Excoriated Skin= Sloughing??

[Nurse_Nancie]

Is it usual to refer to the skin of a burn victim as "sloughing"? I think of sloughing as what happens in response to a mild sunburn. Does the 2nd or 3rd degree burned skin "slough" too? We are having a debate as to whether sloughing is a result of erythema (ie...sunburn) or is the excorciated skin referred to as "sloughing off" too? This was a question we had in class.

[AllOfMyWat]

Sloughing is the separation of dead tissue from living, so yes.

[marienm, RN, CCRN]

By AllOfMyWat's good definition, slough can be applied pretty broadly. It sounds like the OP is a student, and as I recall from school there can be a lot of discussion in class about the exact meaning of a term...and then you get to clinical or work and find that people use terms much more loosely. Often, that's fine and everyone knows what is meant. If I need to say that someone's skin is red (like from 1st degree burn) I'll just say it's 'red, intact, no drainage or blisters.' I probably won't say it's erythematous! If their sunburn is now peeling, I'll probably just say it's peeling even though sloughing might be an appropriate term too. If they have a 2nd or 3rd degree burn or a deep pressure ulcer with goopy, formerly-viable tissue in it, I would call this slough...or if it's been there a while and is thicker I would probably call it eschar because by now it's mixed with a lot of dried drainage, etc... I think of excoriation as mechanical or chemical abrasion (friction from clothing/bedding, incontinence) and I wouldn't use this term to describe burned tissue.

So, OP, if you were hoping to have a definitive definition (or fuel for argument of an exam question), then I probably haven't helped too much. Sorry! Maybe I've given you some food for thought...

[Nurse_Nancie]

By AllOfMyWat's good definition, slough can be applied pretty broadly. It sounds like the OP is a student, and as I recall from school there can be a lot of discussion in class about the exact meaning of a term...and then you get to clinical or work and find that people use terms much more loosely. Often, that's fine and everyone knows what is meant. If I need to say that someone's skin is red (like from 1st degree burn) I'll just say it's 'red, intact, no drainage or blisters.' I probably won't say it's erythematous! If their sunburn is now peeling, I'll probably just say it's peeling even though sloughing might be an appropriate term too. If they have a 2nd or 3rd degree burn or a deep pressure ulcer with goopy, formerly-viable tissue in it, I would call this slough...or if it's been there a while and is thicker I would probably call it eschar because by now it's mixed with a lot of dried drainage, etc... I think of excoriation as mechanical or chemical abrasion (friction from clothing/bedding, incontinence) and I wouldn't use this term to describe burned tissue.

So, OP, if you were hoping to have a definitive definition (or fuel for argument of an exam question), then I probably haven't helped too much. Sorry! Maybe I've given you some food

for thought...

Thank you so so much for this response. I really understand in the way that you've explained it! I have more questions to come, if you do not mind. Thank you!

[marienm, RN, CCRN]

Go for it! I only browse AN when I'm not working, so sometimes I don't check in for several days, but I'll always try to answer!

[phoenixrn]

I agree with what Marienm said... I will add:

I would consider eschar to be nonviable tissue that covers a wound bed ... eschar can be yellow, white, or scabby. Eschar doesn't necessarily come off by itself, and in burns we want to get rid of eschar because it impedes tissue healing which needs a clean, pink wound bed to regenerate. We get rid of eschar by surgical debridement, or scrubbing, or sometimes enzyme topicals. If it's sloughing, it's coming off on its own. In burns, we see a lot of sloughing initially when the dead skin is literally sliding off the dermis. Skin graft better not be sloughing!!!