Pediatric Purpura: Causes and Concerns in Young Children

Bruising on the soles of the feet and purpura on the hands and feet?

Hello Dr.
Zhao,
My daughter is currently three years and seven months old.
At the beginning of the month, after riding her bicycle, we suddenly noticed large bruises on the soles of her feet.
That night, she developed some purpura about two centimeters in size on her calves.
We took her to the hospital for admission and examination, where the doctor initially diagnosed her with an allergic purpura.
After a day, purpura also appeared on her hands.
Blood tests came back completely normal, and she did not experience any abdominal pain or joint pain.
She was hospitalized for three days, and after her symptoms improved, she was discharged.
Following her discharge, she continued to take Prednisolone (a corticosteroid) and Amoxicillin (an antibiotic) for about ten days.
However, after stopping the medication, she developed a skin allergy on her feet (which is different from the previous purpura), but there are still some bruises appearing on the soles of her feet.

Could this be an allergic purpura, or is it a sign of vascular fragility? Thank you.

Ryan, 30~39 year old female. Ask Date: 2003/10/24

Dr. Zhao Yongkang reply Pediatrics

Hello Ryan,
The diagnosis of allergic purpura depends on whether the patient has any coagulation abnormalities associated with lower limb purpura; blood tests may not necessarily show abnormalities.
This condition can lead to complications such as nephritis, intussusception, and arthritis, so corticosteroids are required for prevention.
However, corticosteroids can decrease platelet function, making it easier to develop petechiae.
I'm not sure what the "skin allergy" on the child's foot looks like after stopping the medication; if it is petechiae, it may be due to the effects of corticosteroids, while if it is a red spot that fades when pressed, it could be due to other reasons (possibly an antibiotic drug rash or other causes, which would require direct observation for an accurate diagnosis).
I apologize for the inconvenience! Director Zhao is currently abroad for training, so I am responding on his behalf.
Thank you for your letter!
Wishing you safety,
Dr.
Kang Danqi
Attending Physician, Pediatrics
Hsinchu Hospital

Reply Date: 2003/10/24

More Info

Pediatric purpura, particularly in young children, can be a concerning condition for parents. Your daughter's case, where she developed large bruises and purpura after riding her bike, raises important questions about the underlying causes and necessary follow-up care.
Purpura refers to purple or red spots on the skin that occur due to bleeding underneath the skin. In children, this can be caused by a variety of factors, including trauma, infections, or underlying blood disorders. Given that your daughter had a normal blood test and no abdominal or joint pain, it is reassuring that more serious conditions like thrombocytopenia (low platelet count) or coagulopathy (bleeding disorders) were likely ruled out.

The initial diagnosis of "allergic purpura" could refer to a condition known as Henoch-Schönlein purpura (HSP), which is a small-vessel vasculitis that often presents with purpura, abdominal pain, and joint symptoms. However, in your daughter's case, the absence of abdominal pain and joint symptoms makes HSP less likely. The fact that her symptoms improved with corticosteroids suggests that there may have been an inflammatory component to her condition.

The appearance of skin allergies after stopping the medications could indicate a sensitivity or reaction to the medications used, particularly the antibiotics. It's not uncommon for children to develop rashes or allergic reactions after antibiotic treatment, which can sometimes manifest as urticaria (hives) or other forms of dermatitis.
As for the ongoing bruising, it could be due to several factors:
1. Vascular Fragility: Some children may have more fragile blood vessels, leading to easy bruising, especially after minor trauma.

2. Medication Effects: Corticosteroids can affect skin integrity and may lead to easy bruising as well.

3. Underlying Conditions: While less likely given the normal blood tests, it’s still important to monitor for any signs of bleeding disorders or other systemic issues.

In terms of management, it is crucial to maintain regular follow-ups with a pediatrician or a pediatric hematologist. They can monitor your daughter's condition and may recommend further testing if bruising persists or worsens. Keeping a diary of any new symptoms, changes in activity, or dietary factors can also be helpful for your healthcare provider.

In summary, while your daughter's symptoms may align with a form of purpura, the exact cause needs careful evaluation. It is essential to continue monitoring her health, report any new symptoms, and maintain open communication with her healthcare providers. If the bruising continues or if you notice any other concerning symptoms, seeking further evaluation is warranted to ensure her well-being.

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