Eschar

An eschar (/ˈɛskɑːr/; Greek: 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, spotted fevers and exposure to cutaneous anthrax. The term "eschar" is not interchangeable with "scab". An eschar contains necrotic tissue, whereas a scab is composed of dried blood and exudate.

Inoculation eschar Rickettsia sibirica mongolitimonae infection
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.

Escharotic

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, 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.

See also

References

  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.

External links

External resources
African tick bite fever

African tick bite fever (ATBF) is a bacterial infection spread by the bite of a tick. Symptoms may include fever, headache, muscles pains, and a rash. At the site of the bite there is typically a red skin sore with a dark center. Onset usually occur 4–10 days after the bite. Complications are rare, however may include joint inflammation. Some people do not develop symptoms.The disease is caused by the bacterium Rickettsia africae. The bacterium is spread by ticks of the Amblyomma type. These generally live in tall grass or bush rather than in cities. The diagnosis is typically based on symptoms. It can be confirmed by culture, PCR, or immunofluorescence.There is no vaccine. Prevention is by avoiding tick bites by covering the skin, using DEET, or using permethrin treated clothing. Evidence regarding treatment, however, is limited. The antibiotic doxycycline appears useful. Chloramphenicol or azithromycin may also be used. The disease will also tend to resolve without treatment.The disease occurs in sub-Saharan Africa, the West Indies, and Oceania. It is relatively common among travelers to sub-Saharan Africa. Most infections occur between November and April. Outbreaks of the disease may occur. The earliest descriptions of the condition are believed to be from 1911. African tick bite fever is a type of spotted fever. It has previously been confused with Mediterranean spotted fever.

American tick bite fever

American tick bite fever (also known as "Rickettsia parkeri infection") is a term for a spotted fever disease caused by the tick-borne pathogen Rickettsia parkeri. Symptoms may include a fever, red spots on the skin throughout the body, and an eschar at the site of the tick-bite.

Black salve

Black salve, also known by the brand name Cansema, is a controversial alternative cancer treatment. The product is commonly classified as an escharotic—a topical paste which destroys errant skin tissue and leaves behind a scar called an eschar. Escharotics were widely used to treat skin lesions in the early 1900s, but have since been replaced by safer and more effective treatments. Escharotics, such as black salves, are currently advertised by some alternative medicine marketers as treatments for skin cancer, often with unsubstantiated testimonials and unproven claims of effectiveness.The U.S. Food and Drug Administration has listed Cansema as a "fake cancer cure" and warns consumers to avoid it.

Bromelain (pharmacology)

A concentrate of proteolytic enzymes from the pineapple plant enriched in bromelain is approved in Europe for the debridement (removal of eschar, that is dead and damaged tissue) of severe burn wounds under the trade name NexoBrid. In the US, it has completed Phase III clinical trials and has the tentative trade name Debrase. It was developed by MediWound, Germany; and Teva is responsible for development and marketing in the US.The medicine has been granted orphan drug status by the European Medicines Agency (EMA).

Death messenger

Death messengers, in former times, were those who were dispatched to spread the news that an inhabitant of their city or village had died. They were to wear unadorned black and go door to door with the message, "You are asked to attend the funeral of the departed __________ at (time, date, and place)." This was all they were allowed to say, and were to move on to the next house immediately after uttering the announcement. This tradition persisted in some areas to as late as the mid-19th century.

Debridement

Debridement is the medical removal of dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue. Removal may be surgical, mechanical, chemical, autolytic (self-digestion), and by maggot therapy.

In oral hygiene and dentistry, debridement refers to the removal of plaque and calculus (tartar) that have accumulated on the teeth. Debridement in this case may be performed using ultrasonic instruments, which fracture the calculus, thereby facilitating its removal, as well as hand tools, including periodontal scaler and curettes, or through the use of chemicals such as hydrogen peroxide.

In podiatry practitioners such as chiropodists, podiatrists and foot health practitioners remove conditions such as calluses and verrucas.

Debridement is an important part of the healing process for burns and other serious wounds; it is also used for treating some kinds of snake and spider bites.

Sometimes the boundaries of the problem tissue may not be clearly defined. For example, when excising a tumor, there may be micrometastases along the edges of the tumor that are too small to be detected, and if not removed, could cause a relapse. In such circumstances, a surgeon may opt to debride a portion of the surrounding healthy tissue – as little as possible – to ensure that the tumor is completely removed.

Escharotomy

An escharotomy is a surgical procedure used to treat full-thickness (third-degree) circumferential burns. In full-thickness burns, both the epidermis and the dermis are destroyed along with sensory nerves in the dermis. The tough leathery tissue remaining after a full-thickness burn has been termed eschar. Following a full-thickness burn, as the underlying tissues are rehydrated, they become constricted due to the eschar's loss of elasticity, leading to impaired circulation distal to the wound. An escharotomy can be performed as a prophylactic measure as well as to release pressure, facilitate circulation and combat burn-induced compartment syndrome.

An escharotomy is performed by making an incision through the eschar to expose the fatty tissue below. Due to the residual pressure, the incision will often widen substantially.

Esker

An esker, eskar, eschar, or os, sometimes called an asar, osar, or serpent kame, is a long, winding ridge of stratified sand and gravel, examples of which occur in glaciated and formerly glaciated regions of Europe and North America. Eskers are frequently several kilometres long and, because of their peculiar uniform shape, are somewhat like railway embankments.

Eutrombicula

Eutrombicula is a subgenus of mites in the family Trombiculidae. The species of this family are found throughout Europe.

Two genera of chigger mites, each containing many species, are of concern to deployed military forces. They are Eutrombicula and Leptotrombidium. Chiggers in the genus Eutrombicula, such as Trombicula alfreddugesi, do not transmit any known pathogens to people, but they can cause irritating bites, dermatitis and severe itching when they feed on the unsuspecting host. They are widely distributed in the Western Hemisphere, and Europe. By comparison chiggers in the genus Leptotrombidium are the vectors of scrub typhus throughout Asia and portions of Australia. The bite of Leptotrombidium often does not itch, or at least not as intensely, as those of Eutrombicula. Also, a black necrotic lesion known as an eschar develops where the chigger fed.

Finite Automata (band)

Finite Automata is an American dark electronic and electro industrial music group from Atlanta, Georgia. Originally formed in Pensacola, Florida in 2006, they have been based out of Atlanta, Georgia since 2013 and currently consist of vocalist, producer, and lyricist Mod Eschar, keyboardist Scott Storey, and guitarist Timothy Miller. They are known for their deep layered sound, frequent experimental live use of sound making devices such as radios and tapedecks, and their highly politically charged, confrontational, and theatrical stage performances. The group's name stems from the computer science concept of Finite State Machines, used as a metaphor for the predictability of human behavior. The band cites 1980s and 1990s electro-industrial groups Skinny Puppy, Front Line Assembly, and Project Pitchfork as their primary influences. Much of their early work has been referred to as a "throwback" as much of its style is reminiscent of early electro-industrial as opposed to the more recent and popular Aggrotech offshoot. Their more recent work draws heavily on industrial rock and the darker and more experimental sounds of second and third generation industrial like with previous releases, but with a healthy dose of modern production stylings and a more updated sound.

Megadeath

Megadeath (or megacorpse) is one million human deaths, usually caused by a nuclear explosion. The term was used by scientists and thinkers who strategized likely outcomes of all-out nuclear warfare.

Orientia tsutsugamushi

Orientia tsutsugamushi (from Japanese tsutsuga meaning "illness", and mushi meaning "insect") is a mite-borne bacterium belonging to the family Rickettsiaceae and is responsible for a disease called scrub typhus in humans. It is a natural and an obligate intracellular parasite of mites belonging to the family Trombiculidae. With a genome of only 2.4–2.7 Mb, it has the most repeated DNA sequences among bacterial genomes sequenced so far. The disease, scrub typhus, occurs when infected mite larvae accidentally bite humans. Primarily indicated by undifferentiated febrile illnesses, the infection can be complicated and often fatal.

O. tsutsugamushi infection was first reported in Japan by Hakuju Hashimoto in 1810, and to the Western world by Theobald Adrian Palm in 1878. Naosuke Hayashi first described it in 1920, giving the name Theileria tsutsugamushi. Owing to its unique properties, it was renamed Orientia tsutsugamushi in 1995. Unlike other Gram-negative bacteria, it is not easily stained with Gram stain, as its cell wall is devoid of lipophosphoglycan and peptidoglycan. With highly variable membrane protein, a 56-kDa protein, the bacterium can be antigenically classified into many strains (sub-types). The classic strains are Karp (which accounts for about 50% of all infections), Gilliam (25%), Kato (less than 10%), Shimokoshi, Kuroki and Kawasaki. Within each strain, enormous variability further exists.

O. tsutsugamushi is naturally maintained in the mite population by transmission from female to its eggs (transovarial transmission), and from the eggs to larvae and then to adults (transtadial transmission). The mite larvae, called chiggers, are natural ectoparasites of rodents. Humans get infected upon accidental contact with infected chiggers. A scar-like scab called eschar is a good indicator of infection, but is not ubiquitous. The bacterium is endemic to the so-called Tsutsugamushi Triangle, a region covering the Russian Far East in the north, Japan in the east, northern Australia in the south, and Afghanistan in the west. One million infections are estimated to occur annually. Antibiotics such as azithromycin and doxycycline are the main prescription drugs; chloramphenicol and tetracyclin are also effective. Diagnosis of the infection is difficult and requires laborious techniques such as Weil–Felix test, rapid immunochromatographic test, immunofluorescence assays, and polymerase chain reaction. There is no working vaccine.

Pacific Coast tick fever

Pacific Coast tick fever is an infection caused by Rickettsia philipii. The disease is spread by the Pacific coast ticks. Symptoms may include an eschar. It is within a group known as spotted fever rickettsiosis together with Rickettsia parkeri rickettsiosis, Rocky Mountain spotted fever, and rickettsialpox. These infections can be difficult to tell apart.

Pressure ulcer

Pressure ulcers, also known as bedsores, are localized damage to the skin and/or underlying tissue that usually occur over a bony prominence as a result of usually long-term pressure, or pressure in combination with shear or friction. The most common sites are the skin overlying the sacrum, coccyx, heels, and hips, though other sites can be affected, such as the elbows, knees, ankles, back of shoulders, or the back of the cranium.

Pressure ulcers occur due to pressure applied to soft tissue resulting in completely or partially obstructed blood flow to the soft tissue. Shear is also a cause, as it can pull on blood vessels that feed the skin. Pressure ulcers most commonly develop in individuals who are not moving about, such as those who are on chronic bedrest or consistently use a wheelchair. It is widely believed that other factors can influence the tolerance of skin for pressure and shear, thereby increasing the risk of pressure ulcer development. These factors are protein-calorie malnutrition, microclimate (skin wetness caused by sweating or incontinence), diseases that reduce blood flow to the skin, such as arteriosclerosis, or diseases that reduce the sensation in the skin, such as paralysis or neuropathy. The healing of pressure ulcers may be slowed by the age of the person, medical conditions (such as arteriosclerosis, diabetes or infection), smoking or medications such as anti-inflammatory drugs.

Although often prevented and treatable if detected early, pressure ulcers can be very difficult to prevent in critically ill people, frail elders and individuals with impaired mobility such as wheelchair users (especially where spinal injury is involved). Primary prevention is to redistribute pressure by regularly turning the person. The benefit of turning to avoid further sores is well documented since at least the 19th century. In addition to turning and re-positioning the person in the bed or wheelchair, eating a balanced diet with adequate protein and keeping the skin free from exposure to urine and stool is very important.

The rate of pressure ulcers in hospital settings is high; the prevalence in European hospitals ranges from 8.3% to 23%, and the prevalence is 26% in Canadian healthcare settings. In 2013, there were 29,000 documented deaths from pressure ulcers globally, up from 14,000 deaths in 1990.

Rickettsia parkeri

Rickettsia parkeri (abbreviated R. parkeri) is a Gram-negative intracellular bacterium. R. parkeri causes mild spotted fever disease in humans, (sometimes referred to as American tick bite fever), characterized by headache, rash, fever, and an eschar at the site of tick attachment. It is transmitted via tick bite and found mainly in the Western Hemisphere. Doxycycline and Chloramphenicol are the most common drugs of choice for reducing the symptoms associated with disease caused by R. parkeri.

Rickettsia sibirica

Rickettsia sibirica is a species of Rickettsia. This bacterium is the etiologic agent of North Asian tick typhus, which is also known as Siberian tick typhus. The ticks that transmit it are primarily various species of Dermacentor and Haemaphysalis.

Scrub typhus

Scrub typhus or bush typhus is a form of typhus caused by the intracellular parasite Orientia tsutsugamushi, a Gram-negative α-proteobacterium of family Rickettsiaceae first isolated and identified in 1930 in Japan.Although the disease is similar in presentation to other forms of typhus, its pathogen is no longer included in genus Rickettsia with the typhus bacteria proper, but in Orientia. The disease is thus frequently classified separately from the other typhi.

Second Circle

"Second Circle" is a song by American electro-industrial band Finite Automata. It was released on May 1, 2015 by the band as a self-release in digital format, and licensed to Beyond Therapy Records. The track is a reference to the Second Circle of Hell according to Dante's Inferno, and deals with the concept of perversion and blind lust as a means of control. Originally intended as the first single off of the band's follow up album to their 2012 release, Recurse, it is now considered a stand alone release by the band. The record was re-released on Latex Records in 2016 following Beyond Therapy Records' dissolution.

Warfarin necrosis

Warfarin-induced skin necrosis is a condition in which skin and subcutaneous tissue necrosis (tissue death) occurs due to acquired protein C deficiency following treatment with anti-vitamin K anticoagulants (4-hydroxycoumarins, such as warfarin).Warfarin necrosis is a rare but severe complication of treatment with warfarin or related anticoagulants. The typical patient appears to be an obese, middle aged woman (median age 54 years, male to female ratio 1:3). This drug eruption usually occurs between the third and tenth days of therapy with warfarin derivatives. The first symptoms are pain and redness in the affected area. As they progress, lesions develop a sharp border and become petechial, then hard and purpuric. They may then resolve or progress to form large, irregular, bloody bullae with eventual necrosis and slow-healing eschar formation. Favored sites are breasts, thighs, buttocks and penis, all areas with subcutaneous fat. In rare cases, the fascia and muscle are involved.Development of the syndrome is associated with the use of large loading doses at the start of treatment.

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