Effects of Corticosteroid on Henoch-Schönlein Purpura: A Systematic Review

Weiss, Pamela F.; Feinstein, James A.; Luan, Xianqun; Burnham, Jon M.; Feudtner, Chris

doi:10.1542/peds.2007-0667

Cited by 228 publications

(135 citation statements)

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“…Early intervention in the course of HSP has been shown to improve patient outcomes for both children and adults and reduce chronic renal disease. 55 Mizoribine has recently been proven clinically effective and safe for the treatment of nephrotic syndrome, 49 IgA nephropathy 56 and lupus nephritis. 47 Therefore, we propose prophylactic treatment of renal complications in patients with HSP.…”

Section: Treatment For Cutaneous Polyarteritis Nodosamentioning

confidence: 99%

New algorithm (KAWAKAMI algorithm) to diagnose primary cutaneous vasculitis

Kawakami

2010

The Journal of Dermatology

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Palpable purpura tends to indicate involvement of small vessel vasculitis in the upper dermis. Livedo racemosa, nodular lesion and skin ulceration are indicative of involvement of small to medium-sized vessel vasculitis in the lower dermis to subcutaneous fat. We set out to establish a new algorithm (KAWAKAMI algorithm) for primary cutaneous vasculitis based on the Chapel Hill Consensus Conference classification and our research results, and apply to the diagnosis. The first step is to measure serum antineutrophil cytoplasmic antibodies (ANCA) levels. If myeloperoxidase-ANCA is positive, Churg-Strauss syndrome or microscopic polyangiitis can be suspected, and if the patient is positive for proteinase 3-ANCA, Wegener's granulomatosis is most likely. Next, if cryoglobulin is positive, cryoglobulinemic vasculitis should be suspected. Third, if direct immunofluorescence of the skin biopsy specimen reveals immunoglobulin A deposition within the affected vessels, Henoch-Schö nlein purpura is indicated. Finally, the presence of anti-phosphatidylserine-prothrombin complex antibodies and ⁄ or lupus anticoagulant and histopathological necrotizing vasculitis in the upper to middle dermis (leukocytoclastic vasculitis) indicates cutaneous leukocytoclastic angiitis, whereas if necrotizing vasculitis exists in the lower dermis and ⁄ or is associated with the subcutaneous fat, cutaneous polyarteritis nodosa is indicated. The KAWAKAMI algorithm may allow us to refine our earlier diagnostic strategies and allow for efficacious treatment of primary cutaneous vasculitis. In cutaneous polyarteritis nodosa, warfarin or clopidogrel therapies should be administrated, and in cases that have associated active inflammatory lesions, corticosteroids or mizoribine (mycophenolate mofetil) therapy should be added. We further propose prophylactic treatment of renal complications in patients with Henoch-Schö nlein purpura.

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Section: Treatment For Cutaneous Polyarteritis Nodosamentioning

confidence: 99%

New algorithm (KAWAKAMI algorithm) to diagnose primary cutaneous vasculitis

Kawakami

2010

The Journal of Dermatology

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“…Microscopic hematuria and albuminuria are the prominent renal findings. [5,15] Our case had the symptoms of rashes over both lower legs, pain in abdomen, and vomiting. Joint involvement was absent.…”

Section: Discussionmentioning

confidence: 79%

“…A meta-analysis in the Medline database and the Cochrane Controlled Trials Register based on a comprehensive review of the literature by Weiss et al stated that early treatment with corticosteroid significantly reduces the odds of developing persistent renal disease along with surgical intervention and recurrence. [5] In contrary, other trials and updates in the literature have mentioned that there is no long-term renal protective outcome on the early treatment with prednisolone. [16,17] In general, prednisolone is the commonly used steroid for the treatment of HSP.…”

Section: Discussionmentioning

confidence: 97%

“…[4] Corticosteroids if given in the early course of disease can help to provide a better clinical outcome. [5] The prognosis is good, with exception of renal involvement that may need the follow-up till 6 months or longer. [6,7] The exact prevalence of HSP in our settings has yet to be discovered, but various studies revealed it to be one of the important causes of childhood renal disease.…”

Section: Introductionmentioning

confidence: 98%

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Henoch-Schonlein Purpura Successfully Treated with Dexamethasone: A Case Report of Six-Year-Old Female

Adhikari

2017

J Med Res Innov

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Henoch-Schonlein Purpura (HSP) is one of the most common causes of small vessel vasculitis in children. A 6-year-old female presented with abdominal pain, swelling, and rashes over both the legs associated with multiple episodes of vomiting for around 10 days. Stool for the occult blood test was positive, but there was an absence of hematuria and albuminuria. The case was diagnosed as HSP and treated with dexamethasone for 10 days. The patient was finally discharged on the resolution of her symptoms. Early diagnosis and treatment favor the better outcome in cases without any renal complications.

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“…Corticosteroids may have a role for children with severe disease requiring hospitalization, severe abdominal pain, or other severe gastrointestinal complications [61,62]. The use of corticosteroids increased the odds of resolution and reduced the mean time to resolution of abdominal pain [61].…”

Section: Pediatric Considerationsmentioning

confidence: 99%