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Golfer’s vasculitis

Golfer’s vasculitis

Golfer’s vasculitis also called exercise-induced vasculitis is a harmless form of cutaneous small vessel vasculitis 1. Golfer’s vasculitis is a neutrophilic inflammatory disorder involving the small or medium-sized blood vessels of the skin and subcutaneous tissue. When only the small capillary vessels are involved, it is also called exercise-induced capillaritis. Lesions resolve over 3 to 4 weeks. A purplish-brown mark may persist for longer.

Patients that present with golfer’s vasculitis (exercise-induced vasculitis) are often female and over 50 years of age. They are most often otherwise healthy and active.

Common activities which can trigger golfer’s vasculitis (exercise-induced vasculitis) include:

  • Jogging and running, especially long-distance running
  • Hiking and climbing
  • Step aerobics
  • Body building
  • Golf
  • Swimming

It is also suspected that there might be a genetic or familial factor causing susceptibility to golfer’s vasculitis (exercise-induced vasculitis).

Figure 1. Golfers rash

golfers rash on ankles

Footnote: Purpuric eruption on the lower leg above the sock line.

[Source 2 ]

Golfer’s vasculitis causes

As the name implies, golfer’s vasculitis (exercise-induced vasculitis) is typically induced by strenuous muscle activity, particularly during warm and humid weather. It is thought that the temperature regulation mechanisms within the calf muscles break down, leading to reduced venous return and blood stasis. The end result is inflammation and vascular injury.

Golfer’s vasculitis symptoms

Golfer’s vasculitis (exercise-induced vasculitis) mainly affects one or both lower legs and thighs, with single or multiple episodes of a rash with the following characteristics:

  • Involvement of exposed skin and sparing of skin protected by socks or stockings
  • Red patches, urticarial lesions (weals) and purpura (purple spots)
  • Edema (swelling) of the affected leg(s)
  • Intense itching, stinging, pain or burning

The patient is otherwise well, without fever, malaise or other symptoms.

Golfer’s vasculitis diagnosis

Diagnosis of golfer’s vasculitis (exercise-induced vasculitis) can be difficult. It is based on history and physical examination. Some people may undergo investigations, such as:

  • Laboratory tests
  • Imaging, e.g., X-rays and ultrasound scans
  • Skin biopsy

Laboratory tests and imaging are undertaken for 2 main reasons:

  • To exclude another cause of cutaneous vasculitis
  • To determine if other organs are affected, thus diagnosing systemic vasculitis.

Skin biopsy shows leukocytoclastic vasculitis in exercise-induced vasculitis. Direct immunofluorescence examination of new lesions shows complement and immunoglobulins in walls of the blood vessels.

Golfer’s vasculitis treatment

Management of golfer’s vasculitis (exercise-induced vasculitis) involves:

  • Temporary cessation of vigorous exercise.
  • Elevation of affected limb(s)
  • Compression stockings to relieve discomfort and speed up healing. They may possibly help prevent golfer’s vasculitis (exercise-induced vasculitis).
  • Nonsteroidal antiiflammatory drugs and antihistamines to reduce symptoms of burning and itch.

Patients with recurrent episodes of golfer’s vasculitis (exercise-induced vasculitis) should avoid vigorous exercise in warm weather. Although there are no reports of their use in golfer’s vasculitis (exercise-induced vasculitis), active treatments that can control small vessel vasculitis include:

  • Colchicine
  • Dapsone
  • Hydroxychloroquine

Systemic steroids, e.g., prednisone, are reserved for severe cutaneous vasculitis with blistering or ulceration, and are not necessary for golfer’s vasculitis (exercise-induced vasculitis).

References
  1. Exercise-induced vasculitis. https://dermnetnz.org/topics/exercise-induced-vasculitis/
  2. Knoell, K.A. (2009). Exercise-induced vasculitis associated with autoimmune disease. Cutis, 83 6, 319-22. https://pdfs.semanticscholar.org/3373/3389ca02ebeaa60c71e3511ba524b313e192.pdf
Health Jade Team

The author Health Jade Team

Health Jade