By Gary M. White, MD
This older adult woman developed a shower of purpura on the lower legs after spending the day at Disneyland. Note the sparing where socks compress the skin. Support hose might prevent next time.
Exercise-induced purpura (EIP) occurs on the lower legs after unusual or major muscular activity, e.g., running a marathon, golfing or taking a long walk. The exercise is often in hot weather and patients are typically healthy females. There is no relation with chronic venous disorders. EIP is not uncommon, even if very few descriptions have yet been published. On biopsy, a leukocytoclastic vasculitis may be seen. Some however, feel EIP represents a form of exercise-induced capillaritis [JEADV 2016;30;1403].
Erythematous, urticarial, or purpuric plaques arise on the lower leg, usually sparing the skin compressed by socks. Symptoms include itch, pain, and a burning sensation.
No treatment is needed. The lesions fade in days. Wearing compression stockings during exercise may prevent the development of new lesions.
More pictures from the case above.
A mild case. Small petechie on the distal feet in a dog walker.
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