Necrodermis

Necrodermis is a term used in dermatopathology to describe a layer of necrotic dermal tissue. The word derives from Greek nekros, meaning dead, and derma, meaning skin, and it is used to refer to portions of the dermis that have died due to injury, ischemia, infection, or toxin exposure.

Definition and formation: Necrodermis denotes devitalized dermal tissue within or beneath an epidermal wound. It can arise in burns, pressure injuries, traumatic wounds, or infections when blood supply to the skin is compromised or when damaging agents overwhelm local tissue viability. The epidermis overlying necrodermis may be intact or sloughing.

Histology and appearance: In necrodermis, viable skin cells are absent or markedly reduced in the affected area. The dermal collagen may show coagulative necrosis, and inflammatory cells are typically present to varying degrees depending on the timing and cause. The tissue appears discolored, firm, and nonviable to touch, and it can serve as a barrier to re-epithelialization.

Clinical significance and management: Necrodermis can impede wound healing and may harbor bacteria, increasing infection risk. Management focuses on wound bed preparation, frequently requiring debridement (sharp, surgical, or enzymatic) to remove devitalized tissue and promote granulation and re-epithelialization. Addressing underlying factors such as pressure, vascular insufficiency, or ongoing infection is essential.

In clinical literature, necrodermis is not uniformly used; many clinicians refer to “necrotic dermis” or simply “necrosis” of the skin. See also wound debridement, necrosis, dermis, burns, and pressure ulcers.