Henoch-Schonlein Purpura (HSP)

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HSP results from inflammation of small blood vessels in the skin and other organs in the body. The blood vessel damage causes a rash and joint symptoms and can affect other organs, such as kidneys and intestines. No one knows for sure what causes HSP. It may happen after a viral infection, such as a cold or flu, usually starting one to three weeks later. HSP can be diagnosed without any tests. Your doctor may perform tests to check for complications or other conditions. This disease is not contagious (catching).

Signs and Symptoms

  • Skin rash (palpable purpura) – This purple or red rash is palpable, which means you can feel it with your fingers. It usually appears on the legs and buttocks. You might also see it in other areas, such as the face and stomach. This rash usually goes away in about a week, but sometimes it can last as long as one month.
  • Abdominal pain – Belly pain tends to come and go. Most often, it will go away on its own. But if the pain is severe, worsening, or coming in waves, it could mean a more serious problem called intussusception. With intussusception, a part of the child’s intestine is caught within itself and becomes blocked. If this is happening, your child may have abdominal pain that comes in waves. Your child may be unable to move without pain. There may also be vomiting, blood in the stool or behavior changes such as severely decreased activity. If your child has these symptoms, it is a medical emergency. Take your child to the emergency department immediately.
  • Joint pain – Pain or soreness comes in the joints, usually the knees and ankles. It tends to move around from one area to another.
  • Swelling (edema) around the joints – The swelling and pain sometimes can be severe enough that your child may have trouble walking. Smaller children may have swelling of the face and hands. Very rarely a child will have swelling in the genital area. If your child has swelling of the genitals, call your doctor.
  • Kidney problems – Only a very small number of children with HSP end up with kidney problems. It is important to follow up with your doctor to make sure these problems do not develop. Also, if your child had a urine test that showed possible kidney involvement, such as blood in the urine, you will need to follow up with his or her doctor. The doctor will check your child’s blood pressures and do more urine tests.

For about two-thirds of children, all symptoms will be gone in two to four weeks. For the last one-third of children, symptoms are gone in one to three months. Serious complications of HSP are rare, but it is very important to follow up with your child’s doctor.

Treatment

Most of the treatment of HSP is aimed at making sure the child is comfortable and has enough fluids to drink.

  • Bed rest if joints are painful
  • Most often we advise parents to give their children acetaminophen (Tylenol®) or a nonsteroidal anti-inflammatory drug, such as ibuprofen (Motrin® or Advil®) for pain. Please follow the instructions carefully on the ibuprofen or acetaminophen label. In some cases, your doctor may recommend naproxen instead of ibuprofen. If so, make sure the child is not getting both.
  • If your child has severe pain in the joints or severe abdominal pain, he or she should be seen again by a doctor. Sometimes, an additional medicine is necessary.

When to Seek Medical Care

Go to your doctor or return to the Emergency Department IMMEDIATELY if your child has:

  • Blood in the stool, vomit or urine
  • Abdominal pain that does not improve or seems to be getting worse, especially if it comes in “waves” or makes your child unable to move
  • Signs of dehydration such as: no tears when crying, decrease in urination, dry mouth or lips, sunken eyes
  • Urine that is tea-colored or looks like cola
  • Swelling in the genital area
  • Headache, blurry vision, or changes in behavior
  • Heavy or labored breathing
  • Any new symptoms that concern you

If you have any questions, be sure to ask your child’s doctor or nurse.

Henoch-Schonlein Purpura (HSP) (PDF)

HH-I-258 5/06, Revised 4/18 Copyright 2006, Nationwide Children’s Hospital