Exercise-induced vasculitis, also known as Exercise-Induced Vasculitis Syndrome (EIVS), is an uncommon condition characterized by the development of small vessel vasculitis following physical exertion, such as exercise. It is more commonly known as ‘the Disney rash’ or sometimes, a ‘golfer’s rash’ or ‘hikers rash’. It is more common in warmer weather and in females over the age of 50.
Clinical Features:
Typically occurs during or immediately after physical activity, most commonly aerobic exercise like running or jogging (or walking around Disneyland or playing a round of golf). The symptoms usually appear within 24-48 hours and are at their peak at around 3-4 days.
Appears as a red or purple raised patches or rashes, typically on the legs and feet that can be itchy and sometimes painful with some oedema – usually the pattern is bilateral and symmetrical. As it progresses, the lesions may coalesce into larger areas of discoloration.
Typically the lesions resolve within a few days without treatment, but can recur with subsequent bouts of activity.
Differential Diagnosis: urticaria, heat rash, allergic reactions, other causes of small-vessel vasculitis.
Biopsy typically show a leukocytoclastic vasculitis
Aetiology:
Exact cause of exercise-induced vasculitis is not well understood but it is triggered by prolonged or strenuous exercise, the exposure to heat and certain medications. Genetic predisposition may play a role.
It is probably a result of a venous stasis from a failure of the muscle pump of the calf with some issues of thermoregulation.
Treatment:
Most will resolve spontaneously over a few days with relative rest and avoidance of strenuous activity.
Antihistamines may help manage the itching.
Compression hosiery may help reduce the symptoms.
If severe, may need corticosteroids
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