Scalp Necrosis in the Context of Giant Cell Arteritis

An 85-year-old male patient presented with progressive bitemporal necrosis of the scalp. Six months previously, he had been diagnosed with giant cell arteritis based on ultrasound evidence of vasculitis of both temporal arteries. The patient initially presented with typical symptoms including headache, jaw claudication and transient visual impairment. These symptoms dissolved after the initiation of treatment with predisolone 500 mg and did not occur again under steroid tapering. A few weeks ago, he first noticed black lesions on his scalp. The lesions became inflamed, grew in size and became encrusted over time. The diagnosis of scalp necrosis as a rare manifestation of giant cell arteritis was made. Only about 100 cases have been reported in the literature to date, none of which is known to show an onset of necrosis under ongoing corticosteroid therapy. Our patient received 20 mg prednisolone over three weeks, followed by cautious dose reduction. The cutaneous finding was first stable under this therapy, then showed slow signs of healing. To speed up the healing process, necrotic areas were surgically removed by a dermatologist.

Translated from the original German by Christine Rye.

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