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Henoch-Schonlein Purpura (HSP)

What is Henoch-Schonlein Purpura (HSP)?

Henoch-Schonlein purpura causes blood vessels to become inflamed (swollen and irritated) the blood vessels involved are usually the small ones in the skin causing a rash that looks a bit like bruises. This type of rash is called purpura.

Other blood vessels that may be involved are the ones in the kidney, causing blood in the urine, and the ones in the intestines, causing stomach pains.

Why does it happen?

The cause of HSP is unknown. Sometimes infections, like colds, can trigger HSP. Other possible triggers are insect bites, medicines and vaccinations. It usually affects children between 2-10 years of age but it can happen to anyone. HSP is not contagious and there is no way to prevent it.

Which are the signs and symptoms?

Skin rash: This looks like small bruises or small reddish-purple spots. It is usually on the buttocks, on the legs and around the elbows. The skin rash may look very dramatic but is not dangerous.

Swelling: In many children with HSP the skin over hands and feet becomes swollen and tender. In boys this can also involve the scrotum.

Inflamed joints: Joints, most commonly knees and ankles, can become swollen and tender.

Blood in the urine: This can sometimes be seen with the naked eye (macroscopic) and sometimes only discovered when the urine is analysed with a dipstick (microscopic).

Serious kidney problems can occur but are fortunately rare.

Stomach pain: This is common and can sometimes be severe. In rare cases an abnormal folding of the bowel can occur, blocking the bowel. This is an emergency that may need surgery.

What is the treatment?

There is no specific treatment for HSP. Medicines are used only help your child feel more comfortable.

Fortunately almost all children with HSP get better without any treatment.

Painkillers like paracetamol/calpol or ibuprofen can help with joint pain. If stomach or joint pain is severe a drug called prednisolone can be used. Prednisolone may also be used along with other medicines if there are any signs of kidney damage.

About 1 in 3 children who have had HSP will get it once again in the first 6 months.

What follow up will be needed?

Your doctor will want to check urine samples and blood pressure several times to check for kidney problems. These checks should go on for at least 6 months. Your child should receive an appointment in the Paediatric Outpatient Clinic within 1 month from when the HSP started. Your GP may also carry out some of these checks and may prescribe you urine dipsticks that can be used at home.

The long-term follow-up for urine and blood pressure checks are very important.

When to come back to A&E?

If your child gets increasing stomach pains, vomits, blood in the stool (poo) or in the urine, worsening swelling or pains bring them back to the A&E department.

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