Ayurvedic Treatment for Crest Syndrome - Systemic Sclerosis

ABSTRACT

CREST Syndrome is a less severe form of Systemic sclerosis that causes the hardening and tightening of the skin of the face, arms, and legs. It can also involve the digestive tract and can cause lung and heart problems. It is also called limited scleroderma. It has a slow progression. Cases of CREST Syndrome are reported more in females than in males. Let’s discuss!

INTRODUCTION

CREST Syndrome is a heterogeneous group of scleroderma. It is a  multisystem connective tissue disorder. In CREST Syndrome activation of T- helper cells causes damage to blood vessels and skin. It can further lead to fibrosis. The word “CREST” is the acronym for the 5 clinical features of the syndrome. The five main features are Calcinosis, Raynaud’s phenomenon, Esophageal dysmotility, Sclerodactyly and Telangiectasia. Calcinosis is the condition in which there is deposition of calcium in the skin. Raynaud phenomenon is the first manifestation of CREST Syndrome. It is characterised by a white-blue-red transition in skin colour on exposure to stress or cold temperatures. Stress and cold temperature lead to vasoconstriction of small arteries.

It leads to colour transition and is followed by cyanosis of digits and hyperemia as they rewarm. If this phenomenon becomes frequent and persists for long, then it can lead to ulceration, and gangrene resulting in infections and amputation. Atrophy of the smooth muscle of the gastrointestinal tract results in Esophageal dysmotility (3rd cardinal feature of CHREST). People with CREST Syndrome complain of dysphagia (Sensation of food getting stuck in the oesophagus) due to Esophageal dysmotility. The patient may have to sip water in between meals in order to swallow food.

The 4th clinical feature is Sclerodactyly which is skin tightening as a result of collagen cross-linking. It first begins as a skin inflammation and gradually dermal fibroblasts increase the production of the extracellular matrix which causes increased collagen deposition in the skin. CREST Syndrome is also characterised by the presence of tiny dilated capillaries on the skin of the hands called Telangiectasia. CREST Syndrome can cause complications like pulmonary hypertension that lead to heart and respiratory failure. It is very important to treat CREST syndrome in time and stop the progression of CREST Syndrome so that it does not involve internal organs. 

CAUSES

1. Idiopathic (Unknown cause)
2. Autoimmune response
3. Environmental factors like exposure to silica dust, solvents and adhesives etc.

SYMPTOMS

Apart from 5 cardinal clinical features of CREST syndrome following   symptoms are seen in CREST Syndrome:

1. Swelling and stiffness in joints
2. Pulmonary fibrosis
3. Lethargy
4. Muscle weakness
5. Dyspnea
6. Pain in hands and feet
7. Ulceration

DIAGNOSIS

1. History and Physical examination
2. Serum Blood Test: Presence of Anti-Centromere antibody.
3. Imaging: MRI, CT, X Rays can be done to rule out any atypical growths.
4. Electromyography and nerve conduction

AYURVEDIC OVERVIEW

In Ayurveda, it is correlated with Uttana Vatrakta. Uttana Vatrakta is due to aggravated Vata. This aggravated Vata also vitiates the other two doshas. Vata along with the other two doshas travels through various channels present in the body and resides and skin and blood vessels causing symptoms like Twak sankocham (tightening of the skin), Twak vaivarnya (skin discoloration), Sheeta asahishnutha (cold intolerance), Ushna kamitwam (liking a warm environment).

TREATMENT

1. Acharya Charak has described various methods to manage Utana Vata in Chapter 29 (Charak samhita chikitsa sthana) as Alepan (application of vata pacifying ointment), Abhyanga (oil massage), Parisechan (sprinkling herbal water), and Upnah (herbal bandaging).
   
   

The ayurvedic formulation for the management of CREST Syndrome includes

1. Kaishore Guggulu
2. Mahatikthaka Ghrita
3. Gandhaka Rasayana
4. Maharasnadi kashaya
5. Manjishtadi kashaya

HERBAL REMEDY FOR CREST DISEASE BY PLANET AYURVEDA

Planet Ayurveda provides the best combination of effective herbal remedies for the management of CREST Disease. For natural and herbal treatment always look for natural products which contain pure extracts and are formulated under GMP guidelines. Planet Ayurveda products are scientific and certified. They are free from any chemicals, additives, and preservatives. Planet Ayurveda products are formulated by MD Doctors and are 100% natural, pure, and free from side effects. Planet Ayurveda offers the following herbal remedies for the management of CREST Disease.

1. Ashwagandha Capsules
2. Boswellia-Curcumin
3. Gotu Kola Capsules
4. Gandhak Rasayan
5. Sinhnaad Guggul
6. Panchtiktaka Ghrit
7. Sanjivani Vati

PRODUCT DESCRIPTION

1. Ashwagandha Capsules

Ashwagandha capsules are an ayurvedic herbal formulation that contains Ashwagandha (Withania somnifera). Ashwagandha is a rejuvenator and balances Vata and Kapha. It has anti-inflammatory properties and helps in managing pain in the hands and feet due to CREST Syndrome. Ashwagandha is hot in potency therefore it improves blood circulation and maintains normal activity of collagen. It boosts the immune system and eliminates toxins from the body. It also subsides swelling in pain and joints, lethargy and weakness in the body.

Dosage: 1 capsule twice daily with warm water.

2. Boswellia-Curcumin

Boswellia curcumin is a herbal formulation that contains Shallaki (Boswellia serrata) and Curcumin (Extract of curcuma longa). Shallaki helps in balancing Kapha and Pitta. Both Shalaaki and curcumin are rich in antioxidants and have anti-inflammatory properties. It is used in CREST Syndrome because it increases blood supply to joints and supports the immune system. Curcumin is also helpful in maintaining the normal activity of skin cells and manages Sclerodactyly seen in CREST Syndrome.

Dosage: 2 capsules daily with warm water.

3. Gotu Kola Capsules

Gotu Kola capsules are polyherbal capsules that contain Gotu kola(Centella asiatica). Gotu Kola balances all three doshas. The capsules can help in reducing swelling in the skin. It improves blood flow. It is also useful to calm down anxiety due to disease. It also increases healthy collagen production and improves the elasticity of the skin. It also reduces redness due to tiny dilated capillaries (Telangiectasia).

Dosage: 1 capsule twice daily with warm water.

4. Gandhak Rasayan

Gandhak Rasayan is a herbal formulation that contains Shuddh Gandhak (Purified sulphur). It balances all three doshas (Vata, Pitta and Kapha) and is used for the management of skin diseases, Vata vyadhi (Vata disorders) , allergic conditions and many other diseases. It removes dead skin and reduces swelling and tightening of skin (Sclerodactyly). Gandhak rasayan also improves the immunity of the body and protects the skin from microbial activity.

Dosage: 2 tablets twice daily with warm water.

5. Sinhnaad Guggul

Sinhnaad guggul is a wonderful formulation that contains Haritaki (Terminalia chebula), Bibhitaki (Terminalia bellirica), Amla (Emblica officinalis), Shudh Gandhak, Shudh guggulu (Comiphora mukul) and Eranda taila (Ricinus communis oil). It helps in pacifying Vata dosha. Sinhnaad guggul contains Haritaki, Bibhitaki, and Amla which are good for the skin and promote the healing of ulcers. It contains Shudh Gandhak which reduces inflammation of the skin. Guggul balances all three doshas (Vata, Pitta and Kapha). Eranda taila and Guggul both help in managing swelling and pain in joints. Eranda taila promotes the growth of healthy skin cells and provides nourishment to them.

Dosage: 2 tablets twice daily with warm water.

6. Panchtiktaka Ghrit

Panchtiktaka Ghrit is a herbal formulation that contains Neem (Azadirachta indica), Giloy (Tinospora cordifolia), Vasa (Adhatoda vasica), Cow ghee, Guggul (Commiphora mukul) and various other herbs. This ghrit is recommended for CREST Syndrome because it helps in the purification of blood and eliminates toxins from the skin. It has cooling effects and reduces inflammation in the body. It provides hydration to the skin and heals ulcers. The neem present in Panchtiktaka ghrita is known for its antimicrobial properties. It prevents skin from further infections. It also helps in reducing calcinosis and redness on the skin caused due to dilated capillaries supplying skin.

Dosage: 1 tsp twice daily with warm water.

7. Sanjivani Vati

Sanjivani Vati is a classical Ayurvedic formulation used since ancient times for various Ama associated diseases. This remedy is formulated by Planet Ayurveda under the strict regardance of M.D. Ayurveda practitioners. The formulation is available in tablet form & consists of ingredients such as Vidanga (Embelia ribes), Pippali (Piper longum), Amalaki (Emblica officinalis), etc.

CONCLUSION

CREST disease is a less severe form of scleroderma that shows slow progression. It is mainly characterised by 5 cardinal clinical features: Calcinosis, Raynaud's phenomenon, Esophageal dysmotility, Sclerodactyly and Telangiectasia. In Ayurveda, CREST Syndrome is correlated with Uttana Vata Rakta which can be managed in Ayurveda through the use of herbs and various procedures like the application of vata pacifying ointment, oil massage, sprinkling herbal water etc.