Henoch Schonlein Purpura in Children

Henoch Schonlein purpura (HSP) is a condition that causes swelling and irritation (inflammation) of small blood vessels (vasculitis). The inflammation makes blood vessels leak and causes a rash. The rash may look like raised bruises or dots.

The rash changes color over time from reddish-purple to rust-colored. The redness does not go away when the spots are pressed. The rash can appear anywhere, but it is most common on the arms, legs, and buttocks. HSP can also cause:

• Bleeding into the bowel and kidney.
• Joint inflammation.
• Kidney damage. This can develop several months later. Rarely, kidney damage can lead to long-term or end-stage kidney disease.

What are the causes?

HSP is caused by an overactive defense (immune) system. Something triggers your child’s immune system to produce proteins (antibodies) that attack blood vessels. This is called an autoimmune reaction. Triggers for HSP may include:

• Some viral and bacterial infections.
• Medicine.
• Certain foods.
• Insect bites.
• Injury.
• Exposure to cold.
• Vaccines.

What increases the risk?

This condition is more likely to develop in:

• Children who are younger than 10 years of age.
• Boys.
• Children who have had a recent upper respiratory tract infection.
• Children who have had HSP before.
• Children who have a family history of HSP.
• Late autumn to early spring.

What are the signs or symptoms?

The main symptom of this condition is a skin rash from vasculitis. Other symptoms include:

• Pain in the abdomen. This may include nausea, vomiting, and diarrhea.
• Blood in your child’s urine or stool.
• Swollen and painful joints, especially the knees and ankles.
• Fatigue.
• Fever.
• Swollen testicles, if this applies.

How is this diagnosed?

This condition is diagnosed based on your child’s symptoms, physical exam, and lab test results. Your child’s health care provider may also do tests, such as:

• Urine tests to check for blood or protein.
• Blood tests to check for complications and to make sure there is not another cause of your child’s illness.
• A skin biopsy to check for antibodies.

How is this treated?

There is no cure for this condition. HSP usually goes away on its own within a month. In some cases, your child may need to be cared for in the hospital. Symptoms can be managed by:

• Staying in bed (bed rest).
• Raising (elevating) affected arms and legs above the level of the heart.
• Drinking more fluids.
• Taking medicines to reduce inflammation and pain. These may include:
  • NSAIDs to relieve aches and fever.
  • Corticosteroids to reduce inflammation and relieve pain.

Severe kidney damage may be treated with drugs that block the immune system (immunosuppressives). Kidney failure may be treated with a process to clean the blood of wastes, salt, and extra fluid (dialysis).

Follow these instructions at home:

• Give over-the-counter and prescription medicines only as told by your child’s health care provider.
• Have your child drink enough fluid to keep his or her urine clear or pale yellow.
• Keep all follow-up visits with your child’s health care provider. This is important.

Contact a health care provider if:

• Your child’s symptoms are not controlled with medicine.
• Your child has blood in his or her urine or stool.

Get help right away if:

• Your child has severe pain in the abdomen.
• Your child vomits repeatedly.
• Your child has heavy bleeding in his or her urine or stool.
• Your child is unable to pass urine.
• Your child has abdominal pain and is not having any bowel movements.