Henoch-Schönlein purpura

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Question
My daughter has been diagnosed as suffering from Henoch-Schönlein purpura (HSP). Could you please give me some information?

I have to do labstix on her urine twice daily and she has got swelling of the joints.

I need to know if there are any long-term effects on her joints or kidneys.

Answer
Henoch-Schönlein purpura (HSP) is an inflammatory condition of small blood vessels in the skin, bowels and kidneys, called vasculitis.

When blood vessels become inflamed, they may bleed into the skin, causing the classical bruising or purpuric rash.

Bleeding may also occur at other affected sites. HSP occurs when the individual's immune system fails to fight an infection like it should. It occurs most often at this time of year, often after a cold.

HSP can occur at any age, but most commonly affects children aged 2 to 11 years.

The exact cause remains a mystery, but it can be sparked off by infections, medicines, vaccinations, insect bites, cold weather and exposure to certain chemicals.

The condition is not contagious.

The symptoms include the skin rash mentioned earlier around the elbows, buttocks and upper thighs, joint pains and stomach pain.

Fever, vomiting and diarrhoea may also feature and blood may be passed in the stool and urine if bleeding occurs in the bowel or kidneys. The initial symptoms may last for up to six weeks.

There is no specific treatment for HSP, which usually gets better spontaneously. The symptoms of any associated infection have to be treated on their own merits.

Anti-inflammatory medicines can be prescribed to ease the joint pains. Treatment with steroids may be required if there is distress particularly due to the abdominal pain.

Most sufferers therefore have an uneventful recovery with no long-term problems. Unfortunately, the kidneys may become involved within three months of onset in around 50 per cent of older children and 25 per cent of those under age two.

Symptoms such as protein and blood occurring in the urine and a persistence of the rash are indications of the kidneys being involved in the disease process.

Yours sincerely

Dr John ET Pillinger, GP

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