Golfer’s Vasculitis: Oops, I Did It Again!

How to diagnose, prevent and treat Golfers Vasculitis (aka Disney Rash): Five things to know…

This common but often undiagnosed malady is referred to by a number of different names: Golfer’s Vasculitis, Disney Rash, Epcot Rash, Dollywood Rash, Hiker’s Rash, and Exercise-Induced Edema.

Here’s my story along with photos of golfer’s vasculitis:

We had a great day planned with friends: a morning tour at the Uffizi Gallery; followed by lunch at one of our favorite restaurants in Florence, Trattoria Cammillo; and an on-our-own walking tour of the city in the afternoon.

View of the Ponte Vecchio from the Uffizi Gallery

Birth of Venus in the Uffizi Gallery — The Birth of Venus by Botticelli in the Uffizi Gallery

Although it was only May, the changeable weather had turned oppressively hot and humid. We retrieved our rental van from one of the city’s public parking lots at the end of the day.

That’s when I noticed that both my legs had a now-recognizable red rash just above the ankles: a telltale sign of this disorder.

(See photos Golfer’s Vasculitis below)

Golfer’s Vasculitis in Florence

Oops, I did it again

Last year, I encountered this same, often misdiagnosed, malady for the first time. After a long, hot, but enjoyable day exploring the historic center of Orvieto, I was proud of the miles I had logged onto my Fitbit. But I freaked out when I glanced down at my legs.

Had I been bitten by an insect or spider? Even worse, bedbugs? Was I allergic to new laundry detergent or the bedding in the room? Was it cellulitis? The mind does tend to wander.

It turned out to be none of the above. Like any good researcher, I self-diagnosed my rash after finding pictures of equally ugly legs (and some worse ones) on Google.

My physician confirmed the diagnosis after I sent him an email with a series of “wish-you-were-here” photos.

Golfer's Vasculitis in Orvieto (closeup of right leg) — Golfer’s Vasculitis in Orvieto (closeup of right leg)

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Here are five things you should know about Golfer’s Vasculitis:

Golfer’s Vasculitis is usually harmless, resolves on its own, and affects people who are relatively healthy.

It is a form of vasculitis (an inflammation of blood vessels) that appears as a rash, usually above one’s ankles (above the sock line, if you are wearing them). It can extend as high as one’s thighs and affects both legs rather than one.

The red spots are hot and feel like a sunburn. The rash usually doesn’t itch or blister but can cause swelling, especially around the ankles. It looks worse than it feels.

To promote awareness, medical researchers have suggested calling the condition by the same name.

In both the medical and lay literature, Golfer’s Vasculitis is variously called different names.

Disney Rash

Epcot Rash

Dollywood Rash (after that amusement park)

Hiker’s Rash, and

Exercise-Induced Vasculitis (EIV)

In one of the few published studies, an Australian medical researcher suggested using one standard term to promote awareness of the disorder: Golfer’s Vasculitis.

Some individual factors place certain individuals at greater risk than others for experiencing this condition:

Being over the age of 50

Being female

Having blood relatives who have had it

Having had it before (oops…)

Situational/environmental factors also come into play.

The condition tends to occur among at-risk individuals (those already predisposed to getting it) who spend extended periods of time on their feet in hot, humid climates.

For example, the rash is often reported after:

Taking long hikes, city walks, or walking tours

Visiting amusement parks (like Disney, Epcot or Dollywood)

Taking cruise excursions in hot climates

Participating in charity walks

Playing golf

Unfortunately, there’s little you (or I) can do to prevent Golfer’s Vasculitis.

Apart from staying hydrated and stopping to elevate your feet whenever you have the opportunity, there aren’t many practical prevention strategies.

Experts recommend wearing open shoes that are more breathable. Although flip-flops or sandals might reduce the odds of the rash appearing, they predispose travelers to other dangers, especially when walking on uneven streets or in crowded places.

Others suggest wearing compression hosiery (support socks), although they can be quite uncomfortable when visiting hot, humid places for extended periods of time.

There are also no clear-cut treatments for Golfer’s Vasculitis

Because most cases resolve on their own, treatment isn’t necessary. Some clinicians prescribe topical corticosteroids during the acute phase, although there is no solid evidence of their efficacy. For most, the best treatment is tincture of time.