The patient underwent biopsy of the right temporal artery, which showed typical changes of temporal arteritis. She was given treatment with oral steroids (48 mg/day). After two months, the crusting area of the scalp diminished and the ESR normalized (ESR = 20mm/h). Scalp necrosis is a rare but severe complication of temporal arteritis. It is associated with a bad prognosis since it is usually a manifestation of severe, occlusive vasculitis or a result of delayed recognition of temporal arteritis1. Adequate corticosteroid therapy is mandatory2.

References
1. R. Vamma, A. Patel. Scalp lesions in a 78-year-old woman. CMAJ 2005;173:33.
2. J. Currey. Scalp necrosis in giant cell arteritis and review of the literature. Br J Rheum 1997;36:814-816.

Acknowledgement
The case was prepared for the website by Dimitris A. Moutzouris, MD.