Scalp necrosis in giant cell arteritis and review of the literature

Abstract

A patient with giant cell arteritis (GCA) who developed scalp necrosis (SN) is described and 23 other cases in the English language literature are reviewed. SN is rare and occurs in older patients of mean age 77 yr. Thirteen patients presented to dermatologists. Nineteen (79%) had other serious complications of GCA: visual loss in 16, gangrene of the tongue in four and nasal septum necrosis in one. The mean interval between the onset of symptoms of GCA and SN was 3.0 months in the 19 cases which antedated corticosteroid therapy. SN resulted from active arteritis and no case was definitely linked to temporal artery biopsy. Scalp healing was complete or progressing satisfactorily in 18 cases (75%). SN is a potentially reversible complication of GCA and adequate corticosteroid therapy is mandatory. In the current case, SN related to inadequate dosage of prednisolone.