Allergic Purpura in Children: Treatment and Management Insights

Pediatric Purpura

My daughter is currently three and a half years old and has always been healthy.
About two weeks ago, she caught a cold, which has not yet resolved.
On the fourth day of her cold, she developed petechiae on her lower extremities.
On the tenth and eleventh days, she experienced temporary joint pain in her lower limbs, making it difficult for her to walk.
On the twelfth day, she had petechiae behind both ears, and on the thirteenth day, she had diffuse petechiae on her left hand.
The purpura typically resolves on its own within about a day.
On the eleventh day, we took her to Kaohsiung Medical University Hospital for a blood test and she was prescribed Prednisolone.
The joint pain subsided, and her condition has been good since then, with no recurrence of the previous symptoms.
However, the test results indicate that she has allergic purpura and will need to take medication long-term, although it is difficult to determine for how many years.

Long-term medication can be a physical and psychological burden for a child.
I would like to ask if it is truly impossible for her to be cured? She is currently very active, and her symptoms have resolved; is it still necessary for her to continue taking medication? If she stops the medication and then contracts a viral infection again, will the consequences be more severe? Or would supportive treatment suffice for recovery, similar to her previous symptoms? I would appreciate your response to these questions.
Thank you.

Xiao Zhen, 30~39 year old female. Ask Date: 2000/10/03

Dr. Zhao Yongkang reply Pediatrics

1.
In cases of allergic purpura, if the symptoms have fully resolved and there is no renal involvement, a course of prednisolone is generally sufficient before discontinuation, but regular follow-up is still necessary.
2.
There is a chance of recurrence, but it is not high.
3.
Therefore, please ensure that you continue to take your child for regular follow-ups and follow the advice of the local physician.

Reply Date: 2000/10/03

More Info

Allergic purpura, also known as Henoch-Schönlein purpura (HSP), is a small-vessel vasculitis that primarily affects children. It is characterized by the presence of purpura (purple spots) on the skin, often accompanied by joint pain, abdominal pain, and kidney involvement. Your daughter's symptoms, including the appearance of purpura after a viral infection, are consistent with this condition.
In terms of treatment, corticosteroids like Prednisolone are commonly prescribed to manage inflammation and alleviate symptoms. The good news is that many children with allergic purpura experience a self-limiting course, meaning that the condition often resolves on its own without long-term complications. However, the need for ongoing medication can be a concern for parents, especially when considering the potential side effects of long-term steroid use.

Regarding your specific questions:
1. Is allergic purpura curable?
Allergic purpura can often resolve spontaneously, especially in cases where there is no significant kidney involvement. While it may not be "curable" in the traditional sense, many children recover fully without lasting effects. The goal of treatment is to manage symptoms and prevent complications.

2. Is long-term medication necessary?
If your daughter is currently symptom-free and has no signs of kidney involvement, it may be possible to taper off the medication under the guidance of her healthcare provider. Regular follow-ups are essential to monitor her condition and determine the appropriate course of action. If symptoms reappear after stopping medication, a supportive treatment approach may be sufficient, depending on the severity of the symptoms.

3. What happens if symptoms disappear and medication is stopped?
If symptoms resolve and medication is discontinued, there is a possibility that symptoms could recur, especially if she is exposed to infections or other triggers. However, many children do not experience a recurrence after the initial episode. If symptoms do return, supportive care, including pain management and hydration, is typically effective.

4. What are the long-term implications?
Most children with allergic purpura do not experience significant long-term health issues. However, there is a risk of kidney involvement in some cases, which can lead to complications. Regular monitoring of kidney function and overall health is crucial during and after treatment.

In summary, while allergic purpura can be concerning, especially with the need for long-term medication, many children recover well with appropriate management. It is essential to maintain open communication with your daughter's healthcare provider to monitor her condition and adjust treatment as necessary. Regular follow-ups will help ensure that any potential complications are addressed promptly. If you have further concerns or questions, consider seeking a second opinion or consulting a pediatric specialist in hematology or immunology for more tailored guidance.

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