Wounds and grazes

Wound care is mostly mechanical: clean it, keep it clean, keep it moist, and cover it. The preparations are secondary and the choice of them matters less than doing those four things.

Irrigation is the intervention. Copious irrigation with clean running water — or saline — is what reduces infection by removing bacteria and debris physically. Trials of wound cleansing support irrigation with tap water as at least as good as sterile saline for most minor wounds. Antiseptics applied to a fresh wound can damage the tissue they are meant to protect, which is why hydrogen peroxide and iodine are used sparingly and why a scrub brush is worse than water.

Medical-grade honey has randomised trial evidence in wounds and burns, particularly in the debridement of sloughy and infected wounds and in partial-thickness burns. It works by osmotic action, by acidity, and by hydrogen peroxide generation, and different honeys differ substantially — manuka with a high methylglyoxal content is the studied type. Household honey is not the same product, though it is a plausible fallback in a situation with nothing else. Honey must not be used in a deep cavity wound or in anyone at risk of botulism.

Plantain (Plantago major) is the traditional graze and sting remedy. Its constituents — allantoin, mucilage, aucubin — have anti-inflammatory and tissue-healing activity in laboratory and small clinical studies. A crushed leaf or a poultice on a graze is harmless and traditional; the evidence base is modest. Comfrey similarly contains allantoin and is effective topically, but its pyrrolizidine alkaloid content means short-term topical use on intact skin only.

What actually prevents an infection. Cleaning and irrigating; keeping the wound moist with a proper dressing (a film or hydrocolloid); changing it when soiled; not picking at it; and — the one people skip — getting a tetanus booster status checked for a dirty or puncture wound.

What to keep out of wounds. Essential oils neat, vinegar, alcohol rubs, and anything from a jar that has been open in a bathroom. A salve is for intact or nearly intact skin.

The wounds that need a clinician, not a preparation. Anything deep, anything with a foreign body, anything from an animal or human bite, any puncture wound, anything on a diabetic foot, anything with spreading redness or a red streak, and anything in a person who is immunosuppressed.