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Kids Health Info

Henoch-Schönlein purpura (HSP)

  • Henoch-Schönlein purpura (hee-nok shon-line per-per-a), or HSP, is a condition where blood vessels become inflamed (irritated and swollen). HSP usually affects the small blood vessels in the skin, causing a rash that is called purpura. It can also affect blood vessels in the intestines and the kidneys. HSP can lead to complications in the lungs or brain, but this is extremely rare.

    The cause of HSP is unknown, but it is most commonly triggered by a viral illness (e.g. a cold), and it occurs most often in the spring.

    HSP usually affects children from two to 10 years of age, but it can happen in anyone. HSP itself is not contagious, but the infection that has triggered HSP may be contagious. There is no known way to prevent HSP.

    Signs and symptoms of HSP

    The signs of HSP can take days to weeks to fully develop. The distinctive rash almost always occurs in HSP, but is not always the first symptom to develop.

    If your child has HSP, they may have:

    • a skin rash, which looks like small bruises or small reddish-purple spots –  it's usually seen on the bottom, legs and around the elbows
    • swelling of the feet and hands, and the scrotum in male children
    • pain in the joints, such as the knees and ankles
    • stomach pain
    • blood in the faeces (poo) or urine (wee), caused by the blood vessels in the bowel and the kidneys becoming inflamed.

    In rare cases, an abnormal folding of the bowel (called intussusception) can occur. This causes a blockage in the intestines that may need surgery.

    When to see a doctor

    If you think your child has HSP, take them to see your GP.

    Take your child back to the GP if they have HSP and they have increasing pain or swelling, blood in their stools or urine, or if you are worried at all.

    If your child is unwell with a fever and a skin rash (small bright red spots or purple spots or unexplained bruises) that does not turn to skin-colour (blanch) when you press on it, this may be a sign of meningococcal infection (see our fact sheet Meningococcal infection).

    Treatment for HSP

    Your child may not need any medicines; however, the GP may prescribe a drug called prednisolone to help with severe stomach pains or very painful joints. Prednisolone may also be helpful in preventing kidney problems. In some cases, your doctor may prescribe medicines to treat the infection that triggered HSP.

    Care at home

    HSP usually gets better on its own without causing lasting problems. You can give your child pain relief (e.g. paracetamol) or an anti-inflammatory pain reliever (e.g. ibuprofen) to help relieve the joint pain and general discomfort. See our fact sheet Pain relief for children.

    Follow-up

    Long-term follow-up with your doctor is very important. About 50 per cent of children who have had HSP will get it again. A few children will have kidney damage because of HSP, which may happen in the first week or so of illness, but there may be a delay of weeks or months before it appears. Your child's doctor will want to test urine samples and blood pressure several times after the HSP goes away, and this is to check for kidney problems. These checks should continue for at least six months, with a final check at 12 months.

    Key points to remember

    • HSP causes inflammation of the small blood vessels in the skin, causing a rash.
    • HSP can also affect blood vessels around the kidneys and intestines.
    • Paracetamol and anti-inflammatory medicines can help painful joints.
    • See your GP if your child has increasing pain, swelling, blood in the stools or urine, or if you are worried at all.
    • Long-term follow-up with your doctor is very important.

    For more information

    Common questions our doctors are asked

    Are there any natural remedies you recommend for HSP?

    No - there are no natural remedies that have been shown to be adequately effective in the treatment of HSP.

    Is it safe to give my child prednisolone?

    You may have heard about possible side effects from prednisolone. These side effects happen when the medicine is given for months at a time, and will not happen when the prednisolone is given for just a few days.

    Is my child likely to get HSP again?

    In roughly half of patients, HSP will occur again, at least once – and usually within four months from the first episode. Each following episode is usually shorter and milder than the first.

    How long will it take my child to recover from the symptoms of HSP?

    In a simple, first episode of HSP, symptoms should resolve within four weeks, with the rash being the last symptom to disappear. Joint pain usually stops after three days, and abdominal pain will usually stop after two days.


    Developed by The Royal Children's Hospital General Medicine department. We acknowledge the input of RCH consumers and carers.

    Reviewed March 2018.

    This information is awaiting routine review. Please always seek the most recent advice from a registered and practising clinician.

    Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit  www.rchfoundation.org.au.


Disclaimer

This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.