Henoch Schonlein Purpura
(HSP or Anaphylactoid Purpura)

Henoch Schonlein Purpura or hsp is a condition where the wall of the small blood vessels of the skin, internal organs and joints are inflamed, leading to purple rashes, abdominal pain and joint swelling and pain. It is a common condition in children and often gets better on its own.

Has your son or daughter been generally unwell in the last few days and then developed a crop of purple rashes on the legs?

Has he or she been complaining of abdominal pain? Is there any joint swelling or pain? What about his or her stool? Is there blood in the stool or dark colored urine? This may be due to Henoch Schonlein purpura or hsp.

HSP, also called anaphylactoid purpura is a condition where the small blood vessels in the skin, small intestines, kidneys, joints and other internal organs are inflamed, leading to the development of rashes, abdominal pain, joint swellings and pain, blood in urine in severe cases or blood in stool.

It is a condition seen more in children between the ages of 2 and 8 years. It can occur at any age and even in adults.

What Causes HSP

Henoch Schonlein Purpura or hsp is a common cause of rash and abdominal pain

The exact cause of hsp is not known. It is nevertheless believed to be a form of excessive immune reaction by the body to the component of some bacteria or virus infection.  It tends to follow a virus infection or cold.

Research has show that as antibodies are produced against some type of infections by our immune system  to clear them, collateral damages are then inflicted upon the small blood vessels in our internal organs, skin, joint and even brain, leading to hsp.

It has also been reported to have been brought about by reaction to certain food types, medications like antibiotics, insect bites and cold.

  • It tends to occur more during late autumn (fall) to early spring
  • Boys are more affected than girls
  • Black children are less likely to suffer with this condition
  • Tends to follow infection with cold, sore throat, chickenpox, measles and some other infections.

Symptoms of Henoch Scholein Purpura

The symptoms of hsp  or anaphylactoid purpura are usually those of purple rashes on the legs and buttocks, abdominal pain, and joint pain and in some cases swelling.  Many children develop rash only without any of the other symptoms.

The typical hsp child will:

  • Be unwell for a few days with low level fever and flu-like symptoms
  • Tired and would not play as he or she usually does
  • Develop red or purple colored rash on one or both legs.  The buttocks may also be involved with rash and may be the lower back and abdomen. The rash may occur in groups or crops or scanty in isolation
  • He or she may complain of knee or and ankle pain. There may also be swelling of the joints.
  • Some children would look well apart from developing rash or may have been complaining of abdominal pain too in the last few days
  • About a quarter to half of children or adults with hsp would develop kidney problem. They may pass blood in their urine, have swollen face or have difficulty passing urine. Such kidney problem could also lead to raised blood pressure or hypertension
  • HSP could also present with chest pain, fits, weakness of one limb (stroke) pancreatitis or bleed into the muscles
  • Some children with Henoch Schonlein purpura may come up with rash and vomiting coffee ground vomit and or passing dark colored stools or blood in the stool, if they are bleeding into their intestine.

Clearly, this condition could cause very frightening symptoms. The good news is that in the vast majority of children or adults who suffer with hsp, apart from the rash and arthritis pain, they do not suffer most of the complications described above and symptoms resolve within 3 to 10 days.

Occasionally, Henoch Schonlein purpura may be recurrent, occurring at intervals of 1 - 4 months. In some cases, the recurrence of the purpuric rash may last up to 1 year or more.

Tests And Diagnosis Of Henoch Scholein Purpura

The diagnosis of Henoch Schonlein purpura is usually easy to make. The story is usually very typical, with the presence of rash, arthritis and abdominal pain, though many a time, patient may come up with the rash only.

Where there is doubt about the diagnosis, or if other complications are suspected, the following tests may be necessary. None of them on their own could help confirm the presence of this condition.

  • Blood count which may show raised levels or numbers of platelets in teh blood as well as white blood cells
  • The ESR or Erythrocyte Sedimentation rate may be elevated too. This is a crude marker of inflammation. It only tells us that an inflammatory process is going on
  • Raised IgA levels, 
  • Tests for rheumatoid arthritis or rheumatic diseases would be negative, showing that the arthritis witnessed is not due to rheumatism
  • A biopsy of the skin or kidney will show swelling and inflammation of the small blood vessels, a condition referred to as vasculitis
  • Urine test may show blood in the urine
  • An Abdominal ultrasound scan or an abdominal x-ray may be necessary to exclude other causes of abdominal pain
  • Stool test may show blood in stool
  • Your doctor may want to check your child's blood pressure too to be sure that the kidney is not adversely affected, leading to raised blood pressure.

Treatment of Henoch Schonlein Purpura

Thankfully, most cases of Henoch Schonlein purpura gets better on its own with or without the use of regular anti-inflammatory tablets like ibuprofen, and pain killers like paracetamol or acetaminophen.

If the child or adult with hsp is suspected of bleeding internally, they must avoid taking ibuprofen or neurofen. This is to prevent further bleeding.

Adequate rest, drinking plenty of water and normal balanced diet is the best way of helping the body to fight this condition and get well.

In those with serious complications like kidney problem, internal bleeding or stroke, the use of:

  • Steroids
  • Aspirin or
  • Surgery to relieve bowel obstruction may be required.

Henoch-Schönlein Purpura or HSP: Have Your Say!

Are you wondering if your child's rash and abdominal pain may be due to HSP? Why not share your story on how it all began here and pictures of the rash only, to help with the diagnosis?

Have you had an experience with HSP in the past with your child? We would love to hear from you as to how it all started, the symptoms, was it easy to diagnose? Where there any complications and how was he or she treated?

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References:

  • Rajan R,Joseph PK,Govindan V. A rare presentation of Henoch-Schönlein purpura and myocardial infarction at the 5th decade of life. Interventional medicine & applied science, June 2013, vol./is. 5/2(89-93), 2061-1617
  • Park SJ,Suh JS,Lee JH,Lee JW,Kim SH,Han KH,Shin JI. Advances in our understanding of the pathogenesis of Henoch-Schönlein purpura and the implications for improving its diagnosis. Expert review of clinical immunology, December 2013, vol./is. 9/12(1223-38), 1744-8409
  • Tanju IA, Cekmez F, Pirgon O, Karademir F. Diabetic ketoacidosis precipitated by henoch-schonlein purpura. Int J Biomed Sci. 2009 Jun;5(2):189-91.

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