What are the treatments for Henoch-Schönlein purpura?
Depending on the symptoms that develop, someone with Henoch-Schönlein purpura (HSP) may be admitted to hospital for monitoring. For most people, HSP will get better on its own and so no specific treatment is needed. However, there are a number of things that can help with the symptoms. For example:
- Painkillers - these may help with joint pains. Paracetamol is an example. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may also be helpful. However, NSAIDs should be avoided in anyone who has suspected kidney complications or any bleeding within the gut. See separate leaflet called Anti-inflammatory Painkillers for more details.
- Rest - resting with the legs raised may help reduce the degree of rash that develops. This is because the small, round, red spots (petechiae) and areas of reddish-purple skin discolouration (purpura) tend to develop in dependent areas of the body such as the legs.
- Steroid medication - this may be suggested if there are signs that the kidneys are becoming affected. Sometimes steroids are also suggested if other symptoms are severe (such as joint pains or tummy (abdominal) pain), or if boys develop scrotal pain and swelling.
In addition to this, if something is thought to have triggered HSP (for example, a specific medication that was being taken), this should be stopped.
Other treatment will depend on whether complications develop. For example, if the kidneys become involved, referral to a kidney specialist for assessment and their advice about treatment may be advised. A kidney sample (biopsy) may be suggested to help give the specialist more information and guide them as to the best treatment. Treatment may include steroids and other medicines to help suppress the body's defence (immune) system. Sometimes medication to lower blood pressure is needed if high blood pressure develops because of kidney involvement.
Occasionally a process called plasma exchange is needed if the complications caused by HSP are very serious.
Your blood is made up of blood cells and plasma. Plasma is where the damaging antibodies are present. Plasma exchange involves taking your blood out of your body and separating the blood into cells and plasma. The plasma is then removed and the blood cells are returned to the body with a plasma substitute.
A special machine is used for this treatment and only a small amount of blood is actually outside the body at any time. The sooner treatment is started after symptoms begin, the better the effect this treatment is likely to have.
Further reading and references
Saulsbury FT; Henoch-Schonlein purpura. Curr Opin Rheumatol. 2010 Sep22(5):598-602.
Weiss PF, Klink AJ, Localio R, et al; Corticosteroids may improve clinical outcomes during hospitalization for Pediatrics. 2010 Oct126(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. 20127(1):e29512. doi: 10.1371/journal.pone.0029512. Epub 2012 Jan 3.
Henoch-Schönlein purpura; DermNet NZ
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