Exercise-Induced Purpura

Abstract

Exercise-induced purpura (EIP) occurs on the lower legs after unusual or major muscular activity, as in marathon runners or as after long walks, especially in the mountains in hot weather. In leisure walkers, patients are otherwise healthy females. There is no relation with chronic venous disorder. Erythematous, urticarial or purpuric plaques arise on the lower leg, usually sparing the skin compressed by socks. Symptoms include itch, pain and a burning sensation. Histopathology demonstrates leukocytoclastic vasculitis. The lesions fade after some days, with frequent relapses at further muscular exercises and may be prevented in some cases by compression, intake of venoactive drugs and local application of steroids. EIP is not uncommon, even if very few descriptions have yet been published. It appears to be consecutive to venous stasis induced by an acute failure of the muscle pump of the calf and thermoregulation decompensation, after a prolonged and unusual exercise, such as running or walking in hot weather.

Skin manifestations of running

“…8,9,19,26,51,60 Runner's purpura Purpura and petechiae have been noted in runners on the lower extremities and face during vigorous exercise in hot weather conditions. 63,64 Erythematous urticarial or purpuric plaques on the lower legs that may be painful, paresthetic, or pruritic characterize exercise-induced purpura. 63 Purpura may extend to the thighs but usually spares the skin of the lower leg compressed by socks.…”

“…63,64 Erythematous urticarial or purpuric plaques on the lower legs that may be painful, paresthetic, or pruritic characterize exercise-induced purpura. 63 Purpura may extend to the thighs but usually spares the skin of the lower leg compressed by socks. 63 One case of ankle petechiae has been reported in an asymptomatic 29-year-old novice jogger.…”

“…63 Purpura may extend to the thighs but usually spares the skin of the lower leg compressed by socks. 63 One case of ankle petechiae has been reported in an asymptomatic 29-year-old novice jogger. 65 An overloading of the thermoregulatory process with excessive venodilation and secondary failure of the fatigued calf muscle to pump this additional flow is thought to be the cause of these lesions.…”

“…65 An overloading of the thermoregulatory process with excessive venodilation and secondary failure of the fatigued calf muscle to pump this additional flow is thought to be the cause of these lesions. 63 There is no relation to chronic venous insufficiency or sun exposure. 63 Skin biopsy specimen may demonstrate leukocytoclastic vasculitis with C3 and IgM deposits.…”

Skin substitute from stem cells

“…[5][6][7] The temporary covering can be prepared from off-theshelf frozen vials of fetal skin cells, and the burns heal within about 14 days.…”