SCALP NECROSIS IN TEMPORAL (GIANT-CELL) ARTERITIS - IMPLICATIONS FOR THE DERMATOLOGICAL SURGEON

Temporal arteritis, a variant of giant cell arteritis, is a systemic g ranulomatous vasculitis of large and medium-sized arteries. Usually th e clinical features are dominated by ophthalmological and neurological complications. In rare instances, ischaemic necrosis, especially of t he scalp, may lead patients to the dermatologist. We report a 76-year- old woman presenting with a unilateral scalp necrosis, accompanied by a dramatic ipsilateral impairment of vision. Immediately after duplex- sonography of the extracranial vessels and after initiation of cortico steroid therapy, the diagnosis of temporal arteritis was confirmed by temporal artery biopsy. One month later, because of insufficient secon dary healing of the ulcer, the defect was covered by a mesh graft. The taking of the graft was delayed due to immunosuppressive therapy, but was complete. The patient unfortunately died as a result of complicat ions related to surgical removal of an aspergilloma in the sphenoid ca vity secondary to immunosuppressive therapy. We discuss the technique of artery biopsy and the possibility of surgical management of scalp n ecrosis in temporal arteritis.