What are the symptoms of Henoch-Schönlein purpura?
Someone with Henoch-Schönlein purpura (HSP) will often have had an upper respiratory tract infection within the few weeks before they develop the condition. So, for example, they may have had a cough, runny nose, and high temperature (fever) and have been feeling tired.
Everyone with HSP will develop a rash. This will have small, round, red spots (petechiae) and areas of reddish-purple skin discolouration (purpura).
The rash is most often seen on the legs, buttocks, and elbows and around the waistline. It affects both sides of the body. It can start off being very red in colour but then usually changes to purple and then a rusty colour over time. The rash is raised (like a bump on the skin) so you can feel it. The rash usually takes about 10 days to fade. A typical purpuric rash on an adult can be seen in the picture above.
About three in four people with HSP develop inflammation of their joints. Joints, particularly the knees and ankles, can become swollen, tender, warm and painful. The inflammation will gradually clear over time and there is not any lasting damage to the joints. The joint pains tend to come on after the rash has appeared in most people. However, in some people they can develop before the rash.
Most but not all people with HSP develop pain in their tummy (abdomen). The pain can be very bad in some people and usually changes in severity, or comes on in waves. Tummy pain tends to come on about a week after the rash has developed in most cases. Some people may also experience being sick (vomiting) and having diarrhoea.
Does Henoch-Schönlein purpura have any complications?
In many people with HSP, no complications develop. But, complications sometimes develop. They can include the following:
- Kidney involvement - in around half of people with HSP, the kidneys become affected. If immune complexes are deposited in the kidneys, this can lead to inflammation of the kidneys, known as nephritis. This complication usually develops within one month after the rash starts but can sometimes develop up to six months afterwards. In most people, kidney involvement will get better on its own. However, in some people, a more persistent and serious nephritis can develop.
- Bleeding in the gut - about three in ten people with HSP develop this complication. If immune complexes are deposited in the blood vessels of the wall of the gut (intestine), this can cause bleeding within the gut (gastrointestinal bleeding). This can lead to symptoms such as passing blood in the stools (faeces). Rarely, bleeding in the gut can be severe and life-threatening.
- Orchitis - about 3 in 10 boys with HSP develop orchitis. This is inflammation of the testicle (testis), causing pain, redness and swelling of the scrotum.
- Other complications - there are also some other rare, but serious, complications. For example, inflammation can sometimes affect:
- The brain and nervous system, leading to complications such as seizures).
- The heart (leading to complications such as a heart attack).
- The lungs (leading to complications such as a bleeding into the lungs).
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- Weiss PF, Klink AJ, Localio R, et al; Corticosteroids may improve clinical outcomes during hospitalization for Pediatrics. 2010 Oct 126(4):674-81. Epub 2010 Sep 20.
- Watson L, Richardson AR, Holt RC, et al; Henoch schonlein purpura--a 5-year review and proposed pathway. PLoS One. 2012 7(1):e29512. doi: 10.1371/journal.pone.0029512. Epub 2012 Jan 3.
- Henoch-Schönlein purpura; DermNet NZ
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