Eschar (es-CAR) is dead tissue that sheds or falls off from healthy skin. It is caused by burns and also occurs in pressure wounds (bedsores). Eschar is typically tan, brown, or black and may be crusty.
Wounds are classified into stages based on how deep they are and how much skin tissue is affected. When a wound has eschar on top of it, the wound cannot be classified. This is because eschar is dead, dark tissue that makes it difficult to see the wound underneath. Because eschar is part of the body’s natural healing process, a physician will not always recommend removing it.
Eschar is characterized by dark, crusty tissue at either the bottom or the top of a wound. The tissue closely resembles a piece of steel wool that has been placed over the wound. The wound may have a crusted or leathery appearance and will be tan, brown, or black.
The eschar may be either softer or firmer than the skin around it.
Eschar is often a part of a larger wound. The area around the eschar may appear red or tender to the touch. The area also may be swollen or fluid-filled.
While an eschar wound cannot be staged in the same way most wounds can, a wound with eschar often signals a more advanced wound, typically a stage III or stage IV.
The four stages of wounds are
- Stage I: The skin is not broken but may be slightly red in appearance. When the wound is pressed on, the area underneath your finger will not turn white.
- Stage II: The wound is open and/or broken. This may look like a blister that has ruptured or be slightly deep like a basin.
- Stage III: This wound type has a deep, crater-like appearance down into the fat portion of the skin. The tissue will typically have yellow-colored dead tissue or eschar.
- Stage IV: The most serious wound type, a stage IV wound will likely contain some slough and be deep down in the skin. Muscle, bone, and tendons also may be exposed due to the seriousness of the wound.
The more advanced stages of wounds can be due to skin injury or pressure sores. One example is a bedsore where constant pressure on the skin affects blood flow to the tissues. As a result, the tissue becomes damaged and dies. These occur most often on the heels, ankles, hips, or buttocks.
Eschar is caused by burning or cauterizing (to apply chemicals or heat to destroy tissue, stop bleeding, or prevent the spread of infection). It also occurs in pressure wounds (bedsores).
Factors that increase your risk for eschar include
- advancing age
- poor health
- recovery post-surgery
- very dry or moist skin
Wounds that advance to the stages where eschar covers them can be very serious. For example, the broken skin on the wound allows bacteria to enter the body, which can lead to sepsis (body-wide inflammation) or cellulitis (a skin infection). Both conditions can be life-threatening. Your bones and joints also can become infected as a result of the wound.
Your physician will diagnose eschar by viewing the wound and examining the skin around it. A wound care specialist will often measure the length and width of the wound to determine if it is getting larger or smaller.
A physician also will take into account any medical conditions you may have that could affect your body’s ability to heal wounds. These include diabetes or conditions that affect your circulatory system.
Your physician also will test your pulse below the area where eschar appears to ensure the wound is not affecting blood flow to your nearby skin.
Prevention is vital to keeping eschar from occurring. Wounds are significantly easier to prevent than treat.
Constantly re-positioning a patient who is confined to a bed or wheelchair is important to relieve stress and pressure to areas prone to skin breakdown. This may involve switching positions every 15 minutes to one hour. Cushions, specialized mattresses, and special re-positioning devices can help.
Keeping skin clean and dry is vital to preventing wounds. If you cannot control your urine or stool, prompt cleaning is necessary to keep skin breakdown from occurring.
Eating a healthy diet high in protein, vitamin C, and zinc is vital to encourage skin healing. Drinking enough fluids is needed to prevent dry skin.
Stopping smoking and keeping active also can prevent pressure sores by keeping your body as healthy as possible.
Treatment for wounds with eschar depends upon your symptoms. For example, if the area around your wound is dry, is not peeling off, and does not have redness around it, your physician will not recommend removing the eschar as it is considered the body’s natural covering.
However, if the eschar is peeling or oozing or has symptoms of potential infection, your physician may recommend a wound treatment method known as debridement to remove dead tissues.
There are different methods of debridement, including:
- autolytic debridement, which involves applying an enzyme-coated dressing that breaks down dead tissue
- enzymatic debridement, which means to apply chemicals that remove dead skin tissue
- mechanical debridement, which involves using special tools to remove dead skin
- surgical debridement to cut away dead tissue
In addition to treating the wound, your physician will try to make you as comfortable as possible. This includes prescribing pain-relieving medications and medications to relieve muscle spasms, which can affect wound healing. Antibiotics may be used to prevent infection. You will want to eat a healthy diet high in protein, which promotes skin healing.
In severe instances, surgery may be necessary to remove any infection and reconstruct the skin around the wound.