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What You Should Know about Henoch-Schonlein Purpura

Henoch-Schonlein Purpura

Chances are, if you or someone in your family has been diagnosed with Henoch-Schonlein Purpura (HSP), you probably hadn’t even heard of it before!  This strange condition can have some signs and symptoms that are frightening for kids and parents both, but the truth is that in most cases, this problem will go away on its own and leave no lasting damage. Read on to find out more about this condition.

What is HSP?

HSP is an inflammatory condition which causes small blood vessels — usually in the skin, joints, intestines and kidneys — to leak blood.  While this condition usually goes away on its own without lasting complications, it can sometimes do serious damage to the kidneys or intestines.

How Do You Know if You have HSP?

Oftentimes, a few weeks before the main signs of HSP develop, kids will have other symptoms. These symptoms are vague and  include:

  • Headache
  • Muscle ache
  • Fever

Once HSP develops, however, there are four main symptoms to look for:

  • Skin problems. Skin problems occur in nearly every case of HSP. The skin first appears to have small red pustules like hives, but this quickly turns to bruise-like, red-purple spots that occur on both side of the body and often appear on the buttocks, legs and feet. Sometimes, though, these splotches can also appear on the arms, face or chest.
  • Joint problems. In around ¾’s of cases, HSP causes swelling and pain in the joints, especially in the knees and ankles. The joint pain usually begins a few days before skin issues develop and fade away after the disease clears up.
  • Digestive problems. About half of kids with HSP will also develop a variety of digestive problems. These can include nausea and vomiting, upset stomach and stomach pain and blood in the stools.
  • Kidney problems. The bleeding that HSP causes can do lasting damage to the kidneys; in about 5% of cases, this leads to kidney disease — and to kidney failure about 1% of the time.

What Causes HSP?

The exact cause of HSP is not known. However, it is believed that part of the problem is an abnormal immune response.  Often there is a trigger to HSP development. These triggers include:

  • Infections, including respiratory infections, strep throat and chicken pox. Around ⅔’s of all cases of HSP begin after a child has developed a respiratory infection.
  • Certain foods
  • Drugs or medications
  • Insect bites
  • Some vaccinations, such as those for hepatitis and measles

Who is at Risk for HSP?

While anyone can develop HSP, some people are more at risk. These risk factors are based on:

  • Kids between 2 and 6 are most likely to get HSP.
  • Boys get this condition more often than girls.
  • Kids with an Asian or Caucasian heritage are more likely to develop this than those of African heritage
  • Time of year. For unknown reasons, HSP is more likely to develop in fall, winter or spring than it is in the summer.

Are there Complications from HSP?

There are two serious complications which are possible with HSP:

  • Intestinal blockage. This is caused by a condition called intussusception, where the bowels fold over on themselves and prevent a child from going to the bathroom. This usually has to be corrected with surgery.
  • Kidney damage. Kidney damage can be so severe that it can cause kidney failure; this must be treated with dialysis (which acts as a sort of artificial kidney to cleanse the blood) or with a kidney transplant.

How Does the Doctor Know that a Child has HSP?

Diagnosis of HSP is based on many factors, including:

  • Signs and symptoms, especially the four main symptoms discussed above
  • Blood tests that can reveal certain antibodies that indicated HSP
  • Urine tests to find out if there has been kidney damage
  • Imaging tests to help diagnose the cause of abdominal pain
  • Biopsy of the skin or kidneys (especially if the doctor is uncertain of the diagnosis and needs further evidence)

How is HSP Treated?

The good news is that HSP usually goes away on its own, usually in 4-6 weeks, though symptoms can sometimes recur as the condition is resolving. However, some treatments are possible, including:

  • Over-the-counter pain relievers like ibuprofen or acetaminophen to help reduce fever and muscle pain
  • Corticosteroids to reduce inflammation and improve digestive symptoms.
  • Bland diet
  • Adequate hydration
  • Changing medications if certain meds caused the problem to begin with
  • Bowel surgery if needed.
  • Dialysis or kidney transplant if needed.

In short, while HSP has some upsetting signs and symptoms and can be difficult for kids and parents both to deal with, in the vast majority of cases, it does go away on its own with time and treatment focuses in on comfort measures to treat the signs and symptoms. However, damage to the intestines or the kidneys might require surgery, dialysis or other intensive treatments.

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