Storage of hydroxethyl starch in the skin causing pruritus

Background and objective: Hydroxyethyl starch (HES) is a colloidal infusion fluid that has for a long time been used in emergency situations and to im prove impaired blood perfusion, In the last few years there have been numer ous reports about treatment resistant pruritus, often persisting for months , after HES infusion. We investigated the intracellular uptake of HES in th e skin, special attention being focused on associated pruritus. Patients and methods: Skin biopsies were obtained from 120 patients (120 me n, 35 women) and examined immunohistochemically and for their ultrastructur e. Three patients had received various HES preparations, while 22 had been given dextran. Five patients who had received no infusions served as contro ls. Results: All patients given HES had lysosomal deposits in the histiocytes, some of them also in cutaneous epithelium and endothelium. The extent of ly sosomal storage correlated with the amount of infused HES and the interval between biopsy and last HES infusion. Consecutive biopsies in some cases de monstrated a definite decrease over the years of HES deposits in the vacuol es. This suggests that HES is regularly metabolized in the skin. Pruritus a fter high cumulative doses of HES was closely correlated with HES depositio n in cutaneous nerves. Conclusions: These results emphasize the need for starch derivatives that c an be better metabolized and for better adapted infusion schedules to reduc e the high incidence of pruritus.