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July 1991

Picture of the Month

Author Affiliations

Contributed from the Children's Hospital of Philadelphia (Pa).

Am J Dis Child. 1991;145(7):823-824. doi:10.1001/archpedi.1991.02160070119035

Denouement and Discussion 

Henoch-Schönlein Purpura 

Manifestations  Henoch-Schönlein Purpura (HSP) is a systemic vasculitis of unknown cause. Involvement of the skin is the the most characteristic feature of this disorder. The rash of HSP is described as purpuric and, classically, as demonstrating palpable purpura. The children pictured on the previous page all have HSP, but their skin involvements differ considerably in appearance. The variability in appearance of the rash associated with HSP may lead to confusion regarding the correct diagnosis unless associated features make other possibilities less likely.Before the appearance of the purpura, the rash sometimes appears as erythematous maculopapules or as urticarial lesions. These lesions usuallybecome purpuric and can be ecchymotic (Fig 1) or petechial (3 mm, Fig 2). Occasionally, the lesions appear targetoid (Fig 3), but rarely become vesiculobullous (Figs 4 and 5). The elastic sock sign (Fig 6) is helpful in clinically separating the vasculitis of HSP from purpuric