Skin Foreign Body

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DEFINITION

• A sliver or splinter is a foreign body (FB) embedded in the skin.
• Most slivers are in the superficial skin and do not cause much pain.
• Deep or perpendicular slivers are painful to pressure.
• Those on the foot are very painful and may require an incision for removal.

Causes

• Most of these are slivers or splinters of wood.
• Others are slivers (thin fragments) of glass, metal or plastic.
• A few are thorns or cactus needles.
• BBs from an air gun usually lodge superficially.

Need for Removal

• Most small superficially located skin foreign bodies can be removed at home. Examples include splinters, cactus spines, fibeglass spicules, and pieces of glass.
• A general principle is that if a foriegn body in your skin needs to be removed in a medical setting, it's better to get seen sooner, before the foreign body becomes hidden by swelling or accidentally pushed in more deeply. Also, the physician can numb the area before removal.
• Organic slivers (e.g., wood or thorns) usually become infected if they are not removed. Nonorganic slivers (e.g., metal or glass) generally do not become infected.

Pencil Punctures

• There's no danger of lead poisoning. Pencil leads are made of graphite and clay, not lead.
• Sometimes the graphite dust can leave a tiny black stain (tattoo) in the puncture wound.

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WHEN TO CALL YOUR DOCTOR

Call Your Doctor Now (night or day) If

• You feel weak or very sick
• FB is deeply embedded (e.g. needle or toothpick in foot)
• FB has a barb (e.g. fish hook)
• FB is a BB
• Dirt is left in skin after FB removed and scrubbing
• FB is causing severe pain
• You are reluctant to take out FB or can't get it out

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If:

• You think you need to be seen
• Diabetic and splinter is in foot
• Deep puncture wound and last tetanus booster was over 5 years ago

Call Your Doctor During Weekday Office Hours If

• You have other questions or concerns

Self Care at Home If

• Tiny, pain-free slivers that don't need removal
• Tiny plant stickers or spicules (small fragments) of fiberglass
• Minor slivers that need removal and you don't think you need to be seen

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HOME CARE ADVICE FOR MINOR SPLINTERS OR SLIVERS

Removing Slivers, Splinters, and Thorns

1. Needle and Tweezers:
   • You can remove slivers, splinters or thorns with a needle and tweezers.
   • Check the tweezers beforehand to be certain the ends (pickups) meet exactly. (If they do not, bend them.)
   • Sterilize the tools with rubbing alcohol or a flame.
   • Clean the skin surrounding the sliver briefly with rubbing alcohol before trying to remove it. Be careful not to push the splinter in deeper. If you don't have rubbing alcohol, use soap and water, but don't soak the area if FB is wood. (Reason: can cause swelling of the splinter)
2. Step-by-Step Instuctions:
   • STEP 1: Use the needle to completely expose the end of the sliver. Use good lighting. A magnifying glass may help.
   • STEP 2: Then grasp the end firmly with the tweezers and pull it out at the same angle that it went in. Getting a good grip the first time is especially important with slivers that go in perpendicular to the skin or those trapped under the fingernail.
3. Additional Instructions:
   • For slivers under a fingernail, sometimes a wedge of the nail must be cut away with fine scissors to expose the end of the sliver.
   • Superficial horizontal slivers (where you can see all of it) usually can be removed by pulling on the end. If the end breaks off, open the skin with a sterile needle along the length of the sliver and flick it out.
4. Antibiotic Ointment:  Apply an antibiotic ointment (OTC) to the area once after removal to reduce the risk of infection.
5. Tetanus Booster:
   • If your last tetanus shot was given over 10 years ago, you need a booster. 
   • You should try to get this booster shot within the next couple days.

6. Call Back If:

   • Can't get it all out
   • Removed it, but pain becomes worse
   • Starts to look infected 
   • You become worse

Removing Tiny Plant Stickers, Cactus Spines, or Fiberglass Spicules

1. Tiny Plant Stickers:  Plant stickers (e.g. stinging nettle), cactus spines, or fiberglass spicules are difficult to remove. Usually they break when pressure is applied with tweezers.
2. Tape: First try to remove the small spines or spicules by touching the area lightly with packaging tape or another very sticky tape.
3. Wax Hair Remover (If tape does not work):
   • Warm up the wax in your microwave for 10 seconds and apply a layer over the spicules (or fiberglass). Cover it with the cloth strip that came in the hair remover package. Let it air dry for 5 minutes or accelerate the process with a hair dryer. Then peel it off with the spicules. Most will be removed. The others will usually work themselves out with normal shedding of the skin.
   • You can also try all-purpose white glue, but it is far less effective.
4. Tetanus Booster:
   • If your last tetanus shot was given over 10 years ago, you need a booster.
   • You should try to get this booster shot within the next couple days.
5. Call Back If:
   • Can't get it all out and it's painful
   • Starts to look infected
   • You become worse.

Tiny Superficial Pain-Free Slivers

1. Tiny, Pain-Free Slivers: If superficial slivers are numerous, tiny, and pain-free, they can be left in. Eventually they will work their way out with normal shedding of the skin or the body will reject them by forming a tiny little pimple.
2. Tetanus Booster:
   • If your last tetanus shot was given over 10 years ago, you need a booster. 
   • You should try to get this booster shot within the next couple days.
3. Call Back If  

   • Starts to look infected

   • You become worse

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.