PICKING SCABS & POPPING BLISTERS

I remember my mother telling me when I was a little girl that I shouldn’t pick my scabs because it would cause scarring. Now it is believed that the scabs themselves actually cause more scarring and the recommended treatment of skin wounds has moved away from dry healing towards moist healing.

What is dry healing?

This is when a wound is left open to dry out or it’s simply covered with a dressing. This method allows a hard scab to form over the wound on the outside. It was thought that the scab protected the damaged skin underneath and would eventually fall off once the skin defect had healed. The scab was also meant to protect the wound from infection.

What is moist healing?

This is when an ointment is applied to a wound and it is covered with a dressing. It has been proven that epithelialisation (formation of new skin) happens much faster in a moist environment when compared to dry one. Leaving a wound to dry out allows the new skin cells that are trying to grow and cover the skin defect to dry out and die resulting in more inflammation. This causes further pain, slows down the healing process and leads to more scarring. Previous beliefs that a moist dressing resulted in infection have not been proven.

When should you apply a moist dressing?

You should provide a moist, but not too wet, environment for cuts, scrapes and burns. Small cuts and scrapes that have already scabbed can be left open.

What is a blister?

A blister is a pocket of fluid collection within the superficial layers of the skin. They can develop when the skin is damaged by friction, extreme temperature (hot and cold) or certain chemicals that come in contact with the skin. The fluid acts as a barrier protecting the injured tissue underneath so it can heal.

How to treat a blister

Do not pop a blister! The blister protects the underlying skin from infection. The fluid within the blister also contains proteins that help promote healing. As the skin underneath heals the fluid in the blister disappears and the skin peels off. It is best to keep the blister covered with a dry dressing to avoid it getting scraped or torn open. If the blister does burst open, clean the wound gently without pulling off any skin, and apply a moist dressing.

How to clean a wound and apply a moist dressing

1. Clean your hands thoroughly with soap and water or a hand disinfectant.
2. Put on disposable gloves if available.
3. If the wound is bleeding, stop bleeding by applying pressure with a clean gauze, bandage or cloth.
4. Rinse the wound under running water for 10 minutes. Use a gauze pad or cloth soaked in water to gently wipe the wound and surrounding skin of any dirt and debris.
5. Gently pat wound dry using a clean gauze or cloth. Do not use cotton wool as the fluff may stick to the wound.
6. Apply a topical ointment such as petroleum jelly or equivalent. A thin layer of an antiseptic cream such as Cetrimide can also be used if the wound is at risk of infection.
7. Cover the wound with a sterile dressing such as a non-adherent pad and bandage or a plaster.
8. Clean the wound daily with running water and reapply a new moist dressing until the wound has healed.

Moist Healing plasters

Many brands have developed plasters that are designed to keep wounds moist without having to apply a topical ointment. These dressings provide a moist environment by absorbing and retaining fluid from the actual wound. Some of these plasters do not need to be changed daily. Make sure to read the directions on the box before applying your plaster.

As our little ones explore this world there is no doubt you will have to deal with many cuts and scrapes and even though wound healing is individualised most minor wounds will heal well with no complications if looked after from the very beginning.

RESOURCES

Elastoplast, (2018). 4 Reasons for Moist Wound Healing. [online] Available at: https://www.elastoplast.com.au/first-aid/wound-care/moist-wound-healing [Accessed 21 August 2018].

Field, C.K. & Kerstein, M.D. (1994). Overview of wound healing in a moist environment. The American Journal of Surgery, [online] 167 (1), pp. S2-S6. Available at: https://doi.org/10.1016/0002-9610(94)90002-7 [Accessed 21 August 2018].

Junker, J.P.E., Kamel, R.A., Caterson, E.J. & Eriksson, E. (2013). Clinical Impact Upon Wound Healing and Inflammation in Moist, Wet, and Dry Environments. Adv Wound Care, [online] 2 (7), pp. 348-356. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3842869/ [Accessed 22 August 2018].