Exercise-Induced Purpura: Systematic Review of the Literature

Exercise-induced purpura is a distinctive condition occurring after prolonged physical exertion. It is often misdiagnosed as an immune-mediated vasculitis, raising concerns about autoimmune disorders. Although this condition affects physically active individuals, it remains underrepresented in comprehensive reviews on purpura and nontraumatic sports dermatology. To enhance awareness about this condition and to advance understanding of its clinical and histologic features, we conducted a systematic literature review. This study was preregistered in the International Prospective Register of Systematic Reviews (CRD42024557652).

The United States National Library of Medicine, Excerpta Medica, and Google Scholar were screened for the terms "exercise-induced vasculitis" OR "exercise-induced purpura" OR "exercise-induced capillaritis." Data extraction encompasses demographics, symptoms, time latency and recovery, predisposing factors, ancillary tests (blood values and histology), and popular terminology.

We identified 40 typical cases and three case series reporting an additional 71 individuals. Exercise-induced purpura predominantly affected middle-aged women, often in association with chronic venous disease. Petechiae, purpura, or ecchymoses-often accompanied by burning, itching, or mild pain-appeared within 24 hours after prolonged physical activity, especially in warm conditions, and characteristically involved the lower limbs, sparing areas covered by clothing. Symptoms and lesions resolved spontaneously within 1 to 2 weeks. Laboratory tests were unremarkable, and histology revealed leukocytoclastic vasculitis without IgA deposits.

Exercise-induced purpura deserves greater visibility in sports medicine due to its frequency, benign course, and potential for misdiagnosis. Diagnosis is clinical. Early recognition avoids unnecessary investigations and unwarranted concern.