Exercise-Induced Vasculitis: Understanding Golfer's Leg Rash

Exercise-Induced Vasculitis Rash Is Common for Walkers and Golfers

Exercise-Induced Vasculitis
Wendy Bumgardner

Whether you golf, run, walk, or hike, you may end up with a red heat rash on your ankles and calves. Exercise-induced vasculitis can be unsightly and you may worry whether it indicates a more serious condition. The good news is that this is a common rash that happens to otherwise healthy people and usually goes away on its own. Most people don't see their doctor about it.

One of the first names proposed for this rash was golfer's vasculitis, and some researchers call it exercise-induced vasculitis.

You may also hear it called golfer's rash or even Disney leg rash as it's been nicknamed by amusement park visitors who have developed it.

Symptoms of Exercise-Induced Vasculitis

The rash seen with exercise-induced vasculitis often starts above the sock line and makes red patches and splotches up the calf. It usually doesn't itch (although it might). It can appear as red blotches, purple (purpuric) patches, or small dots. It's believed to be heat-related as often people who get it in warm weather don't get it in cooler weather.

The rash is more common in people over 50. Most walkers can't pinpoint anything new they have used that may be causing a reaction. And since so many walkers have it, they couldn't all have contacted the same irritant. It is often noted that it starts above the sock line rather than extending under the socks.

Diagnosis

Ask most physicians about this common rash and they draw a blank.

That is probably due to few people seeking medical help for it. The rash usually clears up in a couple of days, before they are able to get a doctor's appointment.

Researchers interviewed several people with the rash and discovered that many underwent extensive allergy testing because they believed they must have been having a reaction to some chemical or plant.

However, the tests were negative or unremarkable.

Other studies went as far as doing skin biopsies and found that what was going on under the skin was a leukocytoclastic vasculitis, which means there is debris of white blood cells in the walls of the small blood vessels. This can be seen in a variety of conditions as well as occurring for no known reason. Blood tests didn't show anything remarkable in the way of infection or systemic conditions.

Doctors rarely see this condition and when they do, they make a diagnosis based on the appearance of the rash. Your doctor might also do further tests to make sure it isn't a symptom of something of concern and to check on your health in general.

Causes of Golfer's Vasculitis

Researchers conclude that this vasculitis is simply an irritation of the blood vessels following prolonged exercise in the heat, such as walking for extended periods or playing 18 holes of golf.

Aging blood vessels are likely a factor, as it happens more often in people over the age of 50. As you age, your calf muscle isn't as effective at assisting your veins in returning blood "uphill" to your heart.

In warm weather, more blood is sent into the small capillaries under the skin to help keep you from overheating.

When this blood isn't easily returned, you have venous stasis. As a result, prolonged or unusual exercise in hot weather irritates the blood vessels just under the skin of your legs. This results in the red or purple rash.

Prevention and Treatment

There are no established treatment or prevention recommendations. The leg rash will generally go away by itself in 3 to 10 days. Using a topical over-the-counter hydrocortisone cream might reduce the symptoms. Pampering yourself after a good long walk by taking a cool bath, sitting with your feet up, or applying cool wet towels to the rash may help relieve discomfort.

For prevention, one review of studies could only suggest wearing light clothes when you're going to be standing or exercising in the heat. There is no need for allergy testing, according to researchers.

It seems to occur in healthy, active people. The researchers suggest it should not be a health concern and recommend not getting allergy testing.

Other Heat Rashes

Your rash may not be the common exercise-induced vasculitis. Here are other rashes seen by people who walk, golf, or exercise outdoors:

  • Heat Rash and Prickly Heat: Unlike golfer's vasculitis, prickly heat is itchy. It is triggered by blocked sweat glands and causes raised itchy red dots or bumps. It is best treated by getting out of the heat for a few days and not scratching the area.
  • Itchy Legs Syndrome: If your legs are itchy during or after exercise, with no relation to heat, you may have exercise urticaria.
  • Cholinergic Urticaria: With this condition, you break out in tiny itchy hives with an increase in body temperature, whether due to exercise or a hot shower.
  • Poison Ivy and Oak Rash: Poison ivy rash is seen 1 to 3 days after contact with poison ivypoison oak, or poison sumac in sensitive people. It is very itchy, red, bumpy rash, right at the point of contact, often forming a line where the plant rubbed. It may grow into fluid-filled blisters and last from 1 to 3 weeks.

A Word From Verywell

Getting an unsightly leg heat rash is one of 10 weird things walking can do to your body. If it's your only symptom, you are probably safe to continue enjoying your warm-weather activities. But if you have any other symptoms, see a doctor to have them checked. Exercise in hot weather can result in dehydration and heat-related illness. Be sure that you take precautions when exercising in hot weather.

Sources:

Espitia O, Dréno B, Cassagnau E, et al. Exercise-Induced Vasculitis: A Review with Illustrated Cases. American Journal of Clinical Dermatology. 2016;17(6):635-642. doi:10.1007/s40257-016-0218-0.

Kounis N, Kounis G, Soufras G. Exercise-induced urticaria, cholinergic urticaria, and Kounis syndrome. Journal of Pharmacology and Pharmacotherapeutics. 2016;7(1):48. doi:10.4103/0976-500x.179355.

American Osteopathic College of Dermatology. Leukocytoclastic Vasculitis.

Miller, J. Miliaria. UpToDate. Updated 08/25/15.

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