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First, let me state what you should already know.   I AM NOT A DOCTOR and ANYTHING that I share here is only based on my personal experience and you should consult your physician for ANY medical issue….NOT this blog.

Photo: Pam Wright

The being said, let’s talk about Hikers Rash aka Disney Rash, Golfers Vasculitis and Exercise Induced Vasculitis.   Google any of those terms and you’ll be sent down an internet worm hole full of people wondering what the heck is going on with their legs.   I haven’t mentioned it on here until last week because I like to keep things positive. But yesterday, to be totally honest, it stole all of the joy out of my otherwise glorious 16.5 mile training hike.

Photo: Pam Wright

The day started at 6am, with a 23 lb pack and a group of awesome ladies training for their trips to Grand Canyon, Ice Age Trail and John Muir Trails.   I had so much energy, and felt like I could have done 20 miles even with all of Afton’s hills.   Bike commuting, occasional strength training and Saturday hikes have made me stronger and have made all the difference in my endurance (and confidence!).


But somewhere around mile 10, I felt it.    The familiar burning, tightness and prickly feeling just above my ankles.

The discouragement set in about mile 14, as I popped one more electrolyte pill, hoping that would help.   Nope.   I drove the hour back home from the trail discouraged, tired of googling cures, treatments, scary internet diagnoses and having the fun sucked out of yet another summer hike that was over 80 degrees and 8-10 miles.

Here’s where I’m going to conclude my complaining part of the post, because so far, complaining about it just makes me feel worse.   On the flip side,  the only way to beat the darkness is to bring it into the light.   So, my goal of this post is to share what I have tried and am trying next and hopefully help someone else.  I should also note that I have been seen by two dermatologists and my primary care doctor to rule out anything more serious.

Day 1: Hives (this was a particularly bad one 2 years ago)


From what I can piece together Exercise Induced Vasculitis is basically an irritation of the blood vessels during exertion as the body tries to cool itself.   It starts as blotchy hives and eventually blooms into a bright red flat discoloration of the lower legs that can result in swelling and feel hot to the touch.   It is not always painful, but I have found that it has gotten a little angrier over the years and can feel like a sunburn.

Day 2: Flat, bright red spots

As I mentioned above, it has a few other cute nicknames due to where people are most likely to encounter it.    It appears to be most common in women over 50, but affects younger people and men as well.  I have personally noticed that my fair skinned friends seem to be more susceptible.

Considerations that I include on hikes that are over 80 degrees and 8-10 miles:

  1. Antihistamines
  2. Hydration
  3. Electrolytes
  4. Compression

UPDATE:  I have added these considerations/treatments to my hikes and they have helped me. 

  1. Soak legs in cold water ASAP and frequently during hiking breaks.
  2. Elevate elevate elevate.  I now try to to get my legs up after a long hot hike, or during breaks.
  3. Don’t stand around, keep moving or elevate!
  4. Apply Aloe Vera Gel.   This may or may not work, cold water is better
  5. I think compression socks help, just make sure they are not SUPER tight and that they breathe.
Photo of all sorts of beautiful sneezy things


It is thought that histamines play a role in this condition and they get especially active in the heat.    As you get older, your histamine levels can increase too.   So I always make sure to take my antihistamines the day before and day of a hike (which I take for seasonal allergies)

I’ve moved to a Smart water bottle vs. nalgene to save weight, but avoid hydration bladders so I can “see” how much I am drinking during activities


Staying hydrated is important no matter what, but water is especially critical for maintaining your internal cooling system.   I try to drink 2-3 liters on long hot hikes.


Typically, I try to have an electrolyte drink at least one day before and a couple on the day of a big hot hike.   Yesterday I tried a new electrolyte supplement that was recommended to me, but I didn’t feel a noticeable a difference.   I’ll try it again, but taking a pill every hour or two was kind of hard to remember to do vs just drinking a flavored drink.


I noticed a couple of years ago that wearing compression socks as a recovery seemed to help my rash dissipate quicker.    I shifted to wearing compression socks or sleeves while hiking and I believe they have lessened the severity (except for yesterday – what the heck?!) and also help with leg fatigue.   Wearing compression sleeves and lighter ankle socks instead of a full compression sock allows easier to access to feet if I need to address a blister (compression socks are kind of hard to get on and off quickly).  Check out this two part foot care post to read more about how I care for my feet on and off the trail to prevent blisters and injury.


Unfortunately, none of the strategies I have listed above have resulted in a total cure, but they have seemed to help me a little.

Thanks for reading and shoot me a note in the comments if you have any tips that have worked for you.


Read Part 2 for  more tips that I’ve tried since this original post and this helpful article with more information on ‘exercise induced vasculitis ‘ from a local nurse practitioner from the Duluth area.  Hope it helps shed some more light on this annoying medical condition!

And be sure to check out the Wandering Pine Blog to read more about the many wonderful places I’ve (gratefully) hiked since this article was originally published.

Happy hiking!



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12 thoughts on “Wheal n’ Flare!  My Dance with Hiker’s Rash.

  1. Good luck resolving or improving the situation… I’m bouncing this off an acupuncturist I know,

  2. I did not know that some anti-histamines work better for skin reactions, good to know. Read your linked article and then some more, and the follow-up is “what is the difference between Xyzal (levocetirizine) and Zyrtec (cetirizine)”? My summary is: Xyzal is newer, not yet available generically, and thus more expensive anti-histamine that may reduce drowsiness for those people who have problems with Zyrtec. If drowsiness is not a problem for you when taking Zyrtec you can go the cheaper route and use a Zyrtec generic and get the same results. Since I already have it in my kit, I’m good to go 🙂

  3. I’m an ultra runner and had symptoms very similar to this arise in two of my longer ultras. Both were in high sun exposure, high humidity and temps over 80. The first time, it covered 70% of both of my legs, back of the arms, and (covered) low back. It became so painful, I had to quit my race. I saw an allergist who told me I have a grass allergy exacerbated by heat, sun exposure and high temperatures. I’m still not convinced. Xzyal barely affects it, I used a hydrocortisone spray on my legs that also did nothing. Compression socks DO help. I agree about the gaitors keeping temps higher because that’s the spot on the back of the ankles that is most prominent with redness at my last race. If the sun is not direct, the rash is not as intense or barely there. I’m at a loss and thinking that I am not going to be able to participate in long, hot exposed races in the summer time.

    1. Yipes! Sounds like you’ve got a pretty rough case. The 2 most effective things I’ve found are 1. Elevating EVERY TIME you stop…no standing around. 2. Cool and soak your body (rivers, lakes, wet cloth, ice, anything you can find). I hope that helps! I also just avoid the gross hot days if possible. Hang in there! Thanks for reading and please report back if you find anything that works.

  4. Thanks for your post! I just experienced the same sort of rash after a few days of backpacking. I initially thought I was having an allergic reaction to either my socks, shoes, bug spray, and/or sunscreen. Not thrilled with some of the post 50 changes… but helps hearing about others with similar issues. Thanks!

    1. Oof, sorry to hear you got the dreaded hikers rash…tis the season. I got a batch two weeks ago and found relief by elevating and immediately submerging in cold lake superior. Take care and happy hiking!

  5. Hi there! I stumbled upon your post while googling about this condition I just got for the first time. I am an avid hiker and now feeling super anxious that it might ruin my glorious hiking life. I hike a lot, sometimes over 20 miles per day but I got this at my local training 3.5-miler… This rash hurt a lot at first, and now the skin discoloration looks like if it’s here to stay (it’s been a week). How often do you typically get this? Could you please say something reassuring that you can live and hike with it and that the stains go away? I’m just in my 30s and was totally not ready for having ugly skin and any physical limitations…

    1. Hi Lena-Im so sorry you got the dreaded rash. Its no fun.

      Fortunately, it hasn’t kept me from hiking and I have made some adjustments that seem to have helped.

      What I can tell you is that mine typically fades after a week and that not standing around in one place during and after exertion has also seemed to help with prevention. I also wear compression sleeves, elevate my legs during breaks and immediately after on hot hikes. Although I still get a little patch once in a while, the rash I get now seems less severe.

      If it starts to be bothersome or more frequent, its a good idea to get it checked out by a doc just to be safe and rule out anything else that could be causing it.

      Hang in there and happy hiking!

  6. I’m preparing to walk a portion of the Camino and have experienced this twice on a 4 hour walk. Your post has been very informative and helpful with my continuing training.

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