ABSTRACT Objective High-frequency ultrasound (HFUS) combined with Shear Wave Elastography (SWE) was used to observe the characteristics of skin lesions in patients with Henoch-Sch?nlein Purpura (HSP), which provided an objective and quantitative evaluation method for the clinical evaluation of HSP patients.Methods A total of 28 HSP patients were selected as the study group (Group B), divided into three subgroups: B1 group (at admission), B2 group (at discharge), and B3 group (after discontinuing medication). A control group (Group A) consisted of 30 healthy individuals from the health examination center. General clinical data were collected from both groups. 20 MHz high-frequency ultrasound combined with SWE was used to measure the thickness and stiffness of the dermis and subcutaneous tissue on the left anterior tibial skin of both groups. Laboratory indicators (WBC, CRP, ESR, IgE) of the case group were recorded, and their correlation with the mean elastic modulus (MEmean), maximum elastic modulus (MEmax), and minimum elastic modulus (MEmin) was analyzed. Results Compared with Group A, the thickness and stiffness of the dermis and subcutaneous tissue in the B1 and B2 groups were significantly increased, and the dermal stiffness in the B3 group was also increased (all P < 0.05). However, the thickness and stiffness of the dermis and subcutaneous tissue, as well as the subcutaneous tissue stiffness in the B3 group, showed no significant difference compared to Group A (all P < 0.05). There was no significant correlation between SWE parameters and WBC, CRP, IgE, or ESR in Group B (all P < 0.05). Conclusion Compared with Group A, the skin thickness and hardness of HSP lesions increased. HFUS combined with SWE can observe the clinical efficacy of Henoch-Schonlein purpura, and quantitatively assess the degree of skin involvement in HSP patients, so as to provide an accurate ultrasound basis for clinicians to evaluate the treatment effect more objectively.