Cleaning the Skin Surrounding an Eschar
Clean the skin surrounding a stable eschar with clean water or saline—these are the only recommended cleansing agents for diabetic foot ulcers and surrounding tissue. 1
Recommended Cleansing Approach
Primary Cleansing Agents
- Use clean water or saline to clean ulcers and surrounding skin regularly 1
- These basic cleansing solutions are sufficient to remove debris from the wound surface and surrounding tissue 1
- No specialized or antimicrobial cleansers are recommended or necessary 1
What NOT to Use
- Do not use antimicrobial cleansers or antiseptic solutions on the wound or surrounding skin with the goal of improving healing or preventing infection 1
- Avoid topical antiseptics, as they have not been shown to improve outcomes and may impair healing 1, 2
Important Context: Eschar Management
When Eschar Should Be Debrided
- Sharp debridement is strongly recommended to remove slough, necrotic tissue (including eschar), and surrounding callus in most cases 1
- This should be performed by clinicians skilled in debridement to avoid damage to healthy tissue 1
- Sharp debridement is preferred over all other debridement methods (autolytic, enzymatic, larval therapy) 1
When to Leave Eschar Intact (Stable Dry Eschar)
- Relative contraindications to debridement include severe ischemia and significant pain 1
- In severely ischemic limbs, a stable, dry eschar may serve as a protective barrier and should not be debrided until revascularization is achieved 1
- Even when eschar is left intact, the surrounding skin should still be cleaned with water or saline 1
Common Pitfalls to Avoid
- Do not select cleansers based on antimicrobial properties—there is no evidence that antimicrobial cleansing agents improve outcomes in diabetic foot ulcers 1
- Avoid harsh antiseptics (povidone-iodine, hydrogen peroxide, chlorhexidine) that may damage healthy tissue and impair healing 1, 3
- Do not confuse wound cleansing with infection management—if infection is present, systemic antibiotics (not topical antimicrobials) are indicated 1, 4
- Remember that proper cleansing is secondary in importance to sharp debridement and off-loading for ulcer healing 1, 5