Henoch-Schonlein purpura

What is Henoch-Schonlein purpura (HSP)?

Henoch-Schonlein purpura is common in children between the ages of two and 10. The condition causes inflammation (swelling) of small blood vessels. The blood vessels then become easily broken and allow blood to leak.

The bleeding into the skin causes a rash, which often looks more severe than it actually is. HSP does not usually cause much discomfort. On the other hand, if blood leaks into the kidneys, joints, or digestive tract, it can cause various problems, including kidney disease.

HSP affects approximately 20 in 100,000 children annually. 

Signs and symptoms of Henoch-Schonlein purpura

Children with HSP always have a rash consisting of pink, red, or purple blood-filled spots that do not fade when pressed. The spots can either be raised or flat, and can vary in size. The rash usually appears on the arms, face and trunk. The rash can often be worse around the joints like the ankles or knees, or in areas where clothes can apply pressure, such as the sock line and waistline.

The signs and symptoms may also include:

  • abdominal (belly) pain, often accompanied by vomiting and diarrhea
  • joint pain and swelling
  • blood in the stool
  • blood in the urine, which usually indicates of kidney disease

One study found that approximately 1 in 4 children with HSP will have symptoms in the joints before the rash appears. 

Causes of Henoch-Schonlein purpura

Doctors and researchers do not know exactly what causes the inflammation of the small blood vessels, but they suspect HSP may be a reaction to an infection (an overly aggressive response by your child’s immune system). Doctors have noticed that HSP often follows a viral illness, like the common cold.

Complications

About 1 in 2 children with HSP develop problems with their kidneys; most of these are mild and temporary. Only a small minority will have serious kidney disease. The primary sign of kidney problems is microscopic blood in the urine (not visible to the naked eye). 

Recovery

HSP is considered a one-time illness, though children occasionally get it more than once. Most children recover completely from this illness with no long-term side effects. Recovery can take a few days up to a month.

For most children who experienced kidney inflammation, the kidneys return to normal in a few days. In some cases, however, the kidneys can remain inflamed for as long as 2 years.

What you can do to help your child with Henoch-Schonlein purpura

There is no specific treatment for Henoch-Schonlein purpura.  You can support your child by trying to make him comfortable.

Abdominal or joint pain

Acetaminophen (Tylenol® or Tempra or other brands) or ibuprofen​ (Motrin® or Advil® or other brands) can be used to treat joint or abdominal pain. DO NOT give your child ASA (acetylsalicylic acid or Aspirin). 

Bed rest

Allow your child to rest as the rash works through his system and the symptoms eventually disappear.

What your child’s doctor can do for your child with Henoch-Schonlein purpura

Your child’s doctor will physically examine your child in order to make a diagnosis. The doctor may order blood and urine tests to ensure that the rash is HSP, and to rule out other possibilities.

Once the diagnosis is made, the doctor will determine whether your child requires medication to treat the pain that often accompanies HSP. Corticosteroids may be prescribed for severe abdominal pain. If your child has severe kidney inflammation, other medication will be prescribed to prevent serious kidney disease. 

When to see a doctor

Seek immediate assistance from your child’s doctor, or take your child to the Emergency Department, within hours of the onset of symptoms of HSP. The rash of HSP is similar to more serious disorders and the diagnosis of HSP should be made by a physician.

Key points

  • Henoch-Schonlein purpura causes inflammation of small blood vessels, which then become easily broken and allow blood to leak.
  • Symptoms include a distinctive rash and swelling in the joints.
  • Seek immediate medical attention after the onset of HSP symptoms.
  • HSP is most common in children between the ages of two and 10 years, though young adults have also been known to develop the rash.
  • There is no specific treatment for HSP. Treatment is aimed at easing your child’s pain and discomfort.
  • If the doctor suspects kidney inflammation, medication may be prescribed. 
Mark Feldman MD, FRCPC
5/7/2010

Chartapisak W, Opastirakul S, Hodson EM, Willis NS, Craig JC. Interventions for preventing and treating kidney disease in Henoch-Schönlein Purpura (HSP): http://www2.cochrane.org/reviews/en/ab005128.html. Last accessed May 2010. 

Lawee D., Atypical clinical course of Henoch-Schonlein purpura. Can Fam Physician. 2008 Aug;54(8):1117-20.  Department of Family and Community Medicine, University of Toronto, Ontario: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2515239/. Last accessed May 2010. 





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