Henoch-Schönlein purpuraMANAGEMENT

DERMATOLOGY PRESENTATIONS · 12 SECTIONS

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501 items

☷ Legend

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Cardiovascular Presentations66▾

Respiratory Presentations47▾

Neurological Presentations77▾

Gastrointestinal Presentations63▾

Genitourinary and Reproductive Presentations44▾

Infectious Disease Presentations146▾

Trauma Presentations88▾

Toxicologic Presentations67▾

Psychiatric Presentations25▾

Musculoskeletal and Rheumatologic Presentations89▾

Dermatology Presentations21▾

Allergic contact dermatitis Bullous Pemphigoid Cutaneous Abscess Eczema Herpeticum Erysipelas Erythema multiforme Henoch-Schönlein purpura Herpes Zoster (Shingles)Herpetic Whitlow Paronychia Pediculosis (Lice)Pemphigus Vulgaris Pilonidal Abscess Pressure injury Psoriasis (acute flare)Psoriasis Flare Staphylococcal Scalded Skin Syndrome Stevens-Johnson Syndrome (SJS)Toxic Epidermal Necrolysis (TEN)Urticaria (acute)Warfarin-induced Skin Necrosis

Environmental and Exposure Presentations26▾

Hematologic and Oncologic Presentations30▾

Pediatric-Specific Presentations13▾

Endocrine and Metabolic Presentations42▾

ENT and Maxillofacial Presentations21▾

Ophthalmologic Presentations15▾

Obstetric Presentations17▾

Systemic and Miscellaneous Presentations15▾

01Approach to the Critical Patient/attcp50

Immediate priorities

›Stabilization priorities

›Airway compromise

›Stridor

›Reduced level of consciousness

›Shock physiology

›Hypotension

›Delayed capillary refill

›Hemorrhage concern

›Hematemesis

›Melena

›Severe abdominal process

›Guarding

›Rebound tenderness

›Renal failure concern

›Oliguria

›Rising creatinine trend

›Rapid escalation triggers

›Persistent severe abdominal pain

›GI bleeding

›Suspected intussusception

›Nephrotic syndrome

›Nephritic syndrome

›Rapidly progressive glomerulonephritis pattern

›CNS involvement

›Pulmonary hemorrhage

Monitoring and early actions

›Baseline monitoring

›Blood pressure with age appropriate percentiles

›Repeat measurements for confirmation

›Orthostatic vitals if dehydration concern

›Weight

›Edema tracking

›Medication dosing basis

›Urine output trend

›Strict intake output if admitted

›Oliguria threshold individualized to age and size

›Pain assessment

›Joint pain severity

›Abdominal pain severity

›Early consult triggers

›Nephrology for proteinuria or impaired kidney function

›Surgery for suspected intussusception or peritonitis

Key diagnosis confirmation

›Working diagnosis elements

›Palpable purpura with thrombocytopenia excluded

›Lower extremity predominance

›Buttock involvement

›One or more systemic features

›Abdominal pain

›Arthralgia or arthritis

›Renal involvement

›IgA deposition on biopsy if atypical presentation

02History/hx38

Symptom pattern and timeline

›Core symptom timeline

›Rash onset and progression

›Initial location

›New lesions over days

›Joint symptoms

›Migratory arthralgia

›Joint swelling

›GI symptoms

›Colicky abdominal pain

›Nausea or vomiting

›Renal symptoms

›Dark urine

›Reduced urine volume

›Preceding trigger

›Recent upper respiratory infection

›Recent gastroenteritis

Risk features and complications

›High risk historical features

›GI bleeding symptoms

›Hematemesis

›Melena

›Severe abdominal pain requiring admission

›Worsening after meals

›Persistent pain despite analgesia

›Renal involvement indicators

›Prior proteinuria history

›Prior hematuria history

›Scrotal pain in males

›Acute onset

›Associated swelling

›Neurologic symptoms

›Headache

›Seizure

›Pulmonary symptoms

›Hemoptysis

›Dyspnea

›Medication exposures

›NSAID use

›Anticoagulant use

03Physical Exam/exam35

Skin and musculoskeletal

›Typical exam domains

›Purpura characteristics

›Palpable lesions

›Non blanching lesions

›Distribution

›Lower extremities

›Buttocks

›Skin severity markers

›Bullae

›Necrosis

›Joint exam

›Ankles and knees

›Range of motion limitation

Abdominal renal and other systems

›System complication screen

›Abdominal exam

›Tenderness location

›Guarding

›Hydration status

›Dry mucous membranes

›Tachycardia

›Blood pressure

›Hypertension

›Recheck after pain control

›Edema

›Periorbital edema

›Peripheral edema

›Scrotal exam if symptoms

›Tenderness

›Swelling

›Neurologic exam if symptoms

›Focal deficits

›Altered mental status

›Respiratory exam if symptoms

›Crackles

›Hypoxemia signs

04Differential Diagnosis/ddx42

Life threatening mimics

›Immediate exclusions

›Meningococcemia

›Fever with rapidly progressive purpura

›Toxic appearance

›Sepsis with DIC

›Thrombocytopenia

›Coagulopathy

›Hemolytic uremic syndrome

›Hemolytic anemia

›Acute kidney injury

›Thrombotic thrombocytopenic purpura

›Thrombocytopenia

›Neurologic symptoms

›Acute abdomen processes

›Appendicitis

›Volvulus

Common mimics and overlaps

›Non life threatening alternatives

›Immune thrombocytopenia

›Isolated thrombocytopenia

›Petechiae without palpable purpura

›Drug eruption vasculitis

›New medication exposure

›Widespread rash pattern

›ANCA associated vasculitis

›Pulmonary renal syndrome

›Positive ANCA pattern

›Systemic lupus erythematosus vasculitis

›Malar rash

›Low complement levels

›Inflammatory bowel disease with extraintestinal findings

›Chronic diarrhea

›Weight loss

›Rocky Mountain spotted fever where endemic

›Fever

›Rash involving palms or soles

›Acute rheumatic fever

›Migratory arthritis

›Carditis features

›ICD-10 alignment

›D69.0 Allergic purpura

›N05 Glomerular disorders with hematuria

›R10 Abdominal pain

05Laboratory Tests/lt36

Core confirmation and safety

›Baseline labs

›Complete blood count for cytopenias

›Platelet count for thrombocytopenia exclusion

›Hemoglobin for GI bleeding assessment

›Creatinine and electrolytes for renal involvement

›eGFR estimate

›Potassium for RAS blockade planning

›Urinalysis for nephritis screening

›Hematuria

›Proteinuria

›Urine protein creatinine ratio for proteinuria quantification

›Trendable baseline

›Nephrotic range threshold 200 mg/mmol

Additional labs by presentation

›Targeted labs

›Albumin for nephrotic syndrome

›Hypoalbuminemia correlation with edema

›Severity baseline for follow up

›Coagulation profile for bleeding concern

›PT INR

›aPTT

›CRP or ESR for inflammatory context

›Non specific elevation

›Alternative diagnosis support if very high

›Stool testing for GI bleeding concern

›Fecal occult blood if unclear bleeding

›Stool culture if infectious trigger concern

Autoimmune and infectious workup when atypical

›Expanded workup triggers

›Atypical rash distribution or systemic severity

›ANA

›Complement levels

›Pulmonary renal syndrome concern

›ANCA

›Anti GBM antibodies

›Hepatitis risk factors

›Hepatitis B testing

›Hepatitis C testing

06Diagnostic Tests/dt42

Scoring Systems

›Classification and risk stratification

›EULAR PRINTO PRES 2010 classification framework

›Palpable purpura mandatory criterion

›Abdominal pain as supportive criterion

›Arthritis or arthralgia as supportive criterion

›Renal involvement as supportive criterion

›ISKDC histologic grading for IgA vasculitis nephritis

›Mesangial changes and crescents classification

›Higher grade association with progression risk

›MEST-C Oxford score for IgA nephropathy spectrum

›Mesangial hypercellularity component

›Endocapillary hypercellularity component

MRI

›MRI indications

›CNS involvement assessment

›Suspected cerebral vasculitis

›Persistent focal neurologic deficits

›Musculoskeletal complications

›Severe focal limb pain with unclear etiology

›Concern for osteomyelitis mimic

›MRI limitations

›Limited role in routine diagnosis

›Availability and sedation needs in pediatrics

›CT considerations

›Severe abdominal pain with unclear diagnosis

›Concern for bowel ischemia

›Concern for perforation

›Pulmonary hemorrhage evaluation if unstable and CXR equivocal

›CT chest balanced against radiation

›Prefer CXR initial

›CT limitations

›Radiation exposure in children

›Often unnecessary if ultrasound diagnostic

Ultrasound

›Ultrasound first line use cases

›Intussusception evaluation

›Target sign

›Guidance for reduction planning

›Renal ultrasound when renal involvement significant

›Baseline kidney size and echogenicity

›Exclude obstruction if oliguria

›Scrotal ultrasound for acute scrotal pain

›Testicular torsion exclusion

›Orchitis or epididymitis pattern

07Disposition/dispo36

Admission and higher level care

›Admit criteria

›Severe abdominal pain

›Need for parenteral analgesia

›Inability to tolerate oral intake

›GI bleeding

›Hemodynamic instability

›Hemoglobin drop trend

›Suspected or confirmed intussusception

›Need for reduction

›Surgical consultation requirement

›Significant nephritis

›UPCR greater than 200 mg/mmol

›Hypertension

›Rising creatinine

›CNS involvement

›Seizure

›Focal deficits

›Pulmonary hemorrhage

›Hypoxemia

›Hemoptysis

Discharge with follow up

›Discharge criteria

›Stable vitals

›No hypotension

›No new oxygen requirement

›Adequate pain control with oral regimen

›Joint pain controlled

›Abdominal pain mild and improving

›Tolerating oral intake

›Hydration adequate

›No persistent vomiting

›No evidence of significant nephritis on initial screening

›Urinalysis without proteinuria

›Creatinine normal for age

›Follow up plan documented

›Blood pressure recheck schedule

›Urinalysis monitoring schedule

08Treatment/t112

Supportive care

›Symptom control foundation

›Hydration strategy

›Oral fluids if tolerated

›IV isotonic fluids if dehydrated

›Skin care

›Leg elevation for edema

›Compression stockings for dependent edema if tolerated

›Analgesia approach

›Acetaminophen dosing

›Pediatrics 15 mg/kg per dose every 6 hours

›Maximum 60 mg/kg per day

›NSAID use criteria

›Avoid in GI bleeding

›Avoid in impaired kidney function

Glucocorticoids for pain and severe extrarenal disease

›Steroid indications

›Severe abdominal pain refractory to supportive care

›Hospital based initiation when concern for complications

›Monitor for masking peritonitis

›Severe arthralgia limiting function

›Short course consideration

›Taper plan

›Steroids not for nephritis prevention

›No role without kidney involvement or with isolated microhematuria

›Evidence statement from KDIGO practice points

›Prednisone or prednisolone regimen

›Oral dosing framework

›Pediatrics 1 mg/kg per day

›Maximum 60 mg per day

›Typical duration 1 to 2 weeks then taper based on response

›Adults 0.5 to 1 mg/kg per day

›Typical duration individualized

›Taper based on symptom control

›IV methylprednisolone pulse regimen

›Indications

›Severe GI involvement with admission

›Rapidly progressive nephritis pattern with nephrology

›Dose

›Pediatrics 10 to 30 mg/kg per day for 3 days

›Maximum 1000 mg per day

›Transition to oral steroid taper

Renal involvement management

›Nephritis screening and referral

›Urinalysis monitoring duration

›Monthly monitoring for at least 6 months

›Majority nephritis onset within 3 months

›Nephrology involvement

›Persistent proteinuria

›Impaired kidney function

›RAS blockade for proteinuria

›ACE inhibitor or ARB use

›Persistent proteinuria longer than 3 months

›Specialist guided initiation in children

›Enalapril example regimen

›Pediatrics start 0.1 mg/kg per day

›Titrate to effect and tolerance

›Maximum 0.6 mg/kg per day

›Losartan example regimen

›Pediatrics start 0.7 mg/kg per day

›Maximum 50 mg per day in smaller children

›Higher max per adult dosing protocols when appropriate

›Monitoring with RAS blockade

›Creatinine trend after initiation

›Potassium trend after initiation

›Immunosuppression for IgA vasculitis nephritis

›Steroids for nephrotic range proteinuria or RPGN

›Oral prednisone or prednisolone 3 to 6 months consideration

›Nephrotic range proteinuria threshold 200 mg/mmol

›Histologic risk by ISKDC criteria II or higher

›Pulse IV methylprednisolone consideration

›Severe presentations

›Transition plan to oral taper

›Additional immunosuppressants when indicated

›Indications

›PCR greater than 200 mg/mmol with insufficient steroid response

›Steroid sparing need

›Specialist directed severe histology

›Mycophenolate mofetil regimen

›Pediatrics 600 mg/m2 twice daily

›Maximum 1000 mg twice daily

›CBC monitoring for cytopenias

›Cyclophosphamide regimen

›Pediatrics IV 500 to 750 mg/m2 monthly

›Typical course 3 to 6 doses

›Antiemetic and hydration protocol

›Tacrolimus regimen

›Pediatrics 0.05 mg/kg orally twice daily

›Trough guided dosing per nephrology

›Nephrotoxicity monitoring

›Rituximab consideration

›Refractory severe disease

›Specialist directed risk benefit decision

Complication specific management

›Intussusception pathway

›Ultrasound confirmation

›Early radiology involvement

›Evaluate for pathologic lead point

›Reduction planning

›Pneumatic or hydrostatic reduction when stable

›Surgical management when peritonitis or failed reduction

›GI bleeding pathway

›Hemodynamic support

›IV access and fluids

›Blood product support per severity

›Acid suppression when upper GI bleed suspected

›Proton pump inhibitor dosing per local protocol

›Endoscopy consultation based on bleeding severity

›Scrotal involvement pathway

›Ultrasound for torsion exclusion

›Time critical urology involvement if torsion concern

›Orchitis supportive management when confirmed

›Long term monitoring after nephritis

›Follow up duration

›Urinalysis and eGFR monitoring at least 5 years after episode

›Lifelong individualized monitoring for treated nephritis

09Special Populations/sp33

Pregnancy

›Pregnancy considerations

›Maternal risks

›Higher risk of severe disease in adults

›Kidney involvement impact on pregnancy outcomes

›Medication safety

›Avoid ACE inhibitors and ARBs

›Glucocorticoids use when benefits outweigh risks

›Obstetric coordination

›Maternal fetal medicine involvement for nephritis

›Blood pressure monitoring with pregnancy thresholds

Geriatric

›Older adult considerations

›Disease course

›More severe and relapsing disease compared with children

›Higher baseline comorbidity burden

›Medication risks

›NSAID avoidance with CKD risk

›Steroid adverse effects heightened

›Disposition bias

›Lower threshold for admission with renal involvement

›Close follow up for BP and renal function

Pediatrics

›Pediatric specific approach

›Typical demographics

›Peak around school age

›Often self limited course

›Monitoring requirements

›Urinalysis monthly for at least 6 months

›Blood pressure checks at diagnosis and during monitoring

›Admission thresholds

›Severe abdominal pain

›UPCR greater than 200 mg/mmol

›Weight based dosing safeguards

›Steroids and analgesics in mg/kg

›Immunosuppressants by m2 where appropriate

10Background/b34

Epidemiology

›Epidemiology overview

›Most common childhood vasculitis

›Typical presentation in childhood

›Adult disease more severe and relapsing

›Incidence estimate in children

›Around 20 per 100000 children in some populations

›Regional variation

›Organ involvement frequency

›GI involvement up to 72 percent reported in pediatric guideline background

›Kidney involvement around 40 to 50 percent reported in pediatric guideline background

Pathophysiology

›Mechanism summary

›IgA immune complex mediated small vessel vasculitis

›Leukocytoclastic vasculitis in skin

›IgA deposition in vessel walls

›Target organs

›Skin small vessels

›GI tract small vessels

›Glomerular capillaries

›Renal pattern overlap

›IgA vasculitis nephritis shares features with IgA nephropathy

›Histologic severity correlates with progression risk

Therapeutic Considerations

›Treatment principles

›Mild disease supportive care focus

›Hydration and analgesia

›Monitoring for nephritis evolution

›Steroids role

›Symptom control for severe pain

›Nephritis treatment in nephrotic range proteinuria or RPGN

›RAS blockade role

›Proteinuria reduction strategy

›Kidney protection framework

›Immunosuppression escalation

›Specialist guided for severe nephritis

›Risk benefit balancing due to limited RCT data

11Patient Discharge Instructions/pdi26

copy discharge instructions

›Home instructions bundle

›Expected course

›Rash and joint pain may last days to weeks

›Recurrence possible

›Medications

›Acetaminophen as directed for pain

›Avoid ibuprofen and naproxen if kidney problems or bleeding

›Hydration

›Regular fluids

›Return if unable to keep fluids down

›Monitoring plan

›Urine checks and blood pressure checks for 6 months

›Follow up appointments scheduled before leaving

›Return immediately for

›Severe belly pain

›Vomiting blood

›Black stools

›No urine or much less urine

›Swelling around eyes or legs

›Severe headache

›Seizure

›Trouble breathing

›Coughing blood

›Urgent same day contact

›New scrotal pain or swelling

›New large bruising or widespread rash with fever

12References/r17

Clinical guidelines and society recommendations

›Guideline sources

›KDIGO 2025 IgA nephropathy and IgA vasculitis guideline with practice points for IgA vasculitis nephritis

›Nephritis monitoring monthly for at least 6 months from presentation

›No evidence for glucocorticoids to prevent nephritis without kidney involvement

›UK Kidney Association initial management guideline for IgA vasculitis in children and young people

›Use EULAR PRINTO PRES 2010 classification criteria recommendation

›Urinalysis monitoring over 6 months recommendation

›UK Kidney Association complications guideline for IgA vasculitis in children and young people

›Kidney biopsy indications for severe or persistent nephritis

›ACE inhibitor or ARB consideration for proteinuria under specialist guidance

Evidence based reviews and key studies

›Evidence sources

›SHARE European consensus recommendations publication on pediatric IgA vasculitis

›Practice variation acknowledgement and consensus approach

›AAFP clinical review on IgA vasculitis overview and complications

›Classic triad description and self limited course framing

›Open access IPNA pediatric recommendations publication for IgA nephropathy and IgA vasculitis nephritis

›RAS blockade discussion context for pediatric care

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed June 16, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.