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Author: Dr David Lim, Dermatology Registrar, Middlemore Hospital, Auckland, New Zealand, 2011.
Horse chestnut extract (commonly abbreviated HCE or HCSE) is derived from the seeds of the horse chestnut tree (Aesculus hippocastanum). Horse chestnut is native to areas of Europe, but is now grown in many areas around the world. Aescin (also spelt escin) is the most abundant active compound of horse chestnut extract and exhibits a range of actions.
Historically, horse chestnut has been used for purposes as diverse as a whitening agent for fabrics and as a soap. More recently it has been found to be of benefit in disorders of the venous system, particularly chronic venous insufficiency. It has also been used in the past to help with haemorrhoids.
Several studies have shown that horse chestnut extract is better than placebo for improving the symptoms of chronic venous insufficiency. One study has shown it to be equivalent to using compression stockings for reducing oedema or swelling. This study showed a reduction of about 25% of oedema fluid over a 12 week period.
Horse chestnut extract is currently used as an alternative to compression stockings for those who are unable to use compression. Common reasons for not using compression include those who are unable to tolerate compression, have peripheral vascular disease, find it too difficult to use, or simply do not wish to use compression.
Studies have suggested several different actions that are desirable in some diseases. Horse chestnut extract appears to impair the action of platelets (important components of blood clotting). It also inhibits a range of chemicals in the blood, including cyclo-oxygenase, lipoxygenase and a range of prostaglandins and leukotrienes. These effects result in reduced inflammation and reduced blood pressure. Horse chestnut also reduces swelling by constricting vessels of the venous system and slowing the leakage of fluid out of the veins.
Horse chestnut extract is usually well tolerated. Adverse effects are uncommon and usually mild if they do occur. Reported side effects include nausea and abdominal upset.
Horse chestnut extract impairs the action of platelets and as such care should be taken with those who are predisposed to bleeding or have disorders of coagulation. This also includes people who take blood-thinners or anticoagulants such as aspirin, clopidogrel, dipyridamole, warfarin, or dabigatran. Those with a history of significant bleeds, such as internal bleeding of the head or stomach, should also take care.
It is also thought that horse chestnut extract interferes with the regulation of glucose. People who are prone to low blood sugar levels, such as diabetics taking glucose-lowering medication, should take care with horse chestnut extract.
Horse chestnut extract is usually taken orally (by mouth). Studies have commonly used doses of 300 mg of horse chestnut extract once or twice daily. This dose is usually equivalent to 50 mg of aescin. It has also been used topically (applied to the affected areas on the skin), normally in concentrations of 1-2%.
Horse chestnut extract is commonly available at complementary and alternative medicine stores and does not require a prescription. Complementary and alternative medicines are often not regulated and products may contain contaminants and compounds not advertised on the packaging. Care should be taken to find a product from a reputable manufacturer.
In many jurisdictions horse chestnut extract is not funded by health providers or insurance companies and can end up being quite expensive.
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