Male: Sometimes kids go to a doctor and the doctor sees little tiny red dot around the ankles and then black and blue marks and they think it is a blood disease, yet they send her to a rheumatologist like you and you use this term, HSP. It sounds like they made up something? What is HSP?
Female: HSP stands for a disease that the name is Henoch-Schonlein purpura. So the H is for Henoch, S is for Schonlein and P is for purpura. What is purpura? Purpura is a condition where the skin has some very, very discernible, very little blood vessels where the blood is running inside the skin and for some reason, there is inflammation there and you see that these little, little vessels are bleeding outside and this is what you see in the skin. You see just a little bit of blood in the skin. It is not bleeding outside, it is just bleeding inside the skin and this is what you see in the skin.
Male: But if you do blood test to make sure it is not from inside?
Female: Yes, definitely, you do a blood work, you make sure that there is no really a decrease amount of platelets in your blood and you make sure that the coagulation, the blood is making huge and forming clots are actually good and you are safe and you are just having these dots in the skin not because there is a blood problem , it is because there is some intrinsic inflammation in the skin.
Male: Generally, it goes away by itself?
Female: Yes, definitely. It is the most common condition in rheumatology that can give you this kind of skin purpura. This mild inflammation in the little blood vessels in the skin, it is very benign and normally, it goes away by itself without complications.
Male: Do we know the cause?
Female: If we know the cause of HSP? No, we do not know.
Male: Some people think strep antibodies—we find it now and then.
Female: Yes, definitely. We know that kids with strep infections or with a cold like one or two weeks before they have the condition, we know definitely that that sometimes is associated. We cannot really still prove that this is what is causing the HSP.
Male: Is there some chemicals, some things like that—someone thought that that was not going to be true either, right?
Female: It was never proven at all.
Male: It was a theory.
Female: It was a theory. We do not know exactly what is causing this, but we know definitely that patients with a history of some strep infection a couple of weeks before, they can sometimes develop this, but we cannot really prove it yet.
Male: And you have got to check the urine for blood and the stool for blood, is that true?
Female: Exactly, so the same thing that you see in the skin sometimes can happen inside the body. It can happen in the bowel that is why you have to look for blood in the stools and it can also irritate your kidneys, so you need to look for blood in the urine.
Male: Sometimes, the belly gets distended and what about the intestines--?
Female: The problem with this disease although it is very, very benign, there is one thing that we always have to watch for and it is the small inflammation that is happening in the bowel that can make the bowel grow a little bit and not be fitting in the abdomen the way it should be, so these pieces of bowel can hurt each other and sometimes, you can have what is called intussusceptions, you are going to hear about this term and the only thing that it means is that it is like a telescope.
Male: Like it pulls on itself?
Female: Exactly, and if this is happening. It is not really happening very often, but if this is happening, a surgeon needs to be involved.
Male: And more likely, a younger kid than an older kid?
Female: It is happening sometimes, well, I do not think it is really related to the age, although, older kids tend to have more difficult episodes of HSP, if we can say it that way.
Male: Let say, you have got a problematic case and it goes on a long period of time, what can they do to make the kid more comfortable, any medicines for this?
Female: Definitely. There is no place really for medication in HSP, unless, this is going too long, but unless the kid is really feeling miserable and you can offer these patients a little bit of steroids which is a very, very strong anti-inflammatory and they feel definitely better in a very, very short period of time.
Male: So any medicines you cannot use for a patient because you are worried about this?
Female: In HSP exactly, I do not really think that there is a formal contraindication in these patients. Although, if the bowel is bleeding, I will be very, very cautious what medication I would offer to these patient.
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