ABSTRACT Systemic sclerosis (SSc) is a multisystem disorder of unknown cause characterized by fibrosis of skin, blood vessels, and visceral organs including the gastrointestinal tract, lungs, heart, and kidneys. There are two distinct clinical presentations viz., Diffuse and limited forms. We are herewith reporting a case of diffuse cutaneous scleroderma in a 21 year old female student. The possible understanding of the case in terms of Ayurveda and a therapeutic protocol with promising result has beendiscussed

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M P Res 

Y Niranjan

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Global J Res. Med. Plants & Indigen. Med. | Volume 2, Issue 3 | March 2013 | 183–188                
Global Journal of Research on Medicinal Plants & Indigenous Medicine || GJRMI || 
 
ISSN 2277-4289 | www.gjrmi.com | International, Peer reviewed, Open access, Monthly Online Journal 
SYSTEMIC SCLEROSIS: A CASE STUDY IN AYURVEDIC SETTINGS 
Mahesh MP
1
, Niranjan Y
2
*, Mayya Jagadeesha A
3 
1
PG Scholar, Dept. of PG studies in Kayachikitsa, ALN Rao Memorial Ayurvedic Medical College, Koppa. 
Chikmagalore Dt. PIN: 577126 Karnataka INDIA 
2
Lecturer/ Physician, Dept. of PG studies in Kayachikitsa, ALN Rao Memorial Ayurvedic Medical College, 
Koppa. Chikmagalore Dt. PIN: 577126 Karnataka INDIA  
3
Lecturer/ Physician, Dept. of PG studies in Bhaishajya Kalpana, ALN Rao Memorial Ayurvedic Medical 
College, Koppa. Chikmagalore Dt. PIN: 577126 Karnataka INDIA 
* Corresponding Author; Email: ayurniranjan@gmail.com 
Received: 10/02/2013; Revised: 05/03/2013; Accepted: 08/03/2013 
ABSTRACT 
Systemic sclerosis (SSc) is a multisystem disorder of unknown cause characterized by fibrosis of 
skin, blood vessels, and visceral organs including the gastrointestinal tract, lungs, heart, and kidneys. 
There are two distinct clinical presentations viz., Diffuse and limited forms. We are herewith 
reporting a case of diffuse cutaneous scleroderma in a 21 year old female student. The possible 
understanding of the case in terms of Ayurveda and a therapeutic protocol with promising result has 
beendiscussed. 
KEYWORDS: Systemic Sclerosis, Scleroderma, Ayurveda, Vatavyadhi 
  
Case Study 
Cite this article: 
Mahesh MP, Niranjan Y, Mayya Jagadeesha A (2013), SYSTEMIC SCLEROSIS: A CASE STUDY IN 
AYURVEDIC SETTINGS, Global J Res. Med. Plants & Indigen. Med., Volume 2(3): 183–188 
Global J Res. Med. Plants & Indigen. Med. | Volume 2, Issue 3 | March 2013 | 183–188                
Global Journal of Research on Medicinal Plants & Indigenous Medicine || GJRMI || 
 
INTRODUCTION: 
Scleroderma is derived from the Greek 
words Sckleros (hard or indurated) and derma 
(skin). It was initially defined by Hippocrates, 
but a detailed description was given by Carlo 
Curzio (Sapadin AN, Fleischmajer R. 2002). 
Systemic sclerosis (SSc) is a multisystem 
disorder of unknown cause characterized by 
fibrosis of skin, blood vessels, and visceral 
organs including the gastrointestinal tract, 
lungs, heart, and kidneys (Fauci AS et.al., 
1998). There are two overlapping forms. 
Limited cutaneous scleroderma is limited to the 
skin on the face, hands and feet. Diffuse 
cutaneous scleroderma covers more of the skin, 
and is at risk of progressing to the visceral 
organs, including the kidneys; heart, lungs and 
gastrointestinal tract are affected. 
Annual incidence is 19 per million, and 
prevalence is 19–75 per 100,000. Women are 
roughly four times more likely than men to 
develop systemic scleroderma (http:// 
www.clevelandclinicmeded.com). Incidence is 
twice as high among African Americans, and 
the Choctow Native Americans in Oklahoma 
have the highest prevalence in the world 
(469/100,000). The interval of peak onset starts 
at age 30–35 and ends at age 50–55 (Bermas 
BL, 2009 and www.umm.edu) coinciding with 
the greatest changes in hormone levels 
(Chifflot H et.al., 2009). There is some 
hereditary association, some suggestion of 
immune reaction (molecular mimicry) to a 
virus, and some cases caused by toxins (Kasper 
et.al., 2005). 
The outstanding feature of SSc is 
overproduction and accumulation of collagen 
and other extracellular matrix proteins in the 
skin and other organs. While the pathogenesis 
of SSc remains to be further elucidated, the 
disease process involves immunologic 
mechanisms, vascular damage, and activation 
of fibroblasts (Fauci AS et.al., 1998). Clinical 
manifestations of Reynaud’s phenomenon, skin 
thickening, telangiectasia are most commonly 
encountered. Arthralgias, myopathy, 
esophageal dysmotility, pulmonary fibrosis, 
pulmonary hypertension are also observed 
(Fauci AS et.al., 1998). 
At present there are no specific diagnostic 
tests for SSc and the disorder is diagnosed 
primarily based on the collective appearance of 
a cluster of clinical symptoms, such as 
Raynaud’s phenomenon, telangiectasias, 
esophageal dysfunction with gastro-esophageal 
reflux, characteristic pigmentary changes, or 
presence of digital ulcers or calcinotic lesions 
accompanying clinically detectable skin 
induration. It is well recognized that the 
presence of specific autoantibodies is one of the 
most common manifestations of SSc and 
greater than 90% of SSc patients harbor 
antinuclear antibodies in their serum. 
Numerous autoantibodies have been described 
in SSc patients, some of these are highly 
specific for SSc, including anti-Scl-70 and 
anticentromere antibodies, and these have, 
therefore, been used as diagnostic biomarkers 
to support or confirm the clinical diagnosis of 
SSc. Anti-Scl-70 antibodies are directed against 
DNA topoisomerase I and are almost 
exclusively present in the sera of patients with 
the diffuse form of SSc (Castro SV, Jimmenez 
SA, 2010 and Jimenez SA, Derk CT 2004). 
The many complications of scleroderma 
can have a major impact on a person's sense of 
well-being. Patients are greatly concerned 
about changes in their appearance, particularly 
those changes caused by tightening of the facial 
skin. Depression has great impact, along with 
pain, on reducing patients' ability to function 
socially (http://www.umm.edu). 
Prognosis is difficult to predict until the 
disease differentiates into recognizable subsets. 
Patients with limited cutaneous scleroderma 
have a good prognosis, with 10-year survival of 
75%, although <10% develop pulmonary 
arterial hypertension after 10–20 years. Patients 
with diffuse cutaneous scleroderma have a 10-
year survival of 55%. Death is most often from 
pulmonary, heart and kidney involvement, 
although survival has greatly improved with 
effective treatments for kidney failure. 
Immunosuppressive drugs are used, although 
Global J Res. Med. Plants & Indigen. Med. | Volume 2, Issue 3 | March 2013 | 183–188                
Global Journal of Research on Medicinal Plants & Indigenous Medicine || GJRMI || 
 
glucocorticoids have limited application 
(www.en.wikipedia.org). Various therapeutic 
modalities are being used for the treatment of 
localized scleroderma. There is no precise 
treatment scheme for this disease. A majority 
of patients can be successfully treated with 
topical therapy and phototherapy, but the 
progressive forms of the disease with intensely 
expressed skin sclerosis sometimes may need 
even systemic treatment (Braun-Falco O et.al., 
2004). Hence an attempt is made to explain the 
condition in Ayurveda and to derive a treatment 
strategy. 
CASE STUDY: 
A 21 year old college student was referred 
from peripheral outpatient department to 
Kayachikitsa department of the central hospital 
on December 26, 2012 with complaints of 
gradually progressive feeling of tightness of the 
skin and face with skin thickening. She also 
had joint pain involving small joints of hands & 
wrists, elbows, shoulders and knee. There was 
h/o difficulty in squatting, getting up from 
squatting position. She also had Raynaud’s 
phenomenon, digital calcinosis, weight loss 
since onset of illness with discoloration of the 
neck region, (Fig. No.1) hair fall and general 
weakness were also seen. Her ANA Profile for 
Scl 70 was ++ (strong positive). Pulmonary 
function tests were technically poor 
(restriction) and poor patient effort. 
Hemoglobin 11.4g%, Total leucocyte count 
5950/mm
3
, Differential count was 59% of 
neutrophils, 38% of lymphocytes, 02% 
monocytes and 01% eosinophils, ESR was 
10 mm/1
st
 hr, routine urine examination was 
within the normal range. 
 
 
Fig. No. 1: Clinical features 
 
1.1 Shiny, taut facial skin, 1.2 Digital calcinosis, 1.3 calcinosis in the sole,  
1.4 Skin induration, 1.5 Sclerodactyly, 1.6 & 1.7 Discoloration at elbow 
 
  
Global J Res. Med. Plants & Indigen. Med. | Volume 2, Issue 3 | March 2013 | 183–188                
Global Journal of Research on Medicinal Plants & Indigenous Medicine || GJRMI || 
 
Her vitals were stable with Height -
 160 cm, Weight - 38 kg, B.P. - 100/70 mm of 
Hg. On examination, she demonstrated 
srotodushti (morbidity of channels) of Annava 
(food transportation) as aruchi (anorexia), 
Rasavaha srotas (channels carrying food) as 
Aruchi (anorexia), pandutwa (paleness) and 
krushangata (leanness). Raktavaha srotas 
(blood carrying channel) with Skin lesions, 
Asthivaha srotas (channels carrying osseous 
tissue) as Vaivarnya (discolouration), 
asthisoola (pain in bone), Majjavahasrotas 
(channels carrying components of bone 
marrow) as parvaruk (pain in joints) and 
Swedavahasrotas (channels carrying sweat) as 
Aswedana (absence of perspiration) and 
parushyam (roughness). 
DISCUSSION: 
Looking in to the clinical presentation of 
the case, the following probable diagnoses were 
contemplated; Vatarakta, Amavata, Kushta 
(obstinate skin diseases) and Twakgatavata 
(Vayu located in skin). 
The presentation of Reynaud’s 
phenomenon on exposure to cold, shiny taut 
skin over extensor surfaces, sclerodactyly and 
digital calcinosis, the involvement of vitiated 
Vata (bio-humour) is obvious in terms of 
shyavaarunavarna (bluish discoloration) 
(Acharya YT, 1994) over extremities, an 
increase of kharatwa (roughness) and 
rookshatwa (dryness) of Vata. The salt and 
pepper discoloration pointing towards 
Charmakushta (Skin disorder characterized by 
thickening of skin) (Acharya YT, 1994) 
(Fig.No. 2), resembling the skin of an elephant. 
The thinning of skin is a feature in 
TwakgataVata (vayu located in skin) (Acharya 
YT, 1994). The digital calcinosis progressing in 
to rat-bite necrosis (Haustein UF, 2002) 
typically draws attention to the akhuvisha (rat 
bite poisoning) (Acharya YT, 2003 and Khunte 
AM, 2002) simile in Vatarakta. 
 
Fig. No.2 Salt and pepper discoloration in the nape (image 2.1) resembling the skin of elephant 
 
A complex multifactorial etiopathogenesis 
was finally accepted based on the following 
logical sequence; the disease has hereditary 
role, supporting a genetic mutation and auto-
immunity, similarly Kushta has beejadosha 
(genetic) as a factor. The peripheral features of 
scleroderma resembles the laxanas (signs and 
symptoms) of Vatarakta (Acharya YT, 1994); 
of both uttana and gambhira nature at various 
instances of disease progression. The cutaneous 
manifestations mimic a particular variety of 
Kushta especially Charmakhya of Vataja type. 
The joint manifestations point towards 
Amavata (Murthy PHC, 2006) or Sandhivata 
(Khunte AM, 2002) features. However 
systemic involvement may denote various 
srotodushti (vitiation of channels) features. 
Hence, a complex pathological process duly 
Global J Res. Med. Plants & Indigen. Med. | Volume 2, Issue 3 | March 2013 | 183–188                
Global Journal of Research on Medicinal Plants & Indigenous Medicine || GJRMI || 
 
constituted by vitiated Vata by means of 
affliction of twak (skin) with the following 
samprapti ghataka (factors of pathogenesis); 
Vatapradhana Kapha are the involved Dosha 
(bodily humor), Dushya (vitiated bodily tissue) 
being Twak (skin), Snayu (ligaments), Sira 
(veins), Kandara (tendons) and Jatharagni 
(digestive fire) in mandavastha (diminished) 
and Ama (unprocessed food) born out of it. 
Many srotas (channels) are involved in the later 
stages with primary Rasavaha Srotodusti 
(morbid food carrying channels) of Sanga 
(obstruction) type followed by Vimargagamana 
(diversion of flow of the contents to improper 
channels). The Doshakopa (aggravated bodily 
humor) begins at Amapakwashaya, moving 
through Rasayani (circulatory channel) and 
settling at Twak (skin). Scleroderma being a 
physical illness, adhisthana (substratum) is 
Shareera (physical body). The disease has 
Bahyarogamarga (external pathological route) 
involved extending in to Madhyama (median 
route of pathogenesis). Oil application slightly 
improving the dryness and tightness of skin 
may be considered as Upashaya (symptomatic 
relief). Upadrava like Pulmonary hypertension, 
involvement of Sandhi (joints), Sira (blood 
vessels), Snayu (ligaments) are observed as 
complications. 
The conclusion regarding the diagnosis was 
derived as a complex syndrome dominated by 
prakupita Vata (vitiated vata) taking 
ashraya(base) in rasa (circulating fluid tissue), 
later the samprapti (pathogenesis)extends to 
deeper tissues especially sira (blood vessels) , 
kandara (tendons), snayu (ligaments) and 
asthisandhi (bony joints). In therapeutic 
perspective, the condition is managed with 
Vataprasamana (pacifying Vata) and 
raktaprasadana (pacifying Rakta) line of 
treatment in accordance with the chikitsa 
(treatment) advocated for Vatavyadhi (Acharya 
YT, 1994 and Khunte AM, 2002) and 
Vatarakta (Acharya YT, 1994) in classical 
Ayurvedic literatures. 
TREATMENT PROTOCOL: 
On the day of admission, Agnideepana 
(improving digestive fire), amapachana line 
was adopted using Hingvashtaka choorna. 
Abhyanga (oil massage) was done in the next 
two days with Yashtimadhu taila and sweda 
(sudation) using the Nadee sweda apparatus. 
On the third day, Koshtashodhana was done 
with Gandharvahastadi eranda taila 30 ml in 
the morning at 6.30 AM. Avarasuddhi was 
observed. Samsarjana advised for three 
annakala (time of food intake). 
Yogavasti (medicated enema schedule) is 
planned considering the Samprapti Ghataka 
with Anuvasana (oil enema) of Yashtimadhu 
taila and Ksheerabala taila 60 ml with 5 g of 
saindhava lavana  Erandamuladi nirooha was 
carried out as Asthapanavasti (decoction 
enema) using Erandamula kwatha-500ml, 
Ksheerabala taila + yashtimadhu taila-75ml, 
Madhu (honey)-25ml, Saindhava (rock salt)-
10g and Sathapushpa kalka (Anethum sowa 
powder)- 20 g. 
On discharge, she was prescribed with 
Manjishtadi Kwatha 25ml twice daily,Tablets 
of Kaishora guggulu 2 with Kwatha, 
Kamadugha rasa tablet twice daily. 
Guggulutikthaka ghrita 10 ml after food as 
shaman sneha. Yashtimadhu taila was advised 
for external application. 
RESULTS AND CONCLUSION 
After 3 months of active treatment in the 
above lines, the patient was happy with 
relieved tightness over skin of face and limbs, 
improved ability to perform normal activities 
and an enhanced overall quality of life. This 
example may be a silver lining in the horizon 
for the mankind with Scleroderma. 
 
 
 
Global J Res. Med. Plants & Indigen. Med. | Volume 2, Issue 3 | March 2013 | 183–188                
Global Journal of Research on Medicinal Plants & Indigenous Medicine || GJRMI || 
 
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Source of Support: Nil Conflict of Interest: None Declared 


SYSTEMIC SCLEROSIS: A CASE STUDY IN AYURVEDIC SETTINGS

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SYSTEMIC SCLEROSIS: A CASE STUDY IN AYURVEDIC SETTINGS

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