title: Exercise-Induced Vasculitis: A Review with Illustrated Cases.
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.
authors: Department of Internal Medicine, Hôtel-Dieu, Centre Hospitalier Universitaire de Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France. olivier.espitia@chu-nantes.fr.
authors: Olivier
authors: O
authors: Espitia
authors: Department of Dermatology, University Hospital of Nantes, Nantes, France.
authors: Brigitte
authors: B
authors: Dréno
authors: Department of Pathology, University Hospital of Nantes, Nantes, France.
authors: Elisabeth
authors: E
authors: Cassagnau
authors: Department of Internal Medicine, Hôtel-Dieu, Centre Hospitalier Universitaire de Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France.
authors: Quentin
authors: Q
authors: Didier
authors: INSERM UMR957-Laboratoire Physiopathologie de la Résorption Osseuse (LPRO), University of Nantes, Nantes, France.
authors: Thibaut
authors: T
authors: Quillard
authors: Department of Dermatology, University Hospital of Nantes, Nantes, France.
authors: Christelle
authors: C
authors: Nicol
authors: Department of Internal Medicine, Hôtel-Dieu, Centre Hospitalier Universitaire de Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France.
authors: Yann
authors: Y
authors: Le Bouch
authors: Department of Internal Medicine, Hôtel-Dieu, Centre Hospitalier Universitaire de Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France.
authors: Bernard
authors: B
authors: Planchon
authors: Department of Internal Medicine, Hôtel-Dieu, Centre Hospitalier Universitaire de Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France.
authors: Marc-Antoine
authors: MA
authors: Pistorius
mesh_terms: D001706:Biopsy; D001833:Body Temperature Regulation; D015444:Exercise; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006633:Histamine Antagonists / Q000627:therapeutic use*; D006358:Hot Temperature / Q000009:adverse effects; D006801:Humans; D007866:Leg; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012867:Skin / Q000473:pathology; D053828:Stockings, Compression; D016896:Treatment Outcome; D018366:Vasculitis, Leukocytoclastic, Cutaneous / Q000209:etiology / Q000473:pathology / Q000628:therapy
chemical_list: D005938:Glucocorticoids; D006633:Histamine Antagonists