pronounced es-CAR, is dead tissue that sheds or falls off from healthy skin.
It’s 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 can’t 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
What Are the Characteristics of Eschar?
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.
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 has 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 or eschar.
- 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. These occur most often on the heels, ankles, hips, or buttocks.
What Causes Eschar?
Eschar is caused by burning or cauterizing — a method wherein you
apply chemicals or heat to destroy tissue, stop bleeding, or prevent the spread
of infection. It also occurs in pressure wounds such as bedsores.
Factors that increase your risk for eschar include:
- advancing age
- poor health
- recovery post-surgery
- very dry or moist skin
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 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.
How Is Eschar Diagnosed?
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’s getting larger or smaller.
Your doctor 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 doctor also will test your pulse below the area where
eschar appears to ensure the wound is not affecting blood flow to your nearby
How Is Eschar Prevented?
Prevention is vital to keeping eschar from occurring. Wounds are
significantly easier to prevent than treat.
Constantly repositioning 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 repositioning devices can 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 high in protein, vitamin C, and zinc is
vital to encourage skin healing. Drinking enough fluids is needed to prevent
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, isn’t peeling off, and doesn’t have redness around it, your
doctor won’t recommend removing the eschar, as it’s considered
the body’s natural covering.
If the eschar is
peeling or oozing or has symptoms of potential infection, your doctor 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 doctor will try to make you as comfortable as
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’ll want to eat a healthy diet high in protein, which promotes
In severe instances,
surgery may be necessary to remove any infection and reconstruct the skin
around the wound.