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With the diagnosis of polymyalgia rheumatica, treatment was begun with prednisone (20<span class="elsevierStyleHsp" style=""></span>mg per day), with partial improvement of the symptoms. He later presented intense pain and the appearance of ulcers on the scalp (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and B) together with 2 episodes of amaurosis fugax and jaw claudication. The absence of pulse in the temporal arteries was notable. The globular sedimentation and C-reactive protein rates were 84<span class="elsevierStyleHsp" style=""></span>mm/h and 44<span class="elsevierStyleHsp" style=""></span>mg/l, respectively. Due to the clinical suspicion of giant cell arteritis, a biopsy of the left temporal artery was carried out, confirming the diagnosis. Treatment was initiated with intravenous pulses of methylprednisolone (1<span class="elsevierStyleHsp" style=""></span>g per day) for 3 consecutive days, followed by prednisone (30<span class="elsevierStyleHsp" style=""></span>mg per day in descending regime), weekly methotrexate 7.5<span class="elsevierStyleHsp" style=""></span>mg and folic acid and acetylsalicylic acid (100<span class="elsevierStyleHsp" style=""></span>mg per day). One month later the clinical symptoms had receded, the reactants of the acute phase had normalised and the ulcers had improved significantly. Scalp necrosis is an infrequent complication, but giant cell arteritis is potentially serious and must be recognised and treated early.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Rosales-Castillo A, García-Sánchez A, Sabio JM. Necrosis del cuero cabelludo. Med Clin (Barc). 2017;148:e61.</p>" ] ] "multimedia" => array:1 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 667 "Ancho" => 1550 "Tamanyo" => 196042 ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000014800000011/v1_201706250038/S2387020617303406/v1_201706250038/en/main.assets" "Apartado" => array:4 [ "identificador" => "51820" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in medicine" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000014800000011/v1_201706250038/S2387020617303406/v1_201706250038/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020617303406?idApp=UINPBA00004N" ]
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