Leave eschar alone

Remember how as a child your mother told you “not to pick”? As a mom myself, I think it had more to do with the fingernails-on-a-chalkboard reaction to that repetitive action and the subsequent blood than the notion that the scar was protecting the boo-boo from further damage and infection and it best be left alone.

Wound care specialists, however, know (and subsequently, related guidelines have been developed) that eschar/necrotic tissue keeps a wound covered and helps facilitate healing. Concern that eschar prohibits accurate assessment for the most part is assuaged by the realization that if no other signs of trouble are present (such as warmth, redness, and the like) that herald infection or suggest debridement is warranted, the “dead” tissue is best left undisturbed. Obviously, there are exceptions, but the rule of thumb (more accurately, the rule of foot) with regard to heel wound eschar should be: Leave it alone.

Care to debate?

Intertrigo: skin is also a concern in obesity

Say what you will about recent concern that obesity is a disease and not a lifestyle choice, the number of overweight and morbidly overweight persons in the world is increasing. This pandemic affects healthcare providers challenged to manage the comorbid conditions resulting from obesity, payors seeking responsible ways to finance care, and society in general. Airlines (Samoa, the most prominent example) want to charge by weight; some companies require the purchase of an extra seat for the bigger among us. A popular reality show follows the struggles of a select few to embrace healthy eating and exercise habits.

But food, activity, and public opinion are but a few of the issues. Persons with areas of adjacent excessive skin folds are susceptible to intertrigo, a bacterial, fungal, or viral infection that develops as a result of inflammation when skin rubs against skin. Common areas are the inner thighs, genitalia, armpits, under the breasts, the underside of the belly, behind the ears, and the web spaces between the toes and fingers. Usually appearing as red and raw, intertrigo may itch, ooze, and feel sore. You can read more about intertrigo at: 

Intertrigo in the Obese Patient: Finding the Silver Lining
An Overview of Dermatological Conditions Commonly Associated with the Obese Patient