Blistering eruptions in Henoch-Schönlein syndrome: more
common than assumed
Linda De Raeve
Received: 13 July 2017 /Revised: 31 July 2017 /Accepted: 4 August 2017 / Published online: 15 August 2017
Springer-Verlag GmbH Germany 2017
With great interest, we read the article by Ramelli et al.
 reviewing the literature on blistering eruptions in
childhood Henoch-Schönlein syndrome between 1959
and 2016. We congratulate the authors for their extensive
work and want to comment on the reported prevalence of
bullous Henoch-Schönlein purpura in children. The au-
thors identified 39 individual reports on bullous eruptions
in childhood Henoch-Schönlein purpura and another 10
children in 7 case series containing 666 unselected pedi-
atric Henoch-Schönlein cases for the final analysis of their
literature search. The estimated prevalence of bullous
eruptions in pediatric Henoch-Schönlein cases based on
these findings was suggested to be < 2%, a percentage
thatwasalsoproposedbypreviousauthors[1, 2, 4],
which is in contrast to the rather common occurrence of
blistering eruptions in adults affected with Henoch-
Schönlein syndrome . We agree that blister formation
is a rare finding in children with Henoch-Schönlein pur-
pura. However, based on the population of patients with
Henoch-Schönlein purpura that is referred to the Pediatric
Dermatology Clinic of our university hospital, we assume that
this phenomenon is underreported in the literature. Between
February 2015 and March 2017, we have diagnosed 5 cases
of bullous Henoch-Schönlein. All of these cases were
immuno-competent female children aged between 6 and
17 years old. The severity of the lesions varied from subtle
blisters confined to the center of the purpuric maculae in 3
cases to extensive large bullae in the remaining 2 cases.
Especially in subtle cases, recognition of this entity may be
challenging. Four out of five children were treated with sys-
temic corticosteroids and all evolved well. Ramelli et al. 
found a similar course in children treated with systemic ste-
roids and those managed by a wait-and-see approach.
Although we agree with what is found in literature, we do
believe that treating severe cases with systemic corticosteroids
could diminish complications such as necrosis and scarring.
Compliance with ethical standards
Conflict of interest Author Valérie Peeters declares that she has no
financial relationship with the organization that sponsored the research.
Author Linda De Raeve declares that she has no financial relationship
with the organization that sponsored the research.
Author Valérie Peeters declares that she has no conflict of interest.
Author Linda De Raeve declares that she has no conflict of interest.
Human and animal rights and informed consent This article does
not contain any studies with human participants or animals performed by
any of the authors.
1. den Boer SL, Pasmans SG, Wulffraat NM, Ramakers-Van Woerden
NL, Bousema MT (2010) Bullous lesions in Henoch-Schönlein pur-
pura as indication to start systemic prednisone. Acta Paediatr 99:
V.P. and L.D.R. contributed equally to this work.
Communicated by Mario Bianchetti
* Valérie Peeters
Linda De Raeve
Department of Dermatology, Universitair Ziekenhuis Brussel (UZ
Brussel), Vrije Universiteit Brussel (VUB), Laarbeeklaan 101,
1090 Brussels, Belgium
Eur J Pediatr (2018) 177:475–476