Hydroxyethyl starch-induced pruritus

A condition of itching caused by hydroxyethyl starch

Hydroxyethyl starch-induced pruritus is a condition characterized by intense itching that occurs as a side effect of the administration of hydroxyethyl starch (HES), a synthetic colloid used as a plasma volume expander in medical settings.

Pathophysiology

Hydroxyethyl starch is used to treat or prevent hypovolemia, a condition where there is a decrease in the volume of blood plasma. It works by expanding the plasma volume, thereby improving circulation and oxygen delivery to tissues. However, one of the adverse effects associated with HES is pruritus, or itching.

The exact mechanism by which HES induces pruritus is not fully understood. It is hypothesized that the accumulation of HES molecules in the skin may lead to the activation of mast cells and the release of histamine, a compound involved in allergic reactions and itching. Additionally, HES may alter the function of nerve endings in the skin, contributing to the sensation of itch.

Clinical Presentation

Patients experiencing hydroxyethyl starch-induced pruritus typically report severe itching that can be widespread or localized. The itching may occur days to weeks after the administration of HES and can persist for several weeks or even months. The intensity of the pruritus can significantly affect the quality of life, leading to sleep disturbances and psychological distress.

Diagnosis

The diagnosis of hydroxyethyl starch-induced pruritus is primarily clinical, based on the history of recent HES administration and the characteristic itching. It is important to differentiate this condition from other causes of pruritus, such as allergic reactions, dermatitis, or systemic diseases.

Management

Management of hydroxyethyl starch-induced pruritus involves symptomatic treatment. Antihistamines may be used to alleviate itching, although their effectiveness can be variable. Topical treatments, such as emollients and corticosteroids, may provide some relief. In severe cases, systemic treatments such as gabapentin or pregabalin may be considered.

Avoidance of further exposure to HES is crucial to prevent recurrence of pruritus. In patients who require volume expansion, alternative agents such as albumin or crystalloids may be used.

Prognosis

The prognosis for patients with hydroxyethyl starch-induced pruritus is generally good, as the condition is self-limiting and resolves with time. However, the duration of symptoms can vary, and some patients may experience prolonged itching.

Related pages

• Pruritus
• Hypovolemia
• Mast cell
• Histamine