Eschar: Causes, Diagnosis, And Treatment - Healthline

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What You Need to Know About EscharMedically reviewed by Owen Kramer, M.D. — Written by Rachel Nall, MSN, CRNA — Updated on December 13, 2019

Characteristics
Images
Stages of wounds
Causes
Effects
Diagnosis
Prevention
Treatment

Overview

Eschar, pronounced es-CAR, is dead tissue that sheds or falls off from the skin. It’s commonly seen with pressure ulcer 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 can’t be classified. This is because eschar is dead, dark tissue that makes it difficult to see the wound underneath.

What are the characteristics of eschar?

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.

Eschar may be either softer or firmer than the skin around it.

Eschar is often part of a larger wound. The area around the eschar may appear red or tender to the touch. The area may also be swollen or fluid filled.

Images of eschar

How are wounds staged?

While an eschar wound can’t be staged in the same way most wounds can, a wound with eschar often signals a more advanced wound, typically a stage 3 or 4.

The four stages of wounds are:

Stage 1: The skin isn’t broken but may be slightly red in appearance. When the wound is pressed on, the area underneath your finger will not turn white.
Stage 2: The wound is open and/or broken. This may look like a blister that’s ruptured, or be slightly deep like a basin.
Stage 3: 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.
Stage 4: The most serious wound type, a stage 4 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.

Pressure sores occur most often on the heels, ankles, hips, or buttocks.

What causes eschar?

An eschar is a collection of dry, dead tissue within a wound. It’s commonly seen with pressure ulcers. This can occur if the tissue dries and becomes adherent to the wound.

Factors that increase your risk for a pressure ulcer include:

immobility
advancing age
paralysis
poor health
recovery post-surgery
coma
smoking

What are the effects of eschar?

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 cellulitis (a skin infection), bacteremia (bacteria in the blood), and ultimately sepsis (dangerous body-wide inflammation) that can be life threatening.

Your bones and joints can also become infected as a result of the wound.

How is eschar diagnosed?

Your healthcare provider 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’s getting larger or smaller.

Your healthcare provider will also 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.

How is eschar prevented?

Prevention is vital to keeping eschar from occurring. Wounds are significantly easier to prevent than treat.

For those who use a wheelchair or who have been prescribed bed care, it’s important to regularly reposition them to relieve stress and pressure to areas prone to skin breakdown. This may involve switching positions every 15 minutes to 1 hour.

Cushions, specialized mattresses, and special repositioning devices, which can be purchased online, can also help.

Keeping skin clean and dry is vital to preventing wounds. If you can’t control your urine or stool, prompt cleaning is necessary to keep skin breakdown from occurring.

Eating a healthy diet sufficiently high in protein, vitamin C, and zinc is vital to encourage skin healing. Drinking enough fluids is needed to prevent dry skin.

Stopping smoking, if you smoke, and keeping active also can prevent pressure sores by keeping your body as healthy as possible.

How is eschar treated?

Treatment for wounds with eschar depends upon your symptoms. For example, if the area around your wound is dry, isn’t peeling off, and doesn’t have redness around it, your doctor may not recommend removing the eschar, as it’s considered the body’s natural covering.

If the eschar is peeling or oozing, appears infected, or is not healing, your healthcare provider may recommend a wound treatment method known as debridement to remove dead tissue.

There are different methods of debridement, including:

autolytic debridement, which involves applying a dressing that may encourage the breakdown of the dead tissue by your own body’s enzymes
enzymatic debridement, which means to apply chemicals that remove dead tissue
mechanical debridement, which involves using special tools to remove dead tissue
surgical debridement, which involves the use of sharp instruments to cut away dead tissue

In addition to treating the wound, your healthcare provider will try to make you as comfortable as possible.

This includes prescribing pain-relieving medications. Antibiotics may be used to prevent infection. It’s important to try to eat as healthy as possible. As part of your healthy eating routine, be sure to include protein, which promotes skin healing.

In severe instances, surgery may be necessary to remove any infection and reconstruct the skin around the wound.

How we reviewed this article:

SourcesHealthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

BhattacharyaS, et al. (2015). Pressure ulcers: Current understanding and newer modalitiesof treatment. DOI:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4413488/
BoykoTV, et al. (2018). Review of the current management of pressure ulcers. DOI:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5792240/
DeMarco, S. (n.d.). Wound and pressure ulcer management.http://www.hopkinsmedicine.org/gec/series/wound_care.html
Eschar-associated rickettsioses. (2018).https://www.cdc.gov/typhus/Eschar-associated-Rickettsioses-508.pdf
Madhok BM, et al. (2013). New techniques forwound debridement. DOI:https://www.ncbi.nlm.nih.gov/pubmed/23418808
Mayo Clinic Staff. (2018).Bedsores (pressure sores).https://www.mayoclinic.org/diseases-conditions/bed-sores/symptoms-causes/syc-20355893
Pressure ulcer staging guide. (n.d.).https://www.in.gov/isdh/files/Pressure_Ulcer_Staging_Guide.pdf

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Medically reviewed by Owen Kramer, M.D. — Written by Rachel Nall, MSN, CRNA — Updated on December 13, 2019

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