The wound healing process consists of several distinct stages, specific wound colors, and a series of protective mechanisms that keep infection out and healthy tissue in. Two of those protective mechanisms, scabs and eschar, are common on many wound types—and commonly confused.
Knowing the difference between everyday scabs and eschar formation is important, particularly if you’re susceptible to both. Because the term “eschar” is not interchangeable with “scab,” even though both can form on the surface of cuts, surgical wounds, and injuries.
How do scabs and eschar impact wound healing? What’s the difference between healthy eschar formation and a life threatening wound infection? How can you best care for a wound bed?
To answer these questions, let’s start with an overview of the key differences between eschar and scabs.
What is eschar tissue?
Eschar is dead tissue found in a full-thickness wound that can affect any part of the body that experiences a skin injury. Eschar is most likely to form on the feet, over pressure sores and pressure ulcers, and on burn wounds. Eschar may also be visible after a gangrenous ulcer or a fungal infection.
Brown or black eschar is formed when blood flow in the tissue under the eschar wound is poor. The inadequate blood supply darkens the surrounding skin and wound bed, which may cause alarm. But eschar can be one of the most important stages of wound healing.
Eschar may look like dangerous necrotic tissue, but it’s actually a natural defense
Dark patches of dead tissue on the wound surface might be concerning to an individual who is recuperating from a burn wound, pressure sores, or a diabetic ulcer, but this dark or rusty brown tissue is a normal part of the protective healing process.
In a healthy wound, the eschar acts as a natural barrier to infection by keeping bacteria from entering the wound. Unlike slough, which is necrotic tissue that can cause non-healing wounds, eschar can prevent infection from setting in—aiding in the healing process.
In most wounds that form eschar, the dead tissue may not even need surgical removal or mechanical debridement—it will naturally fall off on its own. However, if the eschar becomes unstable, immediate debridement may be necessary, based on your doctor’s recommendations.
If you notice dead tissue on the surface of your wound, don’t wait to visit your physician. Any changes in wound color, chronic wounds, or a burn injury should be reported to your medical professional as soon as possible.
What are scabs?
Unlike eschar, which forms on full-thickness wounds, scabs are found on superficial or partial-thickness wounds. Because these skin-level wounds are much more common than the deep wounds that tend to form eschar, scabs are one of the most well-known signs of proper wound management.
Scabs develop when a dry crust forms on the surface of a wound, as blood and exudate coagulate on a skin injury. Most scabs are dark brown and dry, forming over the wound bed within 24 hours of injury. They also signal a wound is moving towards advanced stages of healing.
Scabs prevent dead tissue and infection from forming on the surface of a healing wound
In less than 10 seconds after a break in the skin, the body does two things. It uses sticky blood cells called platelets to prevent an extended amount of blood loss from the wound. To hold the clot in place, a thread-like protein called fibrin begins to form a structure throughout the clot. Consider it an organic bandage made by your own body. The body also deploys white blood cells to attack any outside substances that may have snuck in before the clot was fully formed. These microorganisms, if allowed to take over the wound, can trigger a dangerous infection that requires medical treatment. That’s why it’s important to keep your skin clean and allow scabs to form and fall off naturally.
Eschar vs. Scab—which one do you have?
It’s easy to understand why so many people use “eschar” and “scab” interchangeably, but it’s important to note the differences between the two wound-healing responses.
If you’re concerned about a wound, notice slough on the surface, or have a non-healing wound, be sure to visit your doctor as soon as possible. Dead tissue and scabbing, while a normal part of wound healing, can also indicate unhealthy tissue or an underlying infection.
While both wound infections and dead tissue can often be treated with antibiotics or a wound cleansing solution like Dakin’s, don’t wait to see your physician. If further treatment or debridement is necessary, the sooner your wound is properly cared for, the sooner it can heal.
What’s the best way to prepare a wound bed?
Whether your wound has formed a scab or eschar tissue, one way to aid in the infection prevention and healing of your wound is to keep the surrounding skin clean and clear of infection.
In the early stages of wound healing, daily dressing changes with a wound care solution like Dakin’s can help prevent biofilm from forming on the surface of the wound, without slowing wound healing. As the wound progresses and your skin cells begin to regenerate, keeping skin clean with Dakin’s and dry dressings can further improve healing and stop dead tissue from slowing the growth of new, healthy skin.
Only Dakin’s offers four wound cleanser strengths for flexible wound management
Dakin’s wound care solutions come in four specific formulations for flexible, affordable, non-irritating wound treatment. Each strength kills at least 99.99999% of MRSA and vancomycin-resistant Enterococcus (VRE) in only 30 seconds, and Dakin’s non-cytotoxic formulation doesn’t slow the wound healing process.
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