Feature Article

Scalp pain and tenderness: early features of temporal arteritis

Feature Article

Scalp pain and tenderness: early features of temporal arteritis

FIONA S. LAU, BRENDON W.H. LEE, ALEXANDRA ALLENDE, Anna Finniss, IAN C. FRANCIS

Figures

© AIMPIX/SHUTTERSTOCK MODEL USED FOR ILLUSTRATIVE PURPOSES ONLY
© AIMPIX/SHUTTERSTOCK MODEL USED FOR ILLUSTRATIVE PURPOSES ONLY

Abstract

Temporal arteritis, a panarteritis occurring in the older population, with female predominance, may present with localised scalp pain and tenderness. The triad of visual disturbances, jaw claudication and new-onset headache, also in combination with scalp symptoms and signs, should arouse suspicion of temporal arteritis. The patient’s sight and life may be preserved by early diagnosis and management.

Key Points

  • This article describes three patients with biopsy-proven temporal arteritis, all of whom presented with scalp symptoms and signs before developing vision loss.
  • To prevent sight- and life-threatening complications, early diagnosis and emergent management of temporal arteritis with corticosteroids are of paramount importance.
  • The classic triad of symptoms of temporal arteritis comprises new-onset headache, visual disturbance and jaw claudication; however, scalp pain and tenderness can be early features of this condition and recognition of these can aid the clinician in making an early diagnosis.
  • Awareness of the differential diagnoses for scalp pain and tenderness assist the diagnosis.
  • A template summarising the 42 symptoms and signs of temporal arteritis, including three newly recognised signs, is useful for guiding diagnosis.
  • Temporal arteritis is optimally managed using a multidisciplinary approach with input from the GP, a rheumatologist, an ophthalmologist and a pathologist.