The best eschar treatment depends on whether removal of the eschar tissue is beneficial to wound healing. Eschar formation can be a natural protective covering for the wound—or complicate wound care.
The term eschar (pronounced es-CAR) refers to dead tissue that forms a moist or dry, sometimes adherent covering on the wound surface. Eschar can appear in several wound types—including pressure injuries, arterial ulcers, diabetic foot ulcers, and full-thickness burns—but it is especially common in pressure ulcers with poor blood flow.
Unlike scabs, which are a superficial crust of dried blood, serum, and cells formed during normal healing, eschar is necrotic tissue. Removing a scab often reveals viable pink tissue or healthy skin underneath, but removing eschar may expose a deeper wound bed that still requires careful wound care and infection management. And unlike healthy granulation or epithelializing tissue, which is moist and resilient, eschar is devitalized.
Dry eschars look similar to a scab, and may be thick or thin, leathery or brittle, and can range from tan to brown to black. In some cases, eschar becomes soft, boggy, or fluctuant, which can signal that excess moisture or infection is trapped beneath the devitalized tissue.
What causes eschar formation?
Eschar formation occurs when tissue becomes non-viable, most often due to poor perfusion or prolonged pressure on the tissue. Without adequate blood flow, healthy cells, tissue, and skin can’t receive oxygen and nutrients, and tissue necrosis can follow.
Wound care professionals typically see eschar tissue form in these type of wounds:
Pressure injuries
In pressure injuries, prolonged pressure compresses small blood vessels, reducing blood flow. If pressure isn’t relieved, the tissue damage can progress from superficial injury to deep necrosis.
Heel or calcaneus wounds
Calcaneus (heel) wounds are a common location for stable eschar because the heel has limited soft tissue coverage and is prone to sustained pressure during immobility.
Burns
Burns are also at risk of developing surface eschar when tissue destruction is significant. Full-thickness burns and deeper partial-thickness burns can form an eschar layer that is firm and restricts motion. When the burn eschar is large or crosses joints, it can compromise circulation and delay healing.
How serious is eschar tissue?
Eschar can be either protective or problematic, depending on the wound context and what is happening underneath it.
In some cases, dry and intact eschar acts like a natural covering for the wound that helps to prevent infection and protect the healing skin. However, eschar can complicate wound care if it traps bacteria or drainage beneath the surface, becomes soft and boggy, is associated with increasing pain or warmth, or prevents proper wound assessment.
Because eschar obscures the wound bed, it can make wounds harder to measure and accurately stage, and it may cover deeper tissue damage. Eschar is commonly associated with more advanced injury—but its severity should be judged by the overall wound characteristics, like blood flow, signs of infection, and location, not by appearance alone.
What is the best eschar treatment to promote wound healing?
The right treatment for eschar depends on local blood flow, whether the eschar is stable or unstable, and whether there are deeper signs of infection or tissue damage.
When eschar may be left in place
Eschar that is dry, firmly attached to the wound, and intact—especially on the heel—can often be left in place, particularly when there is no wound drainage, redness, odor, or other signs of infection present.
In these cases, wound care can be as simple as pressure relief around the area, protecting the surrounding skin from irritation, and keeping the wound dry and clean.
When removal may be recommended
If eschar is lifting, draining, boggy, foul-smelling, or infected, removal of the dead tissue may be recommended to reduce bioburden, evaluate the wound depth, and support wound healing.
In this case, eschar treatment and removal may include:
- Reducing pressure on the area—especially for eschar formed over pressure ulcers
- Surgical debridement for rapid removal of infected tissue
- Autolytic debridement using moisture-retentive dressings to support the body’s enzymes and natural healing process
- Enzymatic debridement when patient circumstances or symptoms limit surgery options
- Mechanical debridement or irrigation
Does eschar wound care require debridement?
No—treating eschar does not always require debridement.
When eschar is stable, dry, and there is no presence of infection, debridement may increase complication risks. While removal may not be necessary—or even beneficial—for proper healing, it’s essential to keep the wound clean until the eschar naturally falls away.
Treating eschar? Here are three reasons to use Dakin’s
When a wound requires cleansing or debridement—whether to reduce bioburden, manage odor, irrigate debris, or support preparation of the wound bed—Dakin’s Solution can be effectively used to promote wound healing.
Why do clinicians choose Dakin’s for eschar wounds?
1. Dakin’s Solution is a no-rinse, broad-spectrum action wound cleanser
For heavily contaminated or malodorous wounds, Dakin’s works as a broad-spectrum antimicrobial rinse that helps reduce bioburden, maintain moisture balance, and wash away loose debris and necrotic tissue.
2. Dakin’s Solution supports autolytic, surgical, mechanical, and chemical debridement
Dakin’s may be used to irrigate and cleanse during or after debridement and to help loosen and remove surface debris and devitalized material, or as the debriding agent itself.
3. Dakin’s works without alcohol, steroids, or systemic side effects
Dakin’s is a topical solution that doesn’t trigger systemic side effects, so it can be used alongside other eschar treatments. With no alcohol or steroids, it’s safe for intact skin, wound beds, and sensitive tissue.
Dakin’s Solution gives healthcare professionals confidence in their wound management plans
Dakin’s is the only wound cleanser with four strengths and formulations available, so clinicians can adjust their treatment plan as the wound progresses. It’s non-irritating and non-sensitizing, and Dakin’s Wound Cleanser is non-cytotoxic to healthy cells and tissue.
You can order Dakin’s Solution in any strength directly through our website, or purchase single bottles through Amazon. You can also get Dakin’s at most major pharmacies—just ask the pharmacist to put in an order for you.
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