Skincare
Disney Rash vs. Hives: Dermatologists Explain How to Tell Them Apart
Exercise-induced vasculitis, dubbed "Disney rash," hits the lower legs after miles of walking in heat and clears in 10 days to two weeks. Dermatologists explain how to distinguish it from hives and treat both.
A rash on your lower legs after a day walking miles through a theme park in the heat is most likely exercise-induced vasculitis — nicknamed "Disney rash" — and it will clear up on its own within 10 days to two weeks, says Omaha, Nebraska dermatologist Joel Schlessinger, MD.
The condition, also called golfer's vasculitis or hiker's rash, got its nickname "because we see it in people returning from theme park vacations, where visitors may walk several miles a day in the heat or stand in lines," Dr. Joel Schlessinger explains. Golfers, hikers and runners can develop it, too. He says it is most common in women over 50.
Distinguishing it from hives matters, because the two conditions have different causes, different timelines and different treatments. Three board-certified dermatologists — Joel Schlessinger, MD and Daniel Schlessinger, MD of Omaha, NE, and Jacob Beer, MD of West Palm Beach, FL — break down the differences and when to seek care.
What is Disney rash?
EIV "happens when small blood vessels (capillaries) appear on the lower legs after long periods of walking or standing in hot weather," explains Dr. Joel Schlessinger. "Heat and exertion cause blood vessels to dilate, at which point, fluid pools in the legs and the tiny vessels become irritated and sometimes burst."
Dr. Beer adds that vascular changes with age may play a role. "The blood vessels in the lower legs become less elastic over time, so they can't push blood back up. The blood pools, leaks out of vessels, and this can create a low-level inflammatory response or vasculitis," he says.
The condition is harmless, Dr. Joel Schlessinger notes.
What are hives?
"Hives are raised, itchy welts that can appear anywhere on the body. They form when immune cells in the skin called mast cells release histamine, which makes small blood vessels leak fluid into the surrounding tissue and cause swelling that is often associated with itching," says Dr. Daniel Schlessinger. They can be acute or chronic and have a wide range of triggers, according to Dr. Beer.
How to tell the difference
Location and sensation come first. Dr. Beer says EIV generally appears on the lower legs and is only slightly itchy, if at all. "Hives can appear anywhere or can be more spread out. They also tend to be raised and very itchy," he says.
Appearance differs, too. Dr. Joel Schlessinger describes hives as "blotchy" and Disney rash as "pinpoint red spots and bruises." Hives come and go; EIV may stay visible for days or weeks.
Context is the final clue. EIV follows prolonged standing, walking or exercise, especially in heat. Hives can be triggered by "foods, medications, infections, insect stings, pressure, temperature changes and stress," says Dr. Daniel Schlessinger.
How to treat both
"These two diagnoses are usually made clinically, so it's important to see a board-certified dermatologist if it persists or starts to worsen," says Dr. Beer.
For suspected Disney rash, get off your feet, elevate your legs, apply cool compresses and stay hydrated, says Dr. Daniel Schlessinger. To calm itching and burning, he recommends FixMySkin 1% Hydrocortisone Healing Body Balm Fragrance-Free ($23). "Once the rash has calmed, DerMend Moisturizing Bruise Formula Cream ($32) can help with the bruise-like discoloration it sometimes leaves behind." For prevention, he recommends compression socks and regular breaks from the heat.
"For hives, start with a non-drowsy oral antihistamine such as Claritin or Zyrtec and cool compresses and avoid hot showers and scratching," advises Dr. Daniel Schlessinger. "Note any possible triggers and take photos, since hives may be gone by the time you see a doctor."
When to seek urgent care
Seek emergency care if hives come with swelling of the lips, tongue or throat, trouble breathing or dizziness, says Dr. Daniel Schlessinger. "If the hives last longer than a few weeks, then generally an allergist or a board-certified dermatologist are best to see for further advice."
Dr. Beer flags one specific trigger that warrants faster evaluation: if "a patient develops hives to cold or ice cubes, that should be diagnosed more promptly, as there is counseling involved with that diagnosis, including avoiding swimming alone to prevent anaphylactic shock."
For travelers heading into summer theme park season, the practical takeaway from the dermatologists is simple: compression socks, shade breaks and hydration reduce the odds that a red-spotted souvenir follows you home.
Original: lovelyskin.com
Amara Osei
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Staff writer covering media and advertising at Eurasian Beauty Journal.
