Philip A. A year-old girl developed a cutaneous macular lesion in the area of the right sternoclavicular joint. In the 3-week period after initial symptoms were noted, the lesion passed through papular, vesicular, and pustular stages before forming a hard black eschar diameter, 2 cm with erythema and edema, as well as regional lymphangitis figure 1. In the early stage of the disease, the patient experienced malaise and had subfebrile temperatures. After treatment with several different antibiotic regimens clindamycin-clarithromycin, then fucidine-imipenem-ciprofloxacin , the patient was admitted to our hospital with suspected cutaneous anthrax.
Scab vs. Eschar
The term "eschar" is not interchangeable with "scab". An eschar contains necrotic tissue, whereas a scab is composed of dried blood and exudate. Black eschars are most frequently attributed in medicine to cutaneous anthrax infection by Bacillus anthracis , 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. Eschar may be allowed to slough off naturally, or it may require surgical removal debridement to prevent infection, especially in immunocompromised patients e. 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.
Eschar, pronounced es-CAR, is dead tissue that sheds or falls off from the skin. Eschar is typically tan, brown, or black, and may be crusty. Wounds are classified into stages based on how deep they are and how much skin tissue is affected. This is because eschar is dead, dark tissue that makes it difficult to see the wound underneath. Eschar is characterized by dark, crusty tissue at either the bottom or the top of a wound. The tissue closely resembles a piece of steel wool that has been placed over the wound. The wound may have a crusted or leathery appearance and will be tan, brown, or black. Eschar is often part of a larger wound.
Scrub typhus is an acute febrile illness usually endemic in many parts of Asia including India, caused by a microbe Rickettsia tsutsugamushi R. Though transmission occurs throughout the year in tropical areas, in India the peak occurs between October and February. In this letter we stress the importance of eschar in diagnosing the scrub typhus fever. A year-old male farmer was admitted with the history of fever and generalized body ache of three days duration. On examination he was conscious and febrile. His vitals were stable. He had icterus, axillary lymphadenopathy and a punched out ulcer with blackened scab, the eschar, below the right clavicle [ Figure 1 ].