versus Scratches: Helping You Decide

  • The skin is 2 mm (about 1/8 inch) thick.
  • A cut (laceration) goes through it.  
  • A scratch or scrape (wide scratch) doesn't go through the skin.
  • Cuts that gape open at rest or with movement need stitches to prevent scarring.
  • Scrapes and scratches never need stitches, no matter how long they are.
  • So this distinction is important.

Call 911 Now

  • Major bleeding that can't be stopped
  • Deep cut to chest, stomach, head or neck (such as with a knife)

Go to ER Now

  • Bleeding won't stop after 10 minutes of direct pressure
  • Deep cut and can see bone or tendons
  • Large deep cut that will need many stitches

Call Doctor Now or Go to ER

  • Skin is split open or gaping and may need stitches
  • Severe pain and not improved 2 hours after taking pain medicine
  • Age under 1 year old
  • Dirt in the wound is not gone after 15 minutes of scrubbing
  • Skin loss from bad scrape goes very deep
  • Bad scrape covers large area
  • Cut or scrape looks infected (spreading redness, red streak)
  • You think your child has a serious injury
  • You think your child needs to be seen, and the problem is urgent

Call Doctor Within 24 Hours

  • Very large bruise after a minor injury
  • Some bruises appear without any known injury
  • You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

  • Dirty cut and no tetanus shot in over 5 years
  • Clean cut and no tetanus shot in over 10 years
  • Doesn't heal by 10 days
  • You have other questions or concerns

Self Care at Home

  • Minor cut, scrape or bruise

Care Advice for Minor Cuts, Scrapes or Bruises

  1. Cuts, Scratches and Scrapes - Treatment:
    • Use direct pressure to stop any bleeding. Do this for 10 minutes or until the bleeding stops.
    • Wash the wound with soap and water for 5 minutes. Try to rinse the cut under running water.
    • Caution: Never soak a wound that might need sutures. Reason: It may become more swollen and harder to close.
    • Gently scrub out any dirt with a washcloth.
    • Cut off any pieces of loose skin using a fine scissors. Clean the scissors first with rubbing alcohol.
    • Use an antibiotic ointment (such as Polysporin). No prescription is needed. Then, cover it with a bandage (such as Band-Aid). Change daily.
  2. Liquid Skin Bandage for Minor Cuts and Scrapes:
    • Liquid skin bandage seals wounds with a plastic coating. It lasts up to 1 week.
    • Liquid skin bandage has several benefits compared to other bandages (such as Band-Aid). Liquid bandage only needs to be put on once. It seals the wound and may promote faster healing and lower infection rates. Also, it's water-proof.
    • Wash and dry the wound first. Then, put on the liquid. It comes with a brush or swab. It dries in less than a minute.
    • You can get this product at a drugstore near you. There are many brands of liquid bandage. No prescription is needed.
  3. Bruises - Treatment:
    • Use a cold pack or ice bag wrapped in a wet cloth. Put it on the bruise once for 20 minutes. This will help to stop the bleeding.
    • After 48 hours, use a warm wet wash cloth. Do this for 10 minutes 3 times per day. This helps to reabsorb the blood.
  4. Pain Medicine:
    • To help with the pain, give an acetaminophen product (such as Tylenol).
    • Another choice is an ibuprofen product (such as Advil).
    • Use as needed.
  5. Tetanus Shot:
    • A tetanus shot update may be needed for cuts and other open wounds.
    • Check your vaccine records to see when your child got the last one.
    • For Dirty Cuts and Scrapes. If last tetanus shot was given over 5 years ago, need a booster.
    • For Clean Cuts. If last tetanus shot was given over 10 years ago, need a booster.
    • See your child's doctor for a booster during regular office hours. It's safe to give it within 3 days or less.
  6. What to Expect:
    • Small cuts and scrapes heal up in less than a week.
  7. Call Your Doctor If:
    • Bleeding does not stop after using direct pressure to the cut
    • Starts to look infected (pus, redness)
    • Doesn't heal by 10 days
    • You think your child needs to be seen
    • Your child becomes worse

Care Advice for Minor Cuts, Scrapes or Bruises

Abrasion on Elbow

This picture shows a shallow abrasion on the left elbow.

First Aid Care Advice for Minor Abrasion:

  • Apply direct pressure for 10 minutes to stop any bleeding.
  • Wash the abrasion with soap and water.
  • Gently scrub out any dirt with a washcloth.
  • Apply an antibiotic ointment, covered by a Band-Aid or dressing. Change daily.
  • Another option is to use a Liquid Skin Bandage that only needs to be applied once. Avoid ointments with this.
Abrasion on Elbow (3 Days Old)

This abrasion near the elbow occurred 3 days ago. The picture shows an abrasion that is starting to crust over.

There are no signs of infection (e.g., spreading redness, pus).

Bruise on Forearm

Small minor bruise (contusion) on forearm.

Bruise on Thigh (1 Day Old)

This bruise is one day old.

Bruises (contusions) result from a direct blow or a crushing injury; there is bleeding into the skin from damaged blood vessels without an overlying cut or abrasion.

 

First Aid - Cut - Gaping and Needing Sutures
  • Apply direct pressure for 10 minutes to stop any bleeding.
  • Wash the wound with soap and water.
  • Cover the wound with a sterile gauze or a clean cloth until seen.
First Aid - Wound - How to Clean
  • Wash the wound with soap and water for 5 minutes.
  • Gently scrub out any dirt with a washcloth.
  • Cover the wound with a sterile gauze or a clean cloth.
  • Apply direct pressure for 10 minutes to stop any bleeding.
Impetigo of Elbow

The photo shows an abrasion of elbow that has become infected with bacteria.

Laceration - Chin

This photo shows a gaping laceration (cut) of the chin. It will require closure with either sutures or with skin glue (i.e., Dermabond).

First Aid Care Advice:

  • Apply direct pressure for 10 minutes to stop any bleeding.
  • Wash the cut with soap and water.
  • Cover with a gauze dressing or adhesive bandage (e.g., Band-Aid).
Laceration - Chin (After Skin Glue)

The photograph shows a chin laceration that was closed with skin glue (i.e., Dermabond).

Dermabond (2-octylcyanoacrylate, Ethicon) is a tissue adhesive or "skin glue" which received FDA approval in the United States in 1998. It is used as an alternative to suturing for the repair of simple lacerations. The cosmetic outcome of wounds closed with tissue adhesive is comparable and in some cases superior to suturing.

To apply, the wound edges are held firmly together, and several coats of the glue are painted along the wound margins. The glue dries quickly, within 45-60 seconds. The glue will come off on its own as the wound heals and the top skin layer falls off, usually in about one week.

Laceration - Scalp

This scalp laceration (cut) is gaping open. It will require closure with sutures or medical staples.

First Aid Care Advice:

  • Apply direct pressure for 10 minutes to stop any bleeding.
  • Wash the cut with soap and water.
Laceration - Scalp

This scalp laceration (cut) is gaping open. It will require closure with sutures or medical staples.

First Aid Care Advice:

  • Apply direct pressure for 10 minutes to stop any bleeding.
  • Wash the cut with soap and water.
Laceration - Scalp (After Staples)

This photo shows a scalp laceration after it has been closed with 4 metal medical staples.

Scratches from a Cat

The photo shows 3-4 parallel scratches on the wrist caused by a cat.

First Aid Care Advice:

  • Wash the scratches with soap and water.
  • Apply an antibiotic ointment twice daily.
  • Watch closely for signs of infection, especially the first 1-3 days.

Disclaimer

The information contained in these topics is not intended nor implied to be a substitute for professional medical advice, it is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Always seek the advice of your physician or other qualified healthcare provider before starting any new treatment or discontinuing an existing treatment. Talk with your healthcare provider about any questions you may have regarding a medical condition. Nothing contained in these topics is intended to be used for medical diagnosis or treatment.

  • Not a Substitute - The information and materials in Pediatric HouseCalls Symptom Checker should not be used as a substitute for the care and knowledge that your physician can provide to you.
  • Supplement - The information and materials presented here in Pediatric HouseCalls Symptom Checker are meant to supplement the information that you obtain from your physician. If there is a disagreement between the information presented herein and what your physician has told you -- it is more likely that your physician is correct. He or she has the benefit of knowing your child's medical problems.
  • Limitations - You should recognize that the information and materials presented here in Pediatric HouseCalls Symptom Checker have the following limitations, in comparison to being examined by your own physician:
    • You can have a conversation with your child's doctor.
    • Your child's doctor can perform a physical examination and any necessary tests.
    • Your child could have an underlying medical problem that requires a physician to detect.
    • If your child is taking medications, they could influence how he experiences various symptoms.

If you think that your child is having a medical emergency, call 911 or the number for the local emergency ambulance service NOW!

And when in doubt, call your child's doctor NOW or go to the closest emergency department.

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