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Golfer’s vasculitis

Rosemary L Nixon, Jacinta M Opie and Robert I Kelly
Med J Aust 2005; 183 (1): 32.

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”!

A: Purpuric rash on skin of lower leg. B: Skin biopsy of lower leg showing a perivascular infiltrate of predominantly lymphocytes with occasional eosinophils, endothelial swelling and some extravasated red blood cells.

Rosemary L Nixon, FACD, FAFOM, Dermatologist
Jacinta M Opie, MB BS, DRANZCOG, Dermatology Registrar
Robert I Kelly, MB BS, FACD, Dermatologist
Skin and Cancer Foundation, Carlton, VIC.
Reference Text: 
Kelly RI, Opie J, Nixon R. Golfer’s vasculitis. Australas J Dermatol 2005; 45: 11-14.
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