5 Signs Of Henoch-Schonlein Purpura (HSP) In Children

Although the exact cause is not known, the triggers are well-defined.

Medically reviewed by Dr. Regina A. Hardin, MD Dr. Regina A. Hardin Dr. Regina A. HardinMD facebook_iconlinkedin_iconinsta_icon Specialty: PediatricsExperience: 20 years
Written by Dr Bisny T. Joseph
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Henoch-Schonlein Purpura (HSP) In Children: Symptoms And Treatment

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Henoch-Schonlein purpura (HSP) or IgA vasculitis is a condition where small blood vessels of the skin, kidneys, intestines, and joints become inflamed. HSP in children is usually more common and often affects boys between two and six years of age (1).

The condition leads to characteristic purple-colored rashes, often on the buttocks and lower legs. HSP usually resolves in children without causing any long-term effects. However, if kidneys are involved, timely medical intervention is needed to avoid complications.

Keep reading to know the various symptoms, risk factors, causes, and treatments for Henoch-Schonlein purpura in children.

Signs And Symptoms Of Henoch-Schonlein Purpura

Henoch-Schonlein purpura causes inflammation of the blood vessels, which may cause bleeding in the abdomen, kidneys, and skin. The common signs and symptoms of Henoch-Schonlein purpura in children include (2) (3) (4) (5).

  1. Purpura (rash): HSP rashes are reddish-purple spots that appear on the feet, legs, and buttocks in children. These may look like spots of bruises on the skin. Some children can develop purpura on the face, arms, trunk, or pressure areas, such as the waistline or sock line. Subcutaneous edema (swelling), especially periorbital edema, may also be seen in younger children.
  1. Sore and swollen joints: HSP could cause arthritis in children. Pain and swelling on the knees and ankle joints are usually seen, and joint pain may occur one or two weeks before the onset of rashes. These symptoms often resolve when the disease passes and do not cause permanent damages.
  1. Gastrointestinal symptoms: Abdominal pain (belly pain) is one of the most common digestive tract symptoms in HSP. Vomiting, nausea, and bloody stools are seen in some children. These symptoms generally occur before the onset of purpura. Dark stools (melena) due to GI bleeding and acute pancreatitis are other common GI symptoms.
  1. Kidney symptoms: Kidney (renal) involvement, termed IgAV nephritis or HSP nephritis, is the most severe complication of HSP. Proteinuria (proteins in the urine) and hematuria (blood in the urine) are seen in HSP with kidney involvement. These symptoms may not be visible and are often identified via urine tests.
  1. Neurological symptoms: In some rare cases, the central nervous system may also be involved. Headache, seizures, vision problems, and intracranial hemorrhages are common symptoms seen in nervous system involvement.

Some children may have cardiac and pulmonary symptoms such as breathing difficulties due to the small vessels’ involvement in the heart or lungs. Swelling of the scrotum can also be seen in boys. These symptoms can also be seen in other diseases. Thus, seek medical care for the exact diagnosis and treatment.

Causes And Risk Factors For Henoch-Schonlein Purpura

The exact cause of Henoch-Schonlein purpura is not known (1). However, it is believed that the initial inflammation may be due to the immune system’s abnormal responses to certain triggers, and in some rare cases, allergic reactions. The following factors are known to trigger HSP in some children (3).

  • Upper respiratory infections such as flu or cold
  • Chickenpox
  • Hepatitis
  • Strep throat
  • Measles
  • Food
  • Exposure to cold weather
  • Medications
  • Insect bites

Although they are exposed to these triggering factors, some children may not develop the disease. Boys are at a higher risk for developing HSP than girls, and Asian and white children are more likely to develop HSP than other ethnicities.

Complications Of Henoch-Schonlein Purpura

Henoch-Schonlein purpura may resolve within a month without any damages in most children, and there is a chance for recurrence in some children.

The possible complications of Henoch-Schonlein purpura include (6).

  • Kidney damages or renal failure
  • Bowel perforation
  • Intussusception
  • Gastrointestinal bleeding
  • Pleural effusion (water on the lungs)
  • Seizures
  • Testicular torsion
  • Intracranial hemorrhage
  • Pulmonary hemorrhage

When To See A Doctor?

If your child has HSP symptoms, seek pediatric care as soon as possible to ensure it does not cause permanent damages, such as kidney problems.

Although purpura is a characteristic symptom of HSP, the other symptoms may develop one or two weeks before these rashes. So, do not hesitate to consult the doctor for other symptoms.

Diagnosis Of Henoch-Scholein Purpura

Doctors may diagnose Henoch-Schonlein purpura by observing the skin rashes and inquiring about your child’s health history. The following tests are often ordered to confirm or rule in the diagnosis (7).

  • Laboratory tests

Lab tests may help exclude the diagnosis of other conditions that cause similar symptoms. Blood tests are ordered to look for any abnormalities if the diagnosis is not precise. The presence of proteins and blood in urine may help determine kidney involvement.

  • Imaging tests

Imaging tests, such as abdominal ultrasound, are often recommended to rule out abdominal pain. Complications such as bowel obstruction can also be identified via abdominal ultrasound.

  • Biopsies

Henoch-Schonlein purpura may cause IgA (immunoglobulin A) deposit in the affected organs. Biopsies of the affected part can confirm this. Skin biopsies are usually done in most children. However, renal (kidney) biopsies are ordered if there is suspicion of severe kidney involvement.

Although the diagnostic tests are not very specific, they are often required to make appropriate treatment decisions.

Treatment For Henoch-Schonlein Purpura

Treatment options may vary in each child depending on the severity, organs involved, complications, and health status. The treatment options may include (8).

  • Home remedies

Henoch-Schonlein purpura may resolve in a month without long-term effects. So, doctors may recommend home care remedies for mild cases. These may include:

  • Rest
  • Over-the-counter pain relievers
  • Proper hydration

Home care measures are only recommended for mild cases. Do not use OTC medications for HSP in children before pediatric consultation.

  • Medications

There are no specific medications to cure Henoch-Schonlein purpura. Doctors may prescribe corticosteroids, such as prednisone, for symptomatic management to reduce the intensity and duration of joint and abdominal pain.

Prednisolone is not recommended for all cases since it does not prevent renal involvement and complications or alter the recurrence rate. You may discuss the risks and benefits of corticosteroid treatment with your pediatrician based on individual factors.

  • Surgery

Surgery is required for complications such as bowel perforation, severe GI bleeding, and intussusception. Kidney transplantation is considered in children who have severe kidney disease and do not respond to medications. Tonsillectomy with pulse corticosteroid therapy is recommended for progressive IgAV nephritis.

How Long Does It Take To Recover From HSP?

Henoch-Schonlein purpura may go away within a month in most children. However, recurrence occurs in about one-third of children within four to six months after the initial onset (5).

Monthly urinalysis and blood pressure measurement are recommended for the first six months after diagnosis to identify renal involvement. Other tests to assess the renal function are ordered during follow-up visits if the urinalysis is positive. Never delay or stop follow-up care until recommended since early identification of organ involvement may prevent potential long-term complications.

Frequently Asked Questions

1. Can HSP be fatal in children?

Yes. HSP in children can be fatal if they cause kidney or lung complications or if swelling and edema develop in the throat, causing breathing difficulties (2). In rare cases, children may develop kidney failure (1) or diffuse alveolar hemorrhage (DAH) (9), which can be severe.

2. Does HSP rash spread in children?

Yes. In children, the HSP rash usually appears on the legs and buttocks, but it can also spread to the arms, torso, and face (10).

Rashes and swollen joints are common symptoms of HSP in children. Exposing them to triggering factors such as measles, hepatitis, or insect bites might also increase the chances of occurrence of this condition. Therefore, ensure that your child gets proper rest and has their medications in time to recover from the condition. Although it takes about a month for HSP to cure completely, consult your doctor immediately if you notice signs and symptoms of the same, even after a stipulated time.

Key Pointers

  • Henoch-Schonlein purpura (HSP) causes inflammation in the small blood vessels of the skin, intestines, kidneys, and joints.
  • The common symptoms include rashes, swollen joints, nausea, bloody stools, and vision problems.
  • Some factors that may trigger HSP in children are cold weather, hepatitis, and respiratory infections.
  • The treatment usually involves rest, hydration, medications, and surgeries in some cases.

References

1. Henoch-Schönlein Purpura (HSP) in Children; Cedars-Sinai
2. Henoch-Schönlein Purpura; National Organization for Rare Disorders
3. Henoch-Schonlein purpura; St. Clair Hospital
4. Louise Oni and Sunil Sampath; Childhood IgA Vasculitis (Henoch Schonlein Purpura)—Advances and Knowledge Gaps; Frontiers in Pediatrics (2019).
5. Porsha Roache-Robinson and David T. Hotwagner; Henoch Schönlein Purpura; StatPearls Publishing (2020).
6. Henoch-Schönlein Purpura; American Academy of Family Physicians
7. Henoch-Schönlein purpura; The Royal Children’s Hospital Melbourne
8. Henoch-Schonlein Purpura; The Children’s Hospital of Philadelphia
9. Giada Maria Di Pietro et al.; Henoch-Schönlein Purpura in children: not only kidney but also lung; Pediatric Rheumatology (2019).
10. IgA Vasculitis; National Institute of Diabetes and Digestive and Kidney Diseases
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Dr. Regina A. Hardin
Dr. Regina A. HardinMD, FAAP
Dr. Regina Hardin is a board-certified pediatrician with over 20 years of experience in outpatient and inpatient pediatrics. She also has extensive training in diagnosing and treating Attention Deficit Hyperactivity Disorder.

Read full bio of Dr. Regina A. Hardin
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