Henoch Schonlein Purpura Hsp

Overview

Henoch-Schönlein purpura (HSP) is a condition where small blood vessels in the body become inflamed and leaky. It is also called IgA vasculitis. 'Purpura' means the small amounts of blood that leak out show up as purple or red spots on the skin. HSP can also make joints ache, cause tummy pain, and sometimes affect the kidneys. It is not contagious, so your child cannot pass it on to other children.

Yes, it is one of the more common types of blood vessel inflammation in children. Doctors see it regularly in general practice and children's clinics.

It most often affects children between about 2 and 10 years old, and boys a little more often than girls. Adults can get it too, but it is less common and can sometimes be more serious.

Symptoms

Common symptoms

• A rash of small red or purple spots that feel slightly raised and do not turn white when you press them. It usually starts on the legs and bottom and may spread.
• Joint pain and swelling, most often in the knees and ankles, which can make walking uncomfortable.
• Tummy (abdominal) pain that comes and goes, sometimes with feeling sick or being sick.
• A mild fever and generally feeling unwell, a bit like having a cold.
• Swelling of the hands, feet, or in boys the scrotum (the sac that holds the testicles).
• Blood in the urine or stools, which may not always be visible.

Symptoms in children

• The rash is usually the first thing noticed, often appearing suddenly on the legs and bottom.
• Tummy pain can be bad enough to wake a child at night or make them reluctant to eat.
• Boys may get swelling and pain in the scrotum, which needs checking straight away.
• Children often have had a sore throat, cough, or cold one to three weeks before the rash appears.
• Some children feel tired and irritable for a week or two, and may limp or refuse to walk because of sore joints.

Symptoms in older adults

• Adults tend to have more joint pain and a rash that may look different, sometimes like small bruises or blisters.
• Kidney involvement is more likely in adults, so urine and blood pressure checks are especially important.
• Adults may feel more generally unwell and take longer to recover than children.
• Rarely, adults can have inflammation in the lungs or other organs, which needs specialist care.

Causes

Main causes

• HSP happens when the body's immune system, which normally fights infection, mistakenly causes inflammation in the smallest blood vessels. This is not caused by anything you or your child did wrong.
• A protein called IgA (a type of antibody, a germ-fighting protein) builds up in the walls of tiny blood vessels, making them leaky.
• It often follows an ordinary infection of the throat, chest, or gut by one to three weeks, which seems to trigger the reaction.
• In many cases no exact trigger is ever found, and doctors do not usually need to look for one.

Risk factors

• Being a child between about 2 and 10 years old.
• Having had a recent cold, sore throat, or stomach infection.
• Being male (boys are slightly more often affected).
• A family history of HSP or of other conditions where the immune system attacks the body's own tissues.
• Some medicines can occasionally trigger a similar reaction, so tell your doctor about anything you or your child is taking.

When to see a doctor

See a doctor urgently if:

• Any blood in the urine or stools, or urine that looks dark or cola-coloured.
• Swelling of the face, eyelids, hands, feet, or scrotum.
• Severe or worsening tummy pain, or pain with vomiting.
• A fever that is high or lasting more than a couple of days.
• A rash that suddenly gets much worse, blisters, or becomes painful and dark.
• Your child is not drinking, is passing much less urine than usual, or seems very sleepy.

Book a routine appointment if:

• A new purple or red spotty rash, especially on the legs and bottom, that does not fade when pressed.
• Joint pain or swelling that is making walking or usual activities difficult.
• Tummy pain that comes and goes but your child is otherwise coping.
• Follow-up appointments for urine tests and blood pressure checks, even after your child feels well again.
• Any new symptoms in the weeks after HSP, such as puffiness or changes in how much your child wees.

Diagnosis

There is no single test for HSP. A doctor usually recognises it from the pattern of symptoms — the typical rash on the legs and bottom, together with joint pain, tummy pain, or both. They will examine your child, check blood pressure, and test a urine sample to see whether the kidneys are affected. Because the rash can look like other things, the doctor may do some blood tests to rule out other conditions.

Tests that may be done

• A urine test (dipstick) to look for blood or protein, which can be an early sign of kidney involvement.
• Blood pressure measurement, repeated at follow-up visits.
• Blood tests to check kidney function, blood counts, and general inflammation.
• Sometimes an ultrasound scan of the tummy if there is a lot of pain, to check the bowel and kidneys.
• Rarely, a small skin sample (biopsy) if the diagnosis is unclear.
• In boys with scrotal pain, a scan may be done quickly to rule out a twisted testicle.

What to expect at your appointment

You can expect a physical examination and a urine test at the first visit. Your child will probably be asked to come back for repeat urine checks and blood pressure readings over the next few months — commonly for about six months, even if they feel completely well. This monitoring is the most important part of care, because kidney problems can start quietly and are much easier to manage when found early.

Treatment

Most children with HSP need only rest, plenty of fluids, and simple comfort measures while the body settles down on its own. Treatment focuses on relieving symptoms and watching the kidneys closely. Your doctor will decide whether any medicine is needed based on how severe the symptoms are and whether the kidneys or bowel are involved.

Self-care at home

• Make sure your child drinks plenty of fluids, especially if they have a fever or tummy pain.
• Rest is helpful during the sore phase, but gentle movement is fine as comfort allows.
• Keep the legs raised on a pillow when sitting or resting if they are swollen.
• Use a cool compress on sore joints and loose, comfortable clothing over the rash.
• Keep a simple diary of symptoms, urine colour, and any new problems to share at check-ups.
• Do not give any over-the-counter medicines without checking with a pharmacist or doctor first, as some can affect the kidneys or the stomach.
• Keep all follow-up urine appointments, even when everyone feels well again.

Medical treatments

Doctors may recommend medicines to ease pain and reduce inflammation, and in some cases medicines that calm the immune system, particularly if there is significant tummy pain, kidney involvement, or severe joint symptoms. These decisions are made individually by the care team. Children with kidney involvement may be referred to a kidney specialist (nephrologist) for closer monitoring. Antibiotics are not helpful because HSP is not an infection.

When is surgery considered?

Surgery is rarely needed. In a small number of children, the bowel can become folded or blocked (a condition called intussusception), or a testicle can twist, and these need urgent surgical assessment. Your care team will explain if this is ever a concern.

Living with this condition

In the first week or two your child may be uncomfortable and tired, and may need time off school or nursery. The rash can look dramatic but is not itself harmful, and it slowly fades over weeks, sometimes leaving light brown marks that disappear. Keep up normal routines as much as possible, and go to the follow-up appointments even when everything seems back to normal.

Lifestyle tips

• Encourage gentle activity as comfort allows, and return to school or work when your child feels ready.
• Keep the home calm and offer small, frequent drinks and snacks if appetite is low.
• Note the colour of urine now and then, so you can describe any changes to your doctor.
• Avoid strenuous sports while joints are sore or swollen.
• Tell school or nursery about the diagnosis so they understand the rash is not infectious and can let you know if your child seems unwell.

Diet and exercise

There is no special diet for HSP. Offer normal, balanced meals and plenty of fluids, and don't worry if appetite is poor for a few days — it usually returns. Gentle walking and play are fine. Avoid contact sports or heavy exercise while joints are painful or swollen, and build activity back up gradually over a couple of weeks.

Mental health and emotional wellbeing

A purple rash and tummy pain can be frightening for both children and parents, and the follow-up appointments can feel like a lot to carry. Children may be anxious about being different or missing school. It often helps to explain in simple words that the spots are like small bruises that will fade, and that the body is healing. If worry, low mood, or sleep problems are lasting, tell your doctor — support is available. If you or your child ever feel unable to cope or have thoughts of harming yourself, contact your local emergency number or a crisis support line in your country straight away.

Prevention

HSP cannot usually be prevented, because it is an immune reaction that happens after ordinary infections and is not caused by anything you did. There is no vaccine for it. The best you can do is treat infections normally, follow your doctor's advice, and keep the follow-up appointments — this does not stop HSP, but it helps catch any kidney problems early.

Screening programmes

There is no screening programme for HSP. Instead, anyone diagnosed with HSP is offered regular urine and blood pressure checks for several months, which works like a targeted check-up for the kidneys.

Complications

If left untreated

• Kidney inflammation (called IgA nephritis) can develop in some people, sometimes weeks after the rash. It often causes no symptoms, which is why urine checks matter.
• Bowel problems, including a folded or blocked bowel (intussusception), can cause severe tummy pain and vomiting.
• In boys, a twisted testicle can rarely happen and needs emergency treatment.
• Rarely, inflammation can affect the lungs, brain, or other organs.
• Blood pressure can rise if the kidneys are affected.

Long-term outlook

The outlook is good for most people. Around 9 in 10 children recover fully within about four to six weeks, with no lasting effects. A small number have symptoms that come back once or twice, and a minority develop kidney problems — most of these settle with monitoring and treatment, and only rarely does long-term kidney damage occur. Adults tend to take longer to recover and are more likely to need specialist follow-up. Going to your check-ups is the single most useful thing you can do to protect long-term health.

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