Golfer’s vas­culi­tis is likely cause of red rash

The Weekend Australian - Travel - - Health - LINDA CAL­ABRESI

I am69, fe­male and very ac­tive. My prob­lem is that when I go on long walks last­ing three to four hours, and es­pe­cially if the weather is warm to hot, I get a red rash on my lower legs. No rash ap­pears on shorter walks. I have been pre­scribed an­ti­his­tamine tablets and a cor­ti­cos­teroid cream, nei­ther of which has been ef­fec­tive. Do you know of any so­lu­tion to pre­vent this oc­cur­ring or to clear the rash up quickly?

First, you need an ac­cu­rate di­ag­no­sis of this rash. As­sum­ing you are oth­er­wise well and there are no other symp­toms such as an­kle swelling, it is quite pos­si­ble you have a con­di­tion known as golfer’s vas­culi­tis. This is a be­nign in­flam­ma­tion of the blood ves­sels of the lower leg as­so­ci­ated with pro­longed ex­er­cise and heat (ob­vi­ously most of­ten seen af­ter a per­son has walked around 18 holes of golf). It is more com­mon in peo­ple over the age of 50 and can be as­so­ci­ated with a slight burn­ing sen­sa­tion. Be­cause it usu­ally oc­curs around the sock line, peo­ple of­ten mis­tak­enly think it is re­lated to an al­lergy to a plant or an in­sect bite, but in fact the rash ap­pears to be sim­ply the re­sult of ex­er­cise, heat and age. As for pre­ven­tion and treat­ment there ap­pears very lit­tle you can do for golfer’s vas­culi­tis. The rash will usu­ally get bet­ter by it­self within a week. En­sure you min­imise over­heat­ing dur­ing ex­er­cise and af­ter ex­er­cise, rest with your legs raised, and put cool packs on the ar­eas com­monly af­fected. But un­for­tu­nately even this may not pre­vent the rash.

I have had type 2 di­a­betes for 20 years. In the past few years, my con­di­tion has de­te­ri­o­rated. I now have di­a­betic neu­ropa­thy and the pain in my legs and feet is of­ten so se­vere that it is ru­in­ing my life. I was pre­scribed very strong painkillers (En­done), but I was un­able to tol­er­ate them. Is there any other med­i­ca­tion I can try that will help with­out caus­ing other prob­lems?

Al­though there is no cure for di­a­betic neu­ropa­thy, there are a num­ber of treat­ments that re­search has shown may be ef­fec­tive in help­ing con­trol the pain as­so­ci­ated with this con­di­tion. Un­for­tu­nately with med­i­ca­tions you can never rule out the pos­si­bil­ity of side ef­fects, but th­ese will vary from per­son to per­son. Some of the med­i­ca­tion op­tions in­clude tri­cyclic an­tide­pres­sants (the ma­jor side ef­fect of which is drowsi­ness — which might be seen as a bonus if the neu­ro­pathic pain is stop­ping you from sleep­ing), and cer­tain an­ti­con­vul­sant med­i­ca­tions, such as car­ba­mazepine or gabapentin. It would be worth dis­cussing the var­i­ous op­tions with your doc­tor so you can de­ter­mine which might be suit­able for you to try. En­done (oxy­codone) is a par­tic­u­larly strong painkiller and it is not sur­pris­ing it caused side ef­fects. Th­ese other op­tions work dif­fer­ently so, while not risk-free, they are worth con­sid­er­ing.

I am47 years old and in good health. Is it all right to con­tinue tak­ing the oral con­tra­cep­tive pill?

Pro­vided you have no con­traindi­ca­tions to tak­ing the pill, and you are not a smoker, you can safely take this form of con­tra­cep­tion un­til menopause. In pre­vi­ous times it was ad­vised that other forms of con­tra­cep­tion be con­sid­ered af­ter the age of 35, but th­ese days, be­cause of the lower-dose pills this is no longer the case. Cir­cum­stances that would in­di­cate you should not take the com­bined oral con­tra­cep­tive pill in­clude a his­tory of a deep ve­nous throm­bo­sis (DVT) or pul­monary em­bo­lus, se­vere liver dis­ease, a his­tory of breast can­cer, un­con­trolled high blood pres­sure or com­pli­cated heart valve dis­ease. Linda Cal­abresi is a Syd­ney GP and ex­ec­u­tive ed­i­tor of www.6min­, a news ser­vice for Aus­tralian doc­tors. Send your queries to lin­da­cal­

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