You spend hours at an amusement park, on the golf course or exploring a new hiking trail, then notice a rash on your legs. Is it an allergic reaction? Hives? Something more serious?
Omaha, Nebraska dermatologist Joel Schlessinger, MD says it could be “Disney rash,” a nickname for exercise-induced vasculitis (EIV), also called golfer’s vasculitis or hiker’s rash. We asked experts to break down what sets hives and EIV apart and when to see a doctor.
Featured Experts
- Joel Schlessinger, MD and Daniel Schlessinger, MD are board-certified dermatologists in Omaha, NE
- Jacob Beer, MD is a board-certified dermatologist in West Palm Beach, FL
What Is Disney Rash?
Disney rash, or 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.”
It 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.” Golfers, hikers and runners can develop it, too, and Dr. Joel Schlessinger says it’s most common in women over 50.
West Palm Beach, FL dermatologist Jacob Beer, MD adds that changes in blood vessels 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 explains. Luckily, the condition is harmless and tends to clear up on its own within 10 days to two weeks, says Dr. Joel Schlessinger.
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 Omaha, Nebraska dermatologist Daniel Schlessinger, MD. They can be acute or chronic and have a range of triggers, Dr. Beer adds.
Disney Rash vs. Hives: How to Tell the Difference
Start with where the rash appears and how it feels. Dr. Beer says EIV generally appears on the lower legs and is only slightly itchy, if at all. Hives can look and feel different: “Hives can appear anywhere or can be more spread out. They also tend to be raised and very itchy.”
Dr. Joel Schlessinger describes hives as “blotchy” and Disney rash as “pinpoint red spots and bruises.” Hives can come and go; EIV may remain visible for days or weeks.
You should also consider what happened before the rash appeared. EIV often follows prolonged standing, walking or exercising, especially in the heat. Hives can have a variety of triggers, including “foods, medications, infections, insect stings, pressure, temperature changes and stress,” says Dr. Daniel Schlessinger.
How to Treat Disney Rash and Hives
“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.”
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 adds that hives triggered by cold warrant prompt 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.”
