Treatment of Henoch-Schönlein Purpura
The treatment of Henoch-Schönlein purpura (HSP) is typically supportive. As the condition often resolves on its own without the need for intensive medical intervention. However, symptom severity varies from one person to another, and some patients. Particularly those with gastrointestinal or renal complications—require more focused treatment strategies. The main goal in the treatment of Henoch-Schönlein purpura is to relieve discomfort, minimise inflammation, and prevent long-term complications, particularly in the kidneys.
In the majority of cases, HSP is self-limiting. This means that the body will recover naturally over a period of several weeks. Often without the need for prescription medication. Children in particular tend to recover fully. With only mild symptoms such as joint aches or a skin rash that gradually fades. During this time, rest and hydration are essential. Children should stay home from school if tiredness or discomfort makes it hard to do usual activities, and adults should avoid hard physical work while symptoms last.
For mild to moderate joint pain or swelling, over-the-counter pain relief medications such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs), including ibuprofen, are typically sufficient. These help reduce both inflammation and discomfort. However, people with belly pain or possible kidney problems should use NSAIDs carefully. Because these medicines can make stomach issues worse or harm the kidneys.
Skin care is another consideration. The purpuric rash may be itchy or uncomfortable. While topical treatments are rarely needed, keeping the skin clean and dry helps prevent infections. If itching happens, antihistamines can help, and caregivers should gently stop scratching to protect the skin.
Treatment of Henoch-Schönlein Purpura
When gastrointestinal symptoms such as abdominal pain, nausea, or vomiting become severe, or if there is evidence of gastrointestinal bleeding (e.g. bloody stools), medical treatment becomes more urgent. In such cases, doctors may prescribe oral or intravenous corticosteroids, such as prednisolone. These drugs work by suppressing the immune response and reducing inflammation in the blood vessels. Corticosteroids are often very effective at rapidly relieving abdominal and joint pain, although their use remains somewhat controversial due to limited evidence on their impact on long-term outcomes. Nonetheless, in children with severe or persistent gastrointestinal symptoms, steroids are frequently prescribed.
The same applies to renal involvement. If urine tests reveal blood (haematuria) or protein (proteinuria), the individual may require regular follow-up appointments with a general practitioner or a nephrologist (kidney specialist). In mild cases, monitoring alone is sufficient, as kidney function often returns to normal. However, if protein levels stay high or blood pressure starts to rise. Doctors may use corticosteroids or stronger medicines like azathioprine or cyclophosphamide to stop the disease from getting worse. This is more common in adult-onset HSP or in children who develop nephritic or nephrotic syndromes.
In very rare cases, when HSP leads to intussusception or other serious gastrointestinal complications, surgical intervention may be required. Intussusception can cause intestinal blockage. Furthermore, symptoms such as severe abdominal pain, vomiting, and bloody stools should prompt immediate medical evaluation. Ultrasound or other scans can confirm the diagnosis, and sometimes doctors need to do surgery to fix the problem and help the bowel work normally again.
Another aspect of treatment involves monitoring and follow-up care. Even after symptoms resolve, individuals should continue to undergo periodic urinalysis and blood pressure checks. Typically for six months to a year after the initial episode. This is to detect any delayed kidney involvement, which may not appear until weeks after the initial rash. Those who have had kidney symptoms from the start will require more frequent and longer-term monitoring.
Treatment of Henoch-Schönlein Purpura
For individuals who experience relapses, management is typically the same as for the initial episode. When the rash or joint pain comes back, it is often milder and goes away faster. Most of the time, people can treat these symptoms with the same care as before or a short course of corticosteroids if needed. The chance of relapse does not always mean worse long-term health, but doctors should check each case carefully to make sure the kidneys are not getting worse.
In addition to medical treatment, emotional support and reassurance are key, especially for children and their families. The sudden appearance of a rash and systemic symptoms can be alarming, and the unpredictability of the condition may cause anxiety. Parents may be especially concerned about the possibility of long-term kidney problems. Clear communication about the nature of the disease, what to expect during recovery, and the signs that warrant urgent medical attention can greatly reduce stress.
Education is important for adolescents and adults with HSP as well. They should be advised to maintain a healthy lifestyle, including a balanced diet and good hydration, especially if kidney function has been affected. Avoiding unnecessary use of nephrotoxic medications (such as certain NSAIDs or overuse of painkillers) can help protect kidney health in the long term.
In rare, severe, or treatment-resistant cases, care may be managed by a multidisciplinary team, including rheumatologists, nephrologists, dermatologists, and paediatricians. These specialists may work together to develop an integrated care plan for patients with overlapping or complicated symptoms.
Treatment of Henoch-Schönlein Purpura
In summary, the treatment of Henoch-Schönlein purpura is largely supportive for mild cases, with pain management, rest, and careful monitoring forming the cornerstone of care. Corticosteroids may be used to manage moderate to severe symptoms, particularly involving the gastrointestinal tract or kidneys. Early detection of complications, consistent follow-up, and patient education all play critical roles in ensuring a full and uncomplicated recovery for most individuals.
