Pediatric Henoch-Schonlein Purpura Treatment & Management

  • Author: Pamela L Dyne, MD; Chief Editor: Richard G Bachur, MD   more...
 
Updated: Jan 4, 2011
 

Emergency Department Care

ED treatment of Henoch-Schönlein purpura (HSP) is supportive, with frequent monitoring of vital signs. For minor complaints of arthritis, edema, fever or malaise, symptomatic treatment is advised, including use of acetaminophen, elevation of swollen extremities, eating a bland diet, and adequate hydration.

Most patients with self-limited cases can be safely discharged home with close follow-up by their primary physician. Whether or not to admit the patient to the hospital depends on the practice of the admitting pediatrician and his or her preference. Admission to the hospital is recommended for control of abdominal pain or vomiting, monitoring of renal function, confirming a doubted diagnosis, and observation and monitoring.

One study examined the prevention and treatment of renal disease in patients with Henoch-Schönlein purpura.[1] Meta-analyses of 4 trials revealed no significant difference in the risk of persistent kidney disease at 6 months and 12 months in children given prednisone for 14-28 days upon presentation, compared with placebo or supportive treatment. Also, no significant difference was noted in the risk of persistent renal disease in children given cyclophosphamide compared with supportive treatment and with cyclosporin compared with methylprednisolone. However, data from randomized trials for any intervention used to improve renal outcome in children with Henoch-Schönlein purpura are sparse.

All unnecessary drugs should be discontinued if the etiology is suspected to be drug related.

Patients with renal involvement require close attention in regard to their fluid balance, electrolyte status, and use of antihypertensives (if indicated).

  • Use of immunosuppressive and cytotoxic drugs is gaining favor based on research and case studies.
  • Dapsone has been used to treat associated purpura and arthralgias.
  • Factor VIII concentrate has been used to relieve abdominal pain when corticosteroids are contraindicated.
  • Plasmapheresis is currently under investigation.
  • Kidney transplantation may be indicated in patients with severe renal disease that is resistant to medical therapy.

Surgery may be undertaken to treat severe bowel ischemia.

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Consultations

If the patient has renal involvement, a nephrologist should be consulted for assistance in determining if dialysis is indicated.

Because 1 in 20 patients with Henoch-Schönlein purpura develop renal failure, early consultation is desirable.

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Contributor Information and Disclosures
Author

Pamela L Dyne, MD  Professor of Clinical Medicine/Emergency Medicine, David Geffen School of Medicine at UCLA; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center

Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Stacy Sawtelle, MD  Clinical Instructor, Department of Emergency Medicine, University of California, San Francisco, School of Medicine

Disclosure: Nothing to disclose.

Heather Kesler DeVore, MD  Clinical Attending Physician, Assistant Professor Physician, Department of Emergency Medicine, Washington Hospital Center/Georgetown University Hospital

Heather Kesler DeVore, MD is a member of the following medical societies: Emergency Medicine Residents Association and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Debra Slapper, MD  Consulting Staff, Department of Emergency Medicine, St Anthony's Hospital

Debra Slapper, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH  Associate Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Richard G Bachur, MD  Associate Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston

Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research

Disclosure: Nothing to disclose.

References

  1. [Best Evidence] Chartapisak W, Opastiraku S, Willis NS, Craig JC, Hodson EM. Prevention and treatment of renal disease in Henoch-Schonlein purpura: a systematic review. Arch Dis Child. Feb 2009;94(2):132-7. [Medline].

  2. Narchi H. Risk of long term renal impairment and duration of follow up recommended for Henoch-Schonlein purpura with normal or minimal urinary findings: a systematic review. Arch Dis Child. Sep 2005;90(9):916-20. [Medline].

  3. McCarthy HJ, Tizard EJ. Clinical practice: Diagnosis and management of Henoch-Schönlein purpura. Eur J Pediatr. Jun 2010;169(6):643-50. [Medline].

  4. Chang WL, Yang YH, Wang LC, et al. Renal manifestations in Henoch-Schonlein purpura: a 10-year clinical study. Pediatr Nephrol. Sep 2005;20(9):1269-72. [Medline].

  5. Gonzalez-Gay MA, Garcia-Porrua C, Pujol RM. Clinical approach to cutaneous vasculitis. Curr Opin Rheumatol. Jan 2005;17(1):56-61. [Medline].

  6. Lanzkowsky S, Lanzkowsky L, Lanzkowsky P. Henoch-Schoenlein purpura. Pediatr Rev. Apr 1992;13(4):130-7. [Medline].

  7. Martin J, Paco L, Ruiz MP, et al. Inducible nitric oxide synthase polymorphism is associated with susceptibility to Henoch-Schonlein purpura in northwestern Spain. J Rheumatol. Jun 2005;32(6):1081-5. [Medline].

  8. Tapson KM. Henoch-Schonlein purpura. Am Fam Physician. Feb 15 1993;47(3):633-8. [Medline].

  9. Ting TV, Hashkes PJ. Update on childhood vasculitides. Curr Opin Rheumatol. Sep 2004;16(5):560-5. [Medline].

  10. Tintinalli JE, Kelen GD, Stapczynski JS. Henoch Schonlein purpura. In: Emergency Medicine: A Comprehensive Study Guide. 6th ed. 2004:886.

  11. Trujillo H, Gunasekaran TS, Eisenberg GM, et al. Henoch-Schonlein purpura: a diagnosis not to be forgotten. J Fam Pract. Nov 1996;43(5):495-8. [Medline].

  12. Urbach AM, Londino AV. Rheumatology. In: Atlas of Pediatric Physical Diagnosis. 3rd ed. 1997:203-4.

  13. Urbach AM, Londino AV. Dermatology. In: Atlas of Pediatric Physical Diagnosis. 3rd ed. 1997:236-7.

  14. Yigiter M, Bosnali O, Sekmenli T, et al. Multiple and recurrent intestinal perforations: an unusual complication of Henoch-Schonlein purpura. Eur J Pediatr Surg. Apr 2005;15(2):125-7. [Medline].

 
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A 9-year-old boy with Henoch-Schönlein purpura. Note confluence of purpura around the ankles. Courtesy of Pamela L Dyne, MD.
A 7-year-old girl with Henoch-Schönlein purpura. Courtesy of Pamela L Dyne, MD.
 
 
 
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