Henoch-Schoenlein Purpura

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KEY POINTS

• Henoch-Schoenlein purpura (HSP) is a disease that causes bleeding from small, inflamed blood vessels into the skin causing a red or purple rash called purpura.
• There is no medicine that will cure this illness, though steroid medicine may help control symptoms. In most cases, it lasts 4 to 6 weeks and does not cause lasting problems.
• Follow your child’s healthcare provider's instructions. Ask your provider if there are activities your child should avoid and when your child can return to normal activities.

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What is Henoch-Schoenlein purpura?

Henoch-Schoenlein purpura (HSP) is a disease that causes bleeding from small, inflamed blood vessels into the skin. The bleeding causes a red or purple rash called purpura. Other parts of the body may also be affected such as the joints, intestines, and kidneys. It is most common in school-aged children, but can occur at any age.

What is the cause?

Inflammation (swelling) in the blood vessels causes the symptoms. The cause of the swelling is not known. It may be a response to infection. The illness is often seen in children who had a cold a few weeks earlier. The antibodies made by the body to fight the cold may attack other cells in the body. Other theories are that medicines, insect bites, cold temperatures, chemicals, or some foods are related to the cause. No one knows for certain.

HSP is not an inherited disease, and it is not contagious.

What are the symptoms?

The main symptom is a rash. The rash is often on the buttocks and legs as well as the backs of the elbows and arms. The rash may first look like hives, but usually it changes to purplish or brownish bruises within 1 to 2 days. There is almost always some rash on the ankles.

Other symptoms may include:

• Painful swelling of the joints: The joints that are most often painful are the knees and ankles. The pain may be bad enough to make your child unable or unwilling to walk.
• Belly pain or blood in the bowel movements
• Fever
• Blood in the urine

How is it diagnosed?

Your healthcare provider will ask about your child’s symptoms and medical history and examine your child. Tests may include:

• Blood tests
• Urine tests
• Tests of a sample of bowel movement

How is it treated?

There is no medicine that will cure this illness. In most cases, it lasts 4 to 6 weeks and doesn’t cause any lasting problems. Symptoms may come and go during this time. The older your child is, the more likely it is that he will have the symptoms again. Your child will eventually get better on his own.

Your child's healthcare provider may prescribe a steroid medicine, such as prednisone, to reduce inflammation in the intestine. The steroid may help control pain and bleeding in the bowel. Using a steroid for a long time can have serious side effects. Give steroid medicine exactly as your child’s healthcare provider prescribes. Your child should not take more or less of it than prescribed by your provider and should not take it longer than prescribed. Your child should not stop taking a steroid without your provider's approval. You may have to lower the dosage slowly before stopping it.

Most children recover from HSP completely and have no further problems. In rare cases, it may affect the kidneys. Your child may need to see your healthcare provider for blood pressure checks and urine tests every 1 to 2 months over the next 2 years to check the kidneys.

Call your healthcare provider if your child has:

• Belly pain
• Vomiting
• Bloody or brown colored urine or less frequent urination
• Vomiting
• Swelling of feet or ankles

How can I take care of my child?

You can help relieve your child's symptoms with:

• Pain medicine. Ibuprofen can help with the pain and inflammation of swollen joints. Use the same dose you use when your child has a fever. Nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen, may cause stomach bleeding and other problems. Read the label and give as directed.
• Fluids. Encourage your child to drink plenty of fluids and to eat a normal diet.

Follow your child’s healthcare provider's instructions. Ask your provider:

• How and when you will get your child’s test results
• How long it will take your child to recover from this illness
• If there are activities your child should avoid and when your child can return to normal activities
• How to take care of your child at home
• What symptoms or problems you should watch for and what to do if your child has them

Make sure you know when your child should come back for a checkup. Keep all appointments for provider visits or tests.