Eschar

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An eschar (/ˈɛskɑr/; Greek: eschara, "scab") is a slough[1] or piece of dead tissue that is cast off from the surface of the skin, particularly after a burn injury, but also seen in gangrene, ulcer, fungal infections, necrotizing spider bite wounds, and exposure to cutaneous anthrax.

Inoculation eschar on popliteal area and discrete maculopapular elements in patient with lymphangitis infected with Rickettsia sibirica mongolitimonae, Spain, 2011.

Black eschars are most commonly attributed to anthrax, which may be contracted through herd animal exposure, but can also be obtained from Pasteurella multocida exposure in cats and rabbits. A newly identified human rickettsial infection, R. parkeri rickettsiosis, can be differentiated from Rocky Mountain spotted fever by the presence of an eschar at the site of inoculation.[2] Eschar is sometimes called a black wound because the wound is covered with thick, dry, black necrotic tissue.

Eschar may be allowed to slough off naturally, or it may require surgical removal (debridement) to prevent infection, especially in immunocompromised patients (e.g. if a skin graft is to be conducted).

If eschar is on a limb, it is important to assess peripheral pulses of the affected limb to make sure blood and lymphatic circulation is not compromised. If circulation is compromised, an escharotomy, or surgical incision through the eschar, may be indicated.

An escharotic is a substance that causes tissue to die and slough off. Examples include acids, alkalis, carbon dioxide, metallic salts and sanguinarine, as well as certain medicines like imiquimod. Escharotics known as black salves, containing ingredients such as zinc chloride and sanguinarine containing bloodroot extracts, were traditionally used in herbal medicine as topical treatments for localised skin cancers and can be effective in some cases, but often cause scarring and can potentially cause serious injury and disfigurement. Consequently escharotic salves are very strictly regulated in most western countries and while some prescription medicines are available with this effect, unauthorized sales are illegal. Some prosecutions have been pursued over unlicensed sales of escharotic products such as Cansema.

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References[edit]

  1. ^ "eschar" at Dorland's Medical Dictionary
  2. ^ Paddock, C. D.; Finley, R. W.; Wright, C. S.; Robinson, H. N.; Schrodt, B. J.; Lane, C. C.; Ekenna, O.; Blass, M. A.; Tamminga, C. L.; Ohl, C. A.; McLellan, S. L.  F.; Goddard, J.; Holman, R. C.; Openshaw, J. J.; Sumner, J. W.; Zaki, S. R.; Eremeeva, M. E. (2008). "Rickettsia parkeri Rickettsiosis and Its Clinical Distinction from Rocky Mountain Spotted Fever". Clinical Infectious Diseases 47 (9): 1188–1196. doi:10.1086/592254. PMID 18808353.  edit

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