Ecchymoses and Erosion on Fragile Skin

These wounds occurred when this 77-year-old woman fell when chasing her dog. Such wounds-a combination of ecchymoses and erosion caused by blunt and sheering forces on fragile skin-are common in the elderly, even after relatively mild trauma. Simple interventions will promote healing.

A 77-year-old woman presented for treatment of wounds she suffered when she fell to the sidewalk 2 days earlier while chasing after her dog.

Key point: These types of wounds are common among the elderly, even following relatively minor trauma. She presents with a combination of ecchymoses and erosion due to a combination of blunt force and sheering force exerted on fragile skin.

Treatment: Inquire about pain or limited range of motion, which might suggest a minor fracture. The ecchymoses can be treated by intermittent application of cold (crushed ice in a plastic sandwich bag for 5 to 10 minutes an hour). However, this is most effective during the immediate post-traumatic period. The eroded areas should be covered with an antibiotic ointment to prevent infection and to promote a moist healing environment. The area should not be covered with a bandage, because the adhesive will lead to further skin tearing on removal.

Note: Keep interventions simple and practical. Given time, this would will heal very nicely without complex, time-consuming measures.