Relevant history should be documented, including the time of injury, cause, and mechanism of injury, as well as other relevant details pertaining to the causation as well as management of the injury.

Abrasions are commonly associated with physical trauma; this could result from falls and impact against hard and uneven surfaces, as well as the pressure of impending objects. They are commonly seen along with other forms of blunt force trauma, such as contusions and lacerations.

While the physical examination of abrasions is important for treatment, the medicolegal examination of abrasions is considerably more significant. Abrasions could be present over any part of the body, frequently seen over the exposed parts of the body, especially the head and neck, as well as the extremities. When found over the neck or genitalia, they tend to have a particular significance that could be precarious, if wrongly interpreted.

The physical examination should include the type, size, shape, color, location, size, depth, association with other injuries as well as the presence of extraneous material. The scientific collection and evaluation of these extraneous materials can provide valuable information regarding the scene of a crime, and in linking the suspect to the crime.

The systematic management of the injury for medical and medicolegal purposes will ensure not just treatment of the injury but also help in providing justice to the victim. The medicolegal examination is especially important in injuries over the head and neck and around the genitalia. Injuries around the genitalia could be vital in identifying sexual violence, while minor injuries over the head and neck could be an indication of more serious underlying injuries.

Abrasions are usually simple in nature and frequently small in size. These abrasions usually heal by the first intention and do not leave any scarring. However, the involvement of large surface area can lead to healing by second intentions, resulting in scar formation. This is particularly seen in individuals susceptible to keloid hyperplasia and should be started on steroid therapy to prevent keloid formation.

The medicolegal investigation may require a biopsy of the abrasion for histological examination. The histological examination investigates the stage of wound healing to provide an estimate of time of injury. Wound healing involves a series of coordinated cellular changes that include bleeding and coagulation, inflammatory response, regeneration, and remodeling. The regeneration process further involves migration and proliferation, while remodeling involves extracellular matrix protein and collagen synthesis, as well as the formation of new parenchymal and connective tissue. These processes are four time-dependent phases: (i) bleeding and coagulation, begins immediately (ii) inflammation, also begins without delay; (iii) regeneration, begins in days and lasts for the primary part of the acute healing phase; and (iv) remodeling, begins weeks after the injury and can last for longer than a year.[6][3][5]

The information may be further augmented by histochemical analysis of inflammatory cells and cell mediators. This may assist in informing the law enforcement about the time of occurrence of injury. A skin biopsy is relatively painless and can even be performed in the living if required. Histopathology of an injury can provide vital information for the investigation.[7][8][9]

Infection of the injury is another concern and should be managed judiciously. At the same time, the emergence of antibiotic resistance in many organisms should ensure strict follow-up to evaluate compliance and adherence to the full protocol. Injuries should also be swabbed and sent for culture and sensitivity.

Abrasions are usually simple, minor injuries that do not require much medical intervention. A sponsored study showed that wet healing, using polyurethane and hydrocolloid plasters, are found to be more efficient and effective in wound healing.[10]

Due to the loss of the epidermis, the outermost layer of protection of the body, abrasions are particularly susceptible to Clostridium tetani and Staphylococcus aureus, particularly in sports injuries. Tetanus toxoid status should always be checked. Abrasions should be cleansed and dressed, protecting the area from reinjury. Debridement may be required, especially if dirt or other contaminants are found embedded. Prevention of infection is the primary objective of any medical intervention. Antibiotic ointments may be applied; after confirming the allergy history, a dressing may be necessary, depending on the area and depth of the injury. Systemic antibiotics may be indicated and should be judiciously prescribed.

Facial abrasions and considered more serious as these have a higher risk of cicatrization and should be cleaned, debrided, and dressed daily. Dressings may require skin adhesives like the combination of gum mastic, styrax, alcohol, and methyl salicylate or tincture of benzoin.[11]

The presence of foreign material may indicate the causation and nature of the injury. Abrasion over the eyes, including the conjunctiva, could be mistaken for a variety of ocular conditions, including conjunctivitis, corneal ulcer, and endophthalmitis.

Abrasions are frequently associated with poor hygiene, napkin rashes, and pruritis, etc.

In medico-legal examinations, the nature of abrasion is more important than the gravity of the injury. The location of abrasion may present significant findings and could be a vital piece of evidence. Injuries present over the neck may indicate a case of (attempted) homicide. Similarly, injuries present over the thighs and genitalia could indicate a case of sexual assault.

Abrasions are generally minor injuries and tend to heal within two weeks, without any resultant scarring. Extensive and deep abrasions, as well as infection, may result in scarring, which can be prevented by daily cleaning and dressing. Debridement should be performed to avoid extensive cicatrization.

Wound infection is a common complication. Cleaning the wound is essential. Local antibiotic ointments may be applied to superficial, contaminated wounds. Systemic antibiotics may need to be prescribed in large and deep abrasions. It is important to weigh the need to prevent infection against the increase in antibiotic resistance. The tetanus immunization status of the patient should be assessed.

Wide and deep abrasions may result in the development of soft scars that may persist for months or years. Individuals with a tendency for keloid formation may develop extensive scarring, especially over the chest and shoulders.

The nature and association of abrasions are perhaps the most important and should require adequate attention from clinical physicians to prevent negligence claims. The documentation, including photography of the injuries, should be preserved for a specified period.

Abrasions occur due to a variety of causes, some innocuous and other extremely grievous. Patients and relatives need to be educated on the medicolegal importance of these seemingly inconsequential injuries. Clinicians also need to be advocated on the importance of documentation. Abrasions in sports can be reduced by using protective measures, paddings, and appropriate clothing, etc.

Simple abrasions resulting from falls can be treated with first aid, and the patient and their relatives should receive education on first aid procedures, including cleaning the wound, removal of foreign material, and dressing with a non-adhesive material.

Abrasions are one of the most common physical injuries. While a lot of them are simple and treated at home, healthcare workers will inevitably encounter patients with abrasions. They are usually associated with other injuries. However, the presence of abrasions should be appropriately investigated and managed clinically and medicolegally. The initial assessment may be by emergency medical technicians, trauma nurses, and physicians. Emergency room and ambulatory care nurses provide direct care and educate patients. Pharmacists are often called upon to counsel on over the counter and prescription medications. They, too, inform patients about the use of these treatments. [Level 5]