A 76-year-old woman presented for a routine skin check in late spring. On examination, she was noted to have a marked purpuric rash involving her lower legs (Figure A). The rash was accompanied by a slight burning sensation. The patient had played golf the day before. A skin biopsy revealed limited changes suggestive of leukocytoclastic vasculitis (Figure B). The rash resolved over 3 days. As the patient was concerned about herbicides causing the rash, she was subsequently patch-tested to an extensive panel of contact allergens, but all tests were negative.
In our experience, an erythematous-to-purpuric rash occurring on the legs and ankles of older people is not uncommon after prolonged exercise, such as golfing or hiking, in hot weather. It usually resolves within a week.
Surprisingly, there have been very few published reports of this type of rash occurring. We recently reported a case series of 17 other patients,1 and suggested that the condition — a benign variant of cutaneous vasculitis, for which a combination of exercise, heat and stasis appears to be the most significant cause — be known as “golfer’s vasculitis”. However, a colleague who practises in Florida and who is familiar with the condition refers to it as “Disneyworld leg”!