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Exercise-Induced Vasculitis (“Disney Rash”)

Ting Lun WANG and Yi-Ling SHEN

Introduction: Exercise-induced vasculitis, often referred to as “Disney rash,” is a benign cutaneous small-vessel vasculitis that develops on the lower extremities after sustained physical exertion, particularly in hot or humid conditions. Although the rash may appear striking—with erythematous or purpuric, bruise-like patches—it is not dangerous and does not lead to long-term complications. The underlying mechanism involves inflammation of superficial dermal vessels, and symptoms may include mild pruritus, burning, or local discomfort. The condition is more frequently observed in women over 50 years of age and individuals who are overweight or prone to heat-related circulatory changes.-Case Report: A 65-year-old overweight woman developed a sharply demarcated erythematous rash above the sock line during a summer hiking holiday in a mountainous region. She had been walking more than 10 km daily. On the third day she noticed the sudden onset of a mildly pruritic rash without systemic symptoms. Although still able to continue hiking, she became increasingly alarmed by the vivid appearance of the lesions. As commonly seen in patients unfamiliar with this benign entity, fear of a potentially serious condition prompted her to seek medical evaluation by her general practitioner when the rash failed to improve.–Conclusion: Exercise-induced vasculitis is self-limiting, typically resolving within one to two weeks. Management focuses on rest, cooling measures, leg elevation, adequate hydration, and avoidance of heat exposure. Clinically, it may be mistaken for cellulitis, contact dermatitis, insect bites, stasis dermatitis, or leukocytoclastic vasculitis; therefore, recognition of its characteristic presentation is important to prevent unnecessary treatment.