title: Hydroxyethyl starch-induced itch: relevance of light microscopic analysis of semi-thin sections and electron microscopy.
abstract: BACKGROUND
  Hydroxyethyl starch (HES) is widely used as a plasma substitute for improving microcirculation. A major side effect of HES is severe pruritus caused by HES deposits in the skin. Since specific changes are difficult to see in paraffin sections, electron microscopy is the golden standard technique in the diagnosis of HES-induced skin disease. Our aim was to compare electron microscopic search for HES deposits with other techniques.
  
  
  METHODS
  During the last ten years, we biopsied 21 patients suspected of having HES-induced pruritus. We compared conventional microscopy with hematoxylin & eosin and toluidine blue-stained paraffin sections, toluidine blue-stained glycide ether-embedded, semithin sections and transmission electron microscopy.
  
  
  RESULTS
  In 9 patients specific HES deposits could be found by evaluating toluidine blue stained semithin sections by light microscopy alone. In 6 of these cases electron microscopy was also done and confirmed the findings. In contrast, no specific findings due to HES deposits could be detected by conventional histology.
  
  
  CONCLUSIONS
  If specific HES deposits are found in toluidine blue-stained, glycide ether-embedded semithin sections, electron microscopy is not required.
authors.affiliation: Clinic and Polyclinic for Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany. Stefanie.Kamann@med.uni-muenchen.de
authors.forename: Stefanie
authors.initials: S
authors.lastname: Kamann
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Flaig
authors.forename: Hans Christian
authors.initials: HC
authors.lastname: Korting
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods*; D003875:Drug Eruptions / Q000209:etiology / Q000473:pathology*; D005260:Female; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects*; D008297:Male; D008853:Microscopy / Q000379:methods*; D008854:Microscopy, Electron; D008875:Middle Aged; D010952:Plasma Substitutes / Q000009:adverse effects; D011537:Pruritus / Q000139:chemically induced* / Q000473:pathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes