Golfer’s Vasculitis / Exercise-Induced Vasculitis
Definition
Golfer’s vasculitis (also known as exercise-induced vasculitis) is a benign small vessel vasculitis that typically arises after prolonged physical activity. It primarily involves a neutrophilic inflammation of the skin’s small to medium-sized vessels and presents with superficial rash on the lower extremities.
Pathophysiology
Neutrophilic infiltration in vessel walls occurs in response to the mechanical and thermal stress of exercise.
Commonly triggered by prolonged or strenuous physical activities, often in hot weather.
Clinical Features
Sites: Lower legs, possibly thighs, either unilateral or bilateral.
Rash Characteristics:
Red patches, urticarial weals, purpura
Oedema, sometimes sparing areas covered by socks or stockings
Itching, stinging, pain, or burning sensations
Typically no systemic symptoms (e.g., no fever or malaise)
Rash resolves spontaneously in ~3–4 weeks; may leave purple-brown pigmentation.
Common Triggers: Running, jogging, hiking, climbing, step aerobics, golf, swimming.
Diagnosis
Mostly clinical, based on history of onset during or after exercise, characteristic distribution, and lack of systemic involvement.
Investigations are generally unnecessary unless systemic or atypical signs raise suspicion of other vasculitides (e.g. ANA, ESR, CRP if needed).
Management
General Measures
Rest and limb elevation to reduce swelling and discomfort.
Compression stockings may help prevent or alleviate symptoms by improving venous return.
NSAIDs (e.g. ibuprofen) or antihistamines (e.g. cetirizine) can relieve itching or mild pain.
Recurrent or More Severe Cases
Avoid vigorous exercise in hot weather if this pattern is recurrent.
Consider colchicine, dapsone, or hydroxychloroquine under specialist guidance for recurrent or persistent cases.
Topical or oral corticosteroids are typically reserved for severe ulceration or blistering (rare).
Notes
Also called “golfer’s vasculitis” because it often appears after golfing or similar prolonged outdoor activity, especially in warm climates.
Education and reassurance are important; the condition is benign and usually resolves without scarring.
If you encounter unusual or persistent features (systemic illness, extensive purpura, blistering, necrosis), consider referring to a dermatologist or rheumatologist to exclude systemic vasculitis.
