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Case report
Scalp ulceration: a rare manifestation of giant cell arteritis
  1. Louise McDonald1,
  2. Gavin Baker2 and
  3. Olga Kerr1
  1. 1 Department of Dermatology, Belfast Health and Social Care Trust, Belfast, UK
  2. 2 Department of Histopathology, Belfast Health and Social Care Trust, Belfast, UK
  1. Correspondence to Dr Louise McDonald; louisemcdonald{at}doctors.org.uk

Abstract

An 81-year-old woman presented with an enlarging, tender ulcer on her scalp over an 8-week period, attributing it to a prior graze with garden shears. C-reactive protein and erythrocyte sedimentation rate were elevated at 87.7 mg/L and 112 mm/hour, respectively. Incisional biopsies demonstrated ulceration and full thickness necrosis with no evidence of malignancy. Vasculitis was suggested as a likely cause of such extensive necrosis and subsequent temporal artery biopsy findings were consistent with giant cell arteritis. The patient was initially treated with high-dose oral prednisolone and achieved complete healing of the scalp necrosis within 12 months, with a gradual down-titration of steroid therapy thereafter. Scalp necrosis is a rare, potentially life-threatening complication of giant cell arteritis. This case highlights the importance of considering scalp necrosis as a manifestation of giant cell arteritis when assessing scalp ulceration. Prompt diagnosis and treatment can prevent significant morbidity and potential mortality.

  • dermatology
  • skin
  • rheumatology
  • vasculitis
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Footnotes

  • Contributors LMD has authored this article in full. OK was the supervising Consultant Dermatologist during the case and has provided guidance and approved the content prior to submission for publication. GB is a Histopathology Specialist Registrar and was responsible for oversight of reporting of the temporal artery biopsy, providing commentary on findings and obtaining the most appropriate cross-sectional imaging for inclusion as well as reviewing content of case report prior to submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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