Homoeopathic Management of Crest Syndrome: A Case Study

Abstract:

 CREST syndrome, also known as the limited cutaneous form of systemic sclerosis (lcSSc), is a multisystem connective tissue disorder. The acronym “CREST” refers to the five main features: calcinosis, Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia.

Raynaud’s phenomenon is frequently the first manifestation of CREST/lcSSc. Clinically this manifests as a white-blue-red transition in skin color. This phenomenon can lead to digital ulcerations, gangrene, or amputation. Ulceration can predispose to chronic infections of the involved site. This case demonstrates the efficacy of reviewing the totality as per need during course of the treatment.

 Homoeopathic Case Record:

Preliminaries
Date:  20/12/2018	Name: Mrs.MP	Age/Sex: 30yrs. /Female
Religion: Hindu	Education:  10th Standard	Occupation: Shopkeeper
Marital status: Married	Husband: Paper mill operator	Children :- 1 son , 1 daughter
Diet: Non-Veg.

  Chief Complaint:

Location	Sensation	Modalities	Accompaniments
Lower        Extremities Since 5 years O- Gradual P- Slow	–         Pain & Swelling in toes (B/L) –         Reddish-Brown Discolouration –         Sticky Offensive Watery Discharges	<Walking +2 < Touch < Climbing Up Stairs <Cold application >Rubbing >Rest >Warmth, in Sun >Covering (wearing Socks )	-Pain in Calves Moving Upwards to knees and Hip

 

Past History (P/H):Apparently Healthy . No long standing chronic illnesses

Family History (P/H): Husband  – Apparently healthy. Father- Agriculture Mother Agriculture

Personal History (P/H):

• Appetite: Poor
• Thirst: Good
• Stool: Regular, soft stool
• Urine: Clear
• Thermal Status: Chilly
• Sleep: Disturbed

MENTAL HISTORY –

Patient was born in a low socioeconomic joint family. Father and mother do agriculture.  She has 2 younger brothers. All personal relations with family members are good but she is more attached to mother and shares everything with her.

She failed in 10th standard and family quit her studies to do home chores.

Marriage

She got married at the age of 18 years. Husband works as Operator in papermill. Maintains good relations with husband. started a general store in 2004 and runs it on her own. Inspite of much pain apart from working in shop, she will do tailoring work also.

Anger –When customers hurry her to weigh and pack faster. Feels bad as she can’t walk fast due to her complaint.  Desires to be alone and doesn’t prefer sympathy from others.

On examination (O/E): General Appearance: Moderately Built, Wheatish, Height: 5’1” Temp: 98.4o F Pulse: 76/min Slow Regular RR: 18/min BP: 120/70 mm Hg Weight: 54 kg Throat: NAD

Systemic examination (S/E): CNS:  – CVS: S1S2 Normal R/S: Clear P/A: NAD Local Examination –B/L toes   * Reddish , Hot to touch, Tenderness ++   CNS- central Nervous System, CVS- Cardiovascular System, R/S- Respiratory System, P/A- Per Abdomen NAD- Nothing Abnormal Detected

Investigations Ordered: – Doppler Study.

Case Processing:

• Disease Diagnosis & Miasmatic Understanding with Reasoning:

Disease Diagnosis	Reasoning for Disease Diagnosis	Reasoning for Miasmatic Understanding
CREST Syndrome	-Raynaud’s Phenomenon -Pain, redness on toes < cold – < Walking, Touch ++	Gradual Onset Sensitivity Low Susceptibility low

 

Disease Diagnosis: CREST Syndrome

Hahnemannian Classification of

Disease: Chronic individual dynamic Disease3

Dominant Miasm:syco- syphilitic {Refer reasoning column for miasmatic understanding}3

Susceptibility: Low

Sensitivity: low

Potency: 6c

Repetition: Frequent

Totality of Symptoms: Chronic

1] Mind  –          Consolation aggravation

2] Mind –           Industrious

3] Generals –     Food sweet desires

4] Generals –     Walking aggravation

5] Generals –      Touch aggravation

6] Skin ulcers – Discharges offensive

• Selection of Repertory: Synthesis Repertory
• Repertorial Sheet:

Repertorial Result:

Chilly	Totality & Symptoms Covered	Hot	Totality & Symptoms Covered
SEPIA	16/6	SULPHUR	12/6
SILICEA	13/6	LYCOPODIUM	11/6
PHOSPHURUS	12/6	NATRUM-MUR	10/5

Before treatment :-

Final Selection of Acute Remedy & First Prescription: Considering the thermal status of patient i.e. chilly & the totality covered the final selection of remedy is Silicea 6C

Prescription: Silica 6c BD x WEEKLY

20/12/18	Pain &Discoloration reduced Swelling remained same	Silicea 6c BD x weekly Sac lac for one month
11/01/19	Pain &Discoloration>>70% Swelling reduced slowly	Sac Lac for one month
28/02/19	Pain, discoloration and swelling reduced significantly	Sac lac for one month
16/01/20	No pain and swelling	Sac lac for one month

 

For one year patient was not under treatment as she felt better, no complaints were there. But since three months, complaints reappeared as previously, one month after vaccination and also some changes were there in totality, so we decided to review the case.

After treatment:

Case reviewed.

Appetite – good

Thirst –     adequate

Urine –    Normal

Bowel –    Regular

Desires –   Fish +++

Aversion – Not specific

Sleep      – Sound

Thermals – Sensitive to both heat & cold

Life Space Investigation:

Desires solitude and wants to live alone peacefully, Doesn’t want to be consoled. When husband doesn’t lift up a call and children don’t reach home in time, she constantly calls husband or worries why they are late what had happened to them. At present she wants things to be neat, clean and in their  proper place and if not she gets irritated. Becomes very sensitive to the sufferings of others and tries to help if she can.

Totality of Symptoms: Revised

1] Mind – Consolation aggravation

2] Mind – Sympathetic

3] Mind – Industrious

4] Mind- Anxiety others for

5] Mind – Fastidious

6] Generals – food Fish desires

7] Generals – Vaccination, ailments after

Repertorization chart –

Repertorial Result:

Chilly	Totality & Symptoms Covered	Hot	Totality & Symptoms Covered
Sepia	10/6	Natrum mur	11/5
Phosphorus	09/6	Sulphur	06/5
		Lycopodium	06/5

Remedies after repertorization are Phos., Sepia, which are chilly and Nat m., Sulphur, which are hot remedies. Carcinosin is the remedy which can be thermally hot or chilly or sensitive to both. So as per thermals and repertorization Carcinosin was selected as a final remedy.

Before treatment:

Follow up-

23/07/21	Pain started again Cracks+ Bleeding+ Swelling mild	Carcinosin 1M (1 dose) Sac lac for one Month
29/08/2021	Pain reduced by 30%, Bleeding+, Cracks+. No new complaint. Physical generals – normal	Sac lac for one Month.
26/09/2021	Pain reduced by 60%, Bleeding stopped. Cracks reduced by 50%. No new complaint.	Sac lac for one month

 

After treatment:-

Case was followed up for another six months. In between Carcinosin was repeated once as there was relapse of complaints, but in reduced intensity.

Latest condition of patient as reported:

 Discussion –

In this case Silicea 6c helped in relieving her from all the complaints. She was symptoms free for 1 year. Later on, complaints reappeared; probably covid vaccination may be the triggering factor.  Based on totality, after repertorization Carcinosin 1M was prescribed.