Management of Henoch–Schönlein purpura

Henoch–Schönlein purpura (HSP) is the commonest childhood vasculitis, with a peak incidence in the autumn months. This supports the supposition that it is precipitated by viral infection, which then leads to the production of abnormally glycosylated immunoglobulin A (IgA) and the formation of immune complexes containing this IgA. All organs can be affected, but the purpuric skin lesions are necessary to make the diagnosis. There is little evidence for or against any particular therapeutic strategy and management of the acute episode is mainly supportive with analgesics as necessary. Recent placebo controlled studies do not support the routine use of early steroids. Most children make a full recovery, but severe long-term renal problems can develop in a few, ultimately leading in some cases to established renal failure. Renal involvement is common in the early phase of the disease in the form of haematuria or proteinuria, and those with a more severe nephrotic picture have the greatest risk of long-term problems. However, children with only mild renal involvement initially can still run into difficulties and therefore those children with abnormal urinalysis require follow-up.