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Exercise-Induced Vasculitis: A Review with Illustrated Cases

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Abstract

Although exercise-induced vasculitis (EIV) is usually misdiagnosed, it is not uncommon. Occurring mostly after prolonged exercise, especially in hot weather, EIV is an isolated cutaneous vasculitis with stereotypical presentation. This article reviews the clinical characteristics, treatments, and outcomes of EIV based on the published literature. We report 99 patients who developed EIV after walking, dancing, swimming, or hiking especially during hot weather, including the records of 16 patients with EIV treated at our hospital from 2007 to 2015. Erythematous or purpuric plaques arise on the lower legs, without the involvement of compression socks or stockings. Symptoms include itch, pain, and a burning sensation. EIV is an isolated cutaneous vasculitis. Lesions resolve spontaneously after 10 days. When triggering conditions persist, relapses are frequent (77.5 %). Histopathology demonstrates leukocytoclastic vasculitis in 95 % of cases with C3 or immunoglobulin M deposits in 88 and 46 % of cases, respectively. Blood investigations are negative. EIV appears to be a consequence of venous stasis induced by an acute failure of the muscle pump of the calf and thermoregulation decompensation. Both appear after prolonged and unusual exercise in hot weather. Treatment is not codified; topical corticosteroids may reduce symptoms and wearing light clothes might limit lesion occurrence.

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Acknowledgment

We thank Alexandre Desjonqueres for his help in manuscript editing.

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Authors and Affiliations

  1. Department of Internal Medicine, Hôtel-Dieu, Centre Hospitalier Universitaire de Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France

    Olivier Espitia, Quentin Didier, Yann Le Bouch, Bernard Planchon & Marc-Antoine Pistorius

  2. Department of Dermatology, University Hospital of Nantes, Nantes, France

    Brigitte Dréno & Christelle Nicol

  3. Department of Pathology, University Hospital of Nantes, Nantes, France

    Elisabeth Cassagnau

  4. INSERM UMR957-Laboratoire Physiopathologie de la Résorption Osseuse (LPRO), University of Nantes, Nantes, France

    Thibaut Quillard

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  1. Olivier Espitia
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  2. Brigitte Dréno
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  3. Elisabeth Cassagnau
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  4. Quentin Didier
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  5. Thibaut Quillard
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  6. Christelle Nicol
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  7. Yann Le Bouch
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  8. Bernard Planchon
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  9. Marc-Antoine Pistorius
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Correspondence to Olivier Espitia.

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No funding was received for the preparation of this review.

Conflict of interest

OE, BD, EC, QD, TQ, CN, YLB, BP, and MAP have no conflicts of interest directly relevant to the content of this review.

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Espitia, O., Dréno, B., Cassagnau, E. et al. Exercise-Induced Vasculitis: A Review with Illustrated Cases. Am J Clin Dermatol 17, 635–642 (2016). https://doi.org/10.1007/s40257-016-0218-0

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  • DOI: https://doi.org/10.1007/s40257-016-0218-0

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