Purple spots on your body? It's not an allergy!

Doctor, my son Zhuangzhuang has recently developed a lot of purple and red spots on his legs and buttocks, and sometimes he complains about ankle pain. Do you think he has an allergy?

Judging from the child's current symptoms, Zhuangzhuang has "allergic purpura", which is not the same as allergy...

Ah...? What exactly is "Henoch-Schonlein Purpura"?

1.What is Henoch-Schonlein purpura?

Henoch-Schönlein purpura is a systemic small vessel vasculitis syndrome mediated by immune complexes. This type of disease is more common in preschool and school-age children, mostly children aged 5-10 years old. Among them, the incidence rate in boys is higher than that in girls, with the male-to-female ratio being approximately 1.2:1-1.8:1. It is more common in spring and autumn.

2.What are the clinical manifestations of Henoch-Schönlein purpura?

The clinical manifestations of Henoch-Schönlein purpura include the typical "tetrad syndrome", which mainly involves multiple organs such as the skin, joints, gastrointestinal tract, and kidneys.

(1) Skin purpura (characteristic manifestation): Purple papules appear, mostly on the buttocks and lower limbs, and are symmetrically distributed. They vary in size and appear in batches. They are raised above the skin and do not fade when pressed. In severe cases, they may merge into sheets with blisters in the center of the rash.

(2) Gastrointestinal manifestations: Mild symptoms include abdominal pain, vomiting, and bloody stools; severe symptoms include complications such as intussusception, intestinal obstruction, and intestinal perforation.

(3) Joint symptoms: swelling, pain, and limited movement of the ankles, knees, wrists, elbows and other joints.

(4) Kidney damage: hematuria, proteinuria, tubular urine, etc., usually appear after 2-4 weeks of the disease.

In addition, if the disease develops seriously, a series of complications may arise, such as neurological diseases (dizziness, headache, convulsions, coma, etc.), respiratory diseases (pulmonary hemorrhage), circulatory system diseases (myocarditis, pericarditis, etc.).

3.Is Henoch-Schönlein purpura an allergy?

Henoch-Schonlein purpura is essentially a vasculitis caused by the deposition of immune complexes in the blood vessel walls due to the body's immune dysfunction. This disease is a type III hypersensitivity reaction, but the allergies we generally refer to are type I and type IV hypersensitivity reactions. Therefore, Henoch-Schonlein purpura is not an allergy in the true sense.

The cause of Henoch-Schönlein purpura is still unclear, but according to clinical cases and literature surveys, it is usually related to infection, genetics, drugs, food, environmental allergies, etc.

4. How to treat Henoch-Schönlein purpura?

(1) Skin symptoms: Vitamin C or antihistamines can be used for anti-allergic treatment. Antiplatelet aggregation drugs such as dipyridamole tablets or heparin can be used based on anticoagulation indicators.

(2) Infection: Use antibiotics for anti-infection treatment.

(3) Arthritis: Nonsteroidal anti-inflammatory drugs can be used, and glucocorticoids can be used in severe cases.

(4) Gastrointestinal symptoms: Use H2 receptor blockers, gastric mucosal protective agents, etc. If severe abdominal pain or gastrointestinal bleeding occurs, use glucocorticoids for treatment.

(5) Kidney and others: symptomatic treatment based on clinical symptoms.

5. How should patients with Henoch-Schönlein purpura be cared for in their daily lives?

(1) Avoid contact with allergens: Keep warm, prevent colds, avoid contact with pollen, avoid mosquito bites and other environmental triggers.

(2) Control your diet: Eat a light diet, avoid spicy and irritating foods, avoid contact with suspicious foods such as eggs, milk, fish and shrimp, etc., and appropriately supplement with fruits and vegetables rich in vitamin C.

(3) Moderate activity: Patients in the acute phase should stay in bed and raise their lower limbs. Patients in the chronic phase can carry out normal basic activities, but should avoid strenuous exercise.

Tips

Allergic purpura is not the same as allergy. When symptoms similar to allergic purpura appear in the body, children should be taken to the hospital for treatment in time to avoid delaying the disease. Most patients can get good relief or even recover after active treatment.

References:

[1] Immunology Group, Pediatrics Branch, Chinese Medical Association, Editorial Committee of Chinese Journal of Pediatrics. Recommendations for diagnosis and treatment of Henoch-Schonlein purpura in children[J]. Chinese Journal of Pediatrics, 2013, 51(7): 502-507.

[2] Li Shu, Wang Zheng. Interpretation of the diagnosis and treatment guidelines for Henoch-Schonlein purpura in children. Chinese Journal of Obstetrics and Gynecology, 2014, 10(6): 733-736.

[3] Jiang Zaifang, Shen Kunling, Shen Ying. Zhu Futang's Practical Pediatrics[M]. 8th edition. Beijing: People's Medical Publishing House, 2015: 773-774.

(Author: Zhang Xiaoyue, Henan Provincial Children's Hospital; Reviewer: Zhang Shengnan)