Escaras: Classification, Causes, Symptoms, Diagnosis, Prevention and Treatment

The wounds are classified in stages according to the depth they present and the amount of necrotic tissue.

Eschar is necrotic tissue found in the skin; this appearance of dead tissue can be caused by burns and wounds caused by pressure (eschar).

The damage cannot be classified when the wound has an eschar on the top.

This is because, with the presence of these scabs, it is difficult to see what are the actual conditions of the wound that is under this hard and dark tissue.

The doctor will not always recommend removing the eschar because they are part of the body’s natural healing process.

Classification of wounds

While a wound on the eschar can not be checked in the same way as most wounds, an injury with eschar often indicates more advanced damage, typically a stage 3 or 4.

The four stages of the injuries are:


  • Stage 1: The skin is not broken, but it may look slightly red. When the wound is pressed, the area under your finger will not turn white.
  • Stage 2: the wound is open and broken. This may look like a fractured blister or slightly deep like a basin.
  • Stage 3: This type of wound has a deep appearance similar to a crater in the fatty part of the skin. The tissue will typically have dead tissue or yellow eschar.
  • Stage 4: is the most severe type of wound; a wound in stage 4 probably contains some slough and is at the bottom of the skin. Muscles, bones, and tendons may also be exposed due to the severity of the wound.

The most advanced stages of the wounds may be due to skin lesions or pressure ulcers.

An example is an eschar, where constant pressure on the skin decreases blood flow to the tissues.

As a result, this tissue is damaged and dies. This occurs most often in the heels, ankles, hips, or buttocks of the patient.

Causes of the eschar

Eschar is caused by burns or cauterization, both electrocautery and chemical cauterization (methods in which chemicals or heat are applied to heal tissue, contain bleeding, or prevent infection).

It also occurs in wounds that are called pressure wounds.

Risk factors for bedsores include:

  • The lack of mobility
  • The greater the period, the patient’s age, the greater the risk.
  • Patients who have paralysis.
  • Patients in the postoperative recovery stage.
  • Patients in a coma.
  • Very dry or wet skin.


The eschar is presented as colored brown or black and may be hard to touch.

This tissue closely resembles a piece of steel wool placed over the wound.

Eschar may be 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 sensitive to touch; it may also be swollen or full of fluid.

The broken skin present in the wound allows bacteria to enter the skin, which can cause cellulitis (an infection in the skin), sepsis, and inflammation throughout the body.

These conditions can be life-threatening; this infection can affect the bones and joints.


The doctor will diagnose the eschar with a simple physical examination of the wound and the skin around it.

The doctor will generally consider medical conditions that the patient may have and that may affect the body’s ability to heal wounds.

These include diabetes or conditions that affect the circulatory system.

The doctor will also evaluate the pulse below the area where the eschar appears to ensure the wound does not affect the blood flow in the nearby skin.


In these conditions, it is easier to prevent than cure.

To avoid eschar formation, the patient who is confined to a bed or a wheelchair should be repositioned to avoid the pressure that occurs on the skin of the areas most prone to the appearance of eschar.

It is advisable to make position changes every 15 minutes or maximum every hour.

There are currently on the market special repositioning devices such as cushions and mattresses that prevent the appearance of eschar.

The skin must be kept clean and dry to prevent the appearance of wounds.

If the patient can not control their bowels, cleaning should be performed as soon as it urinates or defecates.

You must consume many proteins, zinc, and vitamin C in the diet; these elements stimulate the healing of the skin.

It is also advisable to consume enough liquid to avoid the dryness of the skin.


The treatment of eschar aims to prevent infection: Special caution should be used when the wound oozes, flakes, and the adjacent area becomes red.

A debridement treatment is necessary to eliminate the dead tissues in these cases.

There are different methods of debridement:

  • Autolytic debridement: consists of applying a dressing coated with an enzyme that breaks down dead tissue.
  • Enzymatic debridement: This means applying chemical products to remove dead skin tissue.
  • Mechanical debridement: This involves using special tools to remove dead skin.
  • Surgical debridement: to cut through tissue.

Usually, the doctor prescribes analgesic drugs, antibiotics, and other medications to relieve pain, promote wound healing, and prevent infection.

In severe cases, surgery may be necessary to eliminate any infection and rebuild the skin around the wound.