Exercise-induced vasculitis, also known as golfer’s vasculitis, is a benign form of cutaneous small vessel vasculitis. This condition involves inflammation of the small or medium-sized blood vessels in the skin and subcutaneous tissue, with a specific form referred to as exercise-induced capillaritis when only capillary vessels are affected.

The clinical manifestations of exercise-induced vasculitis typically occur in one or both lower legs and thighs during or after physical activity and include the following characteristics: affected skin areas are exposed, while those covered by socks or stockings remain unaffected; presentation includes red patches, urticarial lesions (raised, itchy welts), and purpura (purple spots); swelling (oedema) in the affected leg(s).  Patients often experience intense itching, stinging, pain, or burning. Generally, patients do not exhibit fever, malaise, or other systemic symptoms.

The skin lesions tend to resolve within 3 to 4 weeks, leaving a purplish-brown mark that may persist longer. This condition predominantly affects females over 50 years of age, typically without underlying health issues, and they are generally physically active.

Exercise-induced vasculitis can be triggered by various physical activities, including jogging, running, hiking, climbing, step aerobics, bodybuilding, golf, and swimming. There may also be a genetic or familial component that increases susceptibility to this condition. It is important to note that other forms of cutaneous or systemic vasculitis can be exacerbated by exercise but are not primarily caused by it, often having an underlying disease or condition as the primary cause.

The underlying cause of exercise-induced vasculitis appears to be related to strenuous muscle activity, especially in warm and humid conditions. It is believed that breakdowns in temperature regulation within the calf muscles lead to reduced venous return and blood stasis, resulting in inflammation and vascular injury.

Diagnosing exercise-induced vasculitis can be challenging and typically relies on the patient’s medical history and physical examination. Some individuals may undergo additional investigations, such as laboratory tests, imaging (e.g., X-rays and ultrasound scans), and skin biopsies. These tests serve two primary purposes: ruling out other causes of cutaneous vasculitis and assessing whether other organs are affected, indicating systemic vasculitis.

Skin biopsies in exercise-induced vasculitis typically reveal leukocytoclastic vasculitis, and direct immunofluorescence examinations of new lesions show the presence of complement and immunoglobulins in the blood vessel walls.

The management of exercise-induced vasculitis involves several measures: temporary cessation of vigorous exercise, elevating the affected limb(s), wearing compression stockings to alleviate discomfort and expedite healing (i.e. these may also help prevent further episodes), and nonsteroidal anti-inflammatory drugs (NSAIDs) and antihistamines to alleviate symptoms like burning and itching.

For individuals with recurrent episodes, it is advisable to avoid strenuous exercise in warm weather. While there are no specific reports of their use in exercise-induced vasculitis, active treatments that can manage small vessel vasculitis include colchicine, dapsone, and hydroxychloroquine. Systemic steroids, such as prednisone, are prescribed for severe cutaneous vasculitis cases with blistering or ulceration and are not typically needed for exercise-induced vasculitis.