GLOBAL THERAPEUTIC STRATEGIES FOR HENOCH-SCHÖNLEIN PURPURA IN CHILDREN: A DECADE OF CLINICAL EVIDENCE

Abstract

Henoch-Schönlein purpura (HSP), also known as IgA vasculitis, is the most common form of small-vessel vasculitis in the pediatric population. Characterized by the deposition of IgA1-dominant immune complexes, HSP primarily affects the skin, joints, gastrointestinal tract, and kidneys. Although the condition is typically self-limiting in the majority of children, a significant subset develops complications such as glomerulonephritis, which may lead to long-term renal impairment if not adequately managed. This review provides a comprehensive and critical synthesis of recent global clinical studies (2015–2025) focused on therapeutic strategies for pediatric HSP. We examine the roles of corticosteroids, immunosuppressive agents such as mycophenolate mofetil and azathioprine, and biologic therapies including rituximab and interleukin-targeted agents. Emphasis is placed on the effectiveness, safety profiles, and indications for each pharmacologic class based on disease severity and organ involvement. Furthermore, we analyze regional variations in clinical practice, comparing consensus guidelines and treatment protocols from Europe, Asia, North America, and the Middle East. Particular attention is given to the challenges posed by refractory nephritis, relapse risk, and the lack of standardized long-term management strategies.