From the Guidelines
Exercise-induced vasculitis is a benign, self-limiting condition that can be managed with symptom relief measures, and there is no strong evidence to support the use of specific treatments for this condition, as it is not addressed in the provided guidelines. The provided guidelines focus on the management of ANCA-associated vasculitis (AAV) and do not specifically address exercise-induced vasculitis [ 1 ]. However, based on general medical knowledge, treatment for exercise-induced vasculitis typically involves stopping the triggering activity, elevating the legs, applying cool compresses, and taking over-the-counter NSAIDs like ibuprofen or acetaminophen for pain and inflammation. Some key points to consider in managing exercise-induced vasculitis include:
- Stopping the triggering activity to prevent further inflammation
- Elevating the legs to reduce blood flow and swelling
- Applying cool compresses to reduce pain and inflammation
- Taking over-the-counter NSAIDs like ibuprofen (400-600mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours) for pain and inflammation
- Using topical corticosteroid creams like 1% hydrocortisone to reduce inflammation when applied 2-3 times daily to affected areas
- Preventing future episodes by wearing compression stockings during prolonged activity, taking regular breaks to elevate legs, staying hydrated, and avoiding excessive heat exposure. It is essential to note that the provided guidelines [ 1 ] focus on the management of AAV, which is a different condition from exercise-induced vasculitis, and therefore, the recommendations for AAV should not be applied to exercise-induced vasculitis. In the context of real-life clinical medicine, it is crucial to prioritize the patient's symptoms and quality of life when managing exercise-induced vasculitis, and to use the most recent and highest-quality evidence available to inform treatment decisions [ 1 ].
From the Research
Definition and Characteristics of Exercise-Induced Vasculitis
- Exercise-induced vasculitis (EIV) is an isolated cutaneous vasculitis that occurs mostly after prolonged exercise, especially in hot weather 2, 3.
- It is characterized by erythematous or purpuric plaques on the lower legs, without the involvement of compression socks or stockings, and symptoms include itch, pain, and a burning sensation 2, 3.
- Lesions resolve spontaneously after 10 days, but relapses are frequent (77.5%) when triggering conditions persist 2.
Histopathology and Blood Investigations
- Histopathology demonstrates leukocytoclastic vasculitis in 95% of cases, with C3 or immunoglobulin M deposits in 88% and 46% of cases, respectively 2.
- Blood investigations are negative, and no clear relation with chronic venous disease has been established 2, 3.
Treatment and Prevention
- Treatment is not codified, but topical corticosteroids may reduce symptoms, and wearing light clothes might limit lesion occurrence 2.
- Compression hosiery, manual lymphatic drainage, intake of oedema protective agents, or steroids (local or systemic) may prevent relapses in some cases 3.
Relationship with Other Conditions
- 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 of which occur after prolonged and unusual exercise in hot weather 2.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with an increased risk of adverse cardiovascular events, but their use in the context of EIV is not specifically addressed in the provided studies 4, 5, 6.