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Henoch-Schonlein Purpura

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Henoch- Schonlein Purpura (HSP) was probably first described by Heberden and Willan in the early 1800s. HSP is recognized as a systemic small vessel vasculitis involving mainly the blood vessels of the skin, GI tact, the kidneys, and the joints. HSP effects mainly children between the ages of and 10 years. Males are affected more often (1.51) than females and in about two thirds of children an upper respiratory tract infection precedes the onset of HSP by one to three weeks. The incidence shows a seasonal variation with the peak around November to January in the northern hemisphere. In general children are ill, and they frequently have an elevated body temperature, usually not higher than 8 oC.





The disease starts usually with an acute and symmetrical erythematous macular rash. It may initially be restricted to the skin around the malleoli of the ankle, but usually extends to the dorsal surface of the legs, the buttocks and ulnar site of the arms. After 1- 4 hours, the lesions become dusky red and have a diameter of 0.5- cm and they may coalesce into larger patches of ecchymoses. In children younger than three years the clinical picture may be dominated by edema of the scalp, the periorbital area, the hands and the feet. The edema correlates with the activity of the vasculitis and not with the degree of proteinuria. It has also been attributed to the enteric loss of protein. The joints are involved in 60- 75% of the cases and the arthralgias affect most commonly the knees and ankles and less often the wrists and fingers. There is no frank arthritis and joint effusions are rare. GI manifestions occur in about 50% of the cases and consist usually of colicky abdominal pain, melena, or bloody diarrhea. Hematemesis occurs less frequently.



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