An Island Rash: A Case Study of Exercise-Induced Vasculitis

Exercise-induced vasculitis, also known as the Disney rash or Golfer's vasculitis, is a benign, self-limiting, cutaneous small vessel vasculitis that can develop following prolonged physical activity, especially in hot weather. A 65-year-old female teacher with obesity, diabetes, and dyslipidemia contacted her family physician via email regarding a one-day history of a bilateral lower limb rash. Her medications included metformin and atorvastatin. While vacationing in Madeira, she developed an erythematous, petechial rash above the ankles, circumferentially distributed, following prolonged walks in hot, humid conditions. A telephone consultation was scheduled for further assessment. The lesions, which spared sock-covered areas, worsened over the next 48 hours and were associated with pruritus, mild edema, and warmth. She denied systemic symptoms, recent dietary or medication changes, insect bites, exposure to new hygiene products, and other irritants or allergens. A similar episode had occurred the previous year while on vacation. Bilastine provided no relief. Treatment with mometasone cream was prescribed twice daily. Additionally, the use of compression stockings, leg elevation, and reduced physical activity was advised. A dermatology consultation, requested by the family physician, confirmed a presumptive diagnosis of exercise-induced vasculitis. The rash resolved completely by the 10-day follow-up consultation in primary care. Exercise-induced vasculitis remains underrecognized despite its relative frequency. It commonly affects women over 50 after extended exertion in warm climates. While self-limiting and resolving within 10 to 14 days, treatment is mainly supportive. When triggering conditions persist, relapses are frequent. Family physicians should be aware of the characteristic presentation of exercise-induced vasculitis, as this allows early diagnosis and prevents unnecessary interventions.