Monday, April 2, 2012

Rashes are confusing but here's my attempt to explain . . .

I know a lot of you were concerned about this rash, as was I, so I felt it necessitated an update.  After a few days on Prednisone which is a steroid, Henry's leg pain seemed to subside.  The doctors also put him on hydroxyzine,  an antihistamine, which helped significantly with the itching.  You should know that any time a child or anyone has  PURPLE rash, this is a red flag and the child should be seen immediately.  The doctors were concerned when the rash changed color.  The most concerning part of a purple or bruised looking rash is the cause of bleeding.   Does the child have low platelets? Platelets are the part of our blood that helps us to clot.   Reasons for low platelets would include cancers like leukemia or other blood disorders.   After a few days the purple rash faded,  and Henry did not continue to have any fevers or symptoms of illness.   This is the reason that we didn't look any further into the cause of this rash.   From my own study and experience with children, there is something that I remain suspicious of as the cause of his rash.   It is something called Henoch-Schönlein Purpura, which is the most common cause of vasculitis in children.  There is usually a triad of symptoms which include abdominal pain, joint pain or arthritis like symptoms, and usually a palpable purpuritic rash.   While Henry did have purpura it was NOT what I would classify as palpable.   So it is unclear if he actually had HSP or not.   As suspected, the pediatrician confirmed, that after the fact, there is really nothing that we would do differently to treat Henry, as HSP usually resolves on its own.   I should be clear, that there are some children that develop very severe symptoms and often significant abdominal pain.   It is important that constant abdominal pain always be investigated and not ignored, as was the case when I brought Henry into the ER several months ago and found out that he had intussusception, in which his bowel was telescoping onto itself and cutting off the circulation to his intestines.  This is a medical emergency and without intervention the bowel will actually start to die.   The treatment for such an emergency is an air enema, which is exactly what it sounds like, air is pushed into the bowel via an enema, in order to straighten it back out.  If this does not work surgery is necessary to fix the issue.   I found it interestinga complication of  HSP is often intussusception.   That is why, if your child has been diagnosised with HSP, it is important to NOT ignor the symptoms of intermittent severe abdominal pain.   Furthermore, I should note that Henry's intussuception did not present as typical.   It started with intermittent episodes of very short severe abdominal pain, in which he would curl up and scream.  Minutes later he would be running around as if nothing ever happened.  This continued all day and became more and more frequent, but he was completely happy and pain free in between the episodes of intermittent pain.  Many times this pain can be timed as to occur nearly every fifteen or twenty minutes.   Some children will vomit bile, Henry did not.    I thought it odd that he was having abdominal pain but not having vomiting or diarrhea.   This was actually something that signaled  me that something was seriously wrong, usually when Henry had abdominal pain vomiting or diarrhea always followed, why just the pain alone?   It didn't make sense.  Later his abdominal pain seemed to subside, but the regular intervals continued, only this time, rather than pain, he became extreemly sleepy, he would fall asleep in my arms, at times he was very difficult to arouse.  This is another huge red flag, if a child is hard to arouse, you need to go straight to the ER, which I did.  Trust your intuition, and know that there is always an exception to the rule, if your child doesn't seem right, have him examined.    

Thankfully Henry's intussuception was fixed without surgery.   Did he have HSP?    I can't say for sure.  One of the more serious complications of HSP are that the kidneys can be affected.  Oddly my doctors didn't take a urine sample to test for blood or protein in his urine.   This seems an easy an non-invasive way to rule out any kidney involvement and should be standard practice for any child who has had suspected HSP.    Since no lab work was done, I have just been watching him closely for reoccuring symptoms and so far he seems to be well.   I will mention doing a urine test the next time we go in, as it is simple and can be done in the office. 

Henry has had some odd rashes this week, and I am not sure what they are related too.  They appear to look like hives and are very itchy.   I keep looking him over, afraid they will turn back to purpura as they did a few weeks ago.  Sometimes HSP can resurface, so it is something to watch for.   Rashes can be tricky and it takes some experience to know the differences between different types of rashes, this is something I've been studying recently.  It is helpful to go to a doctor if you or your child have any persistant rash, so it can be diagnosed correctly.   It has been extreemly windly lately and pollen is in the air, so Henry's hives could be enviromental, or it could be a food that he's been eating.   I am a little suspicious of strawberries.  After he falls asleep, I think I am going to rub some strawberry on his skin and see if I get the same affect, I'm sure he'll love that!

Okay, so the take home points are as follows:  Rashes are confusing.   Purple rashes MUST be assessed immediately to rule out serious causes like bleeding.  Rashes that occur with fever, or symptoms of illness, also need to be assessed for treatable causes of the fever.   Rashes that don't go away need to be assessed to know what you are dealing with and even if you want to treat them naturally, it helps to know if it is hives or eczema or psorisis--all of which seem to have inflammatory components and are related to over reactive immune systems.     HSP is a common form of vasculitis seen in children, doctors are not sure what causes it exactly, maybe a response to a virus, or a drug reaction, it is treated by treating the symptoms of the rash with steroids and antihistimines if needed.  The  person needs to be monitored for kidney involvement or complications of worsening abdominal pain.

There are of course many natural treatments for rashes, I will not explore this now.  I can say that Henry used to have chronic hives and some eczema prior to our elimination diet which proceeded the GAPS diet which we are on currently.   Rashes are tricky, there are definatley some enviromental componants for some children and often times rashes like eczema are emotionally draining and trying to figure out the root cause of the rash is grueling and frusterating for parents.  The GAPS diet is a great place to start.