Dermatological complications in superficial temporal artery embolization: An illustrative case and literature review

Endovascular embolization is the mainstay of treatment for multiple diseases affecting the superficial temporal artery (STA). However, it is not exempt from complications. While neurologic complications are vastly reported in the literature, dermatological complications are seldom described. Here, we present the case of a 16-year-old female who developed pustules, erythema, trichodynia and regional pain along the facial branch of the STA following endovascular treatment. On trichoscopy follicular crusts with microhemorrhagic areas, erythema, telangiectasia and patchy brown-gray areas were visualized with histopathologic findings compatible with vasculopathy and increased telogen count. Additionally, we performed a literature review of dermatological complications associated with endovascular treatment of the STA. A total of 16 cases were identified, most of which involved trans-arterial embolization (TAE). The most common dermatological complication was scalp necrosis (50%), followed by secondary infection (18.75%) and mass effect (18.75%). The time of presentation varied, from immediately after embolization up to 46 days post-procedure. The most common embolic agent associated with complications was Onyx (50%). According to our review, dermatologic complications seem to arise from multiple mechanisms, including tissue inflammation, cell wall rupture, radiation damage, and infusion rate of the embolic agents. We emphasize the need for greater attention and reporting of these complications, as they can impact cosmetic outcomes and overall quality of life of patients. Physicians should be aware of cutaneous manifestations following STA embolization as early recognition and appropriate management can significantly improve cosmetic outcomes.