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Wednesday 17 July 2019

Purpura in Children

HSP
Vasculitis with arthralgia, abdo pain, and or renal involvement. Purpura occurs in all patients. The rash is distinctive. Urinalysis is needed - manage with analgesia. Consider steroids.

A first episode of HSP usually resolves within 4 weeks with the rash being the last symptom to go.
Joint pain usually resolves spontaneously within 72 hours and abdo pain in 24- 48 hours.
Uncomplicated abdominal pain usually resolves spontaneously within 24-48 hours

ITP
Covered on DFTB.

Petechial Rash 
The flow chart on this website is useful for highlighting when to investigate but this one is probably the best.
NICE say give ceftriaxone if:
  petechiae start to spread
  the rash becomes purpuric
  there are signs of bacterial meningitis
  there are signs of meningococcal septicaemia
  the child or young person appears ill to a healthcare professional
A non specific viral illness is the most likely cause of the rash.

References
https://www.rcemlearning.co.uk/foamed/7-pem-rashes/
https://dontforgetthebubbles.com/henoch-schonlein-purpura-steroids-helpful-preventing-nephropathy/
https://www.rch.org.au/clinicalguide/guideline_index/HenochSchonlein_Purpura/
http://www.clinicalguidelines.scot.nhs.uk/ggc-paediatric-guidelines/ggc-guidelines/emergency-medicine/non-blanching-rash-management-in-children/
https://dontforgetthebubbles.com/itp-idiopathic-thrombocytopenia-purpura/

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