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An eschar (/ ˈ ɛ s k ɑːr /; Greek: ἐσχάρᾱ, romanized: eskhara; Latin: eschara) 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, tick bites associated with spotted fevers and exposure to cutaneous anthrax.
Stable (dry, adherent, intact without erythema or fluctuance) eschar on the heels is normally protective and should not be removed. Deep Tissue Pressure Injury (formerly suspected deep tissue injury) : Intact or non-intact skin with localized area of persistent non-blanchable deep red, maroon, purple discoloration or epidermal separation ...
Escharotomy is the surgical division of the nonviable eschar, which allows the cutaneous envelope to become more compliant. Hence, the underlying tissues have an increased available volume to expand into, preventing further tissue injury or functional compromise.
The original blanched area acquires a brown pigmentation by 24 hours. An eschar forms in the pigmented area by 1 week and sloughs after approximately 3 weeks. Initially, the effects of CX can easily be misidentified as mustard gas exposure. However, the onset of skin irritation resulting from CX exposure is a great deal faster than mustard gas ...
Patients in response categories 4-9 should be considered as failing to respond to treatment (disease progression). Thus, an incorrect treatment schedule or drug administration does not result in exclusion from the analysis of the response rate. Precise definitions for categories 4-9 will be protocol specific.
If the eschar can be identified, it is quite diagnostic of scrub typhus, but this can be unreliable on dark skin, and moreover, the site of eschar which is usually where the mite bites is often located in covered areas. Unless it is actively searched for, the eschar can easily be missed.
The macroscopic appearance of an area of coagulative necrosis is a pale segment of tissue contrasting against surrounding well vascularized tissue and is dry on cut surface. The tissue may later turn red due to inflammatory response. The surrounding surviving cells can aid in regeneration of the affected tissue unless they are stable or permanent.
The bulla progresses into an ulcer which extends laterally. Finally it becomes a gangrenous ulcer with a central black eschar surrounded by an erythematous halo. [4] The lesions may be single or multiple. They are most commonly seen in perineum and under arm pit. However, they can occur in any part of the body. [4]