Guide To Treating CREST Syndrome

CREST syndrome is a form of the disease called scleroderma, and the clinical features that manifest in patients with this disease are what forms the acronym CREST. Calcinosis, or deposits of calcium that develop underneath the skin of the fingers or other body parts, refers to the 'C' in CREST. The 'R' refers to Raynaud's disease, which is a response to stress or cold that occurs in the toes or fingers where blood vessels have spasms.

Esophageal dysmotility or difficulty with swallowing is what the 'E' in CREST refers to. The 'S' stands for a condition where the fingers bend due to a tightening of the skin called sclerodactyly. The 'T' in CREST refers to vessel dilation or telangiectasia that occurs in the skin of the face, inside of the mouth, or on the fingers. At least two of the five symptoms represented in the CREST acronym must be present to receive a diagnosis.

Occupational Therapy

Occupational therapy is a type of treatment that helps individuals who have trouble with everyday activities due to disease or disability. This type of therapy focuses on helping individuals adapt to living with and working around the challenges their condition poses to them. Based on the symptoms the patient with CREST syndrome is experiencing, occupational therapy can help to treat the disease. The best outcomes with occupational therapy occur with individuals with CREST who experience diffuse thickening of the skin and other connective tissues that makes it extremely difficult to stay active.

This type of therapy assists with the stretching of the muscles, joints, and skin being affected by CREST syndrome. Because the symptoms of CREST syndrome often result in the patient becoming sedentary, muscle mass loss almost always occurs. Occupational therapy can help the patient maintain and improve the range of their movements and prevent muscle mass loss. In addition, occupational therapy stimulates the release of natural proteins that decrease pain sensation called endorphins. This type of therapy also helps the patient maintain good lung and heart function, as well as maintain adequate bone strength.

Laser Surgery

For CREST syndrome patients who have calcinosis, laser surgery may help improve the pain and inflammation that result from it. Calcinosis happens when insoluble calcium salts are deposited in the subcutaneous tissue and the skin. Not only do they cause pain, but these deposits can pose problems with the functionality of fingers and joints. Laser surgery involves the use of a concentrated beam of low-level electric current to vaporize, dissolve, or shrink the calcium deposits.

In some cases, the deposits may be located deeper in the tissues of the muscle or joints, and in these cases, using a laser from the outside of the skin may not be entirely effective. Sometimes an incision has to be made to gain better access to the area where the deposits are so the laser can penetrate into the tissue and break them up. Often, laser therapy will be used as a treatment for large calcium deposits, and only in cases where this therapy proves unsuccessful will the surgeon proceed with traditional surgical excision. This includes cases where manual excision would be a complicated and problematic procedure for the patient.

Topical Antibiotics

Individuals with CREST syndrome often experience lesions on the skin as a result of dryness and stiffness, or they can be a result of calcium deposits in the skin. Often, calcium deposits that develop in a pressure point area will result in the development of a skin ulcer or lesion from the irritation the deposit causes. It may be especially difficult for the body to heal these skin ulcers because of where they are located, so infection prevention is imperative.

Topical antibiotics applied to the ulcer can kill any bacteria that may be harboring in the tissues, or any that may be causing the ulcer to heal slowly. This type of topical treatment can also help the lesion retain proper moisture and not dry out excessively. Many topical formulas with antibiotics also contain steroid medications, which can help suppress the autoimmune response that has caused the calcium deposit to develop in the first place. These formulas help reduce inflammation around the site and stop bacteria from growing deeper into other tissues.

Keep Warm As Much As Possible

Raynaud's disease occurs when the blood vessels in the fingers and toes constrict severely in response to stress and or cold temperatures. This causes a shortage of blood supply to the skin, and the affected areas experience a color change to blue, white, gray, or green. The individual will also feel numbness and tingling in their fingers during an episode, and they can temporarily lose function in their fingers. The best way to prevent the symptoms that result from this condition is to keep warm as much as possible in all affected areas.

Episodes of Raynaud's disease can happen in the fingers, toes, nose, lips, and ears. Wearing a scarf, hat, earmuffs, two layers of mittens, socks, and boots when exposure to cold temperatures is anticipated can help reduce the occurrence of Raynaud's disease. Turning the car on fifteen minutes before entering it (never in a closed garage) can also reduce the chance of an episode occurring. When indoors, wearing socks and wearing oven mitts when removing things from the refrigerator and freezer can also decrease the chance of experiencing symptoms. Using insulated drinking glasses and keeping the thermostat in the home at a warmer temperature has also helped individuals with CREST syndrome cope with these symptoms.

Avoid Harsh Products On The Skin

CREST syndrome patients who have sclerodactyly should care for their skin diligently, as it can help treat the problems that arise from it. In many cases, sclerodactyly will result in severe finger swelling to the point where it is too difficult to bend them. The skin can also become tough and hardened. These problems happen as a result of an excess amount of a protein called collagen. The sweat and oil glands are destroyed by collagen, and without those methods to keep the skin moist and healthy, the skin becomes stiffer and excessively dry. It is best to avoid harsh products on the skin by wearing rubber gloves while cleaning or while washing dishes.

Avoiding harsh detergents and soaps in general and using shower gels with added moisturizers can also help keep the skin from becoming overly dry. Bathing every other day rather than every day in addition to using warm water instead of hot water can also help with skin stiffening. Applying a cream-based moisturizer to the skin several times a day and immediately after bathing will help the skin retain moisture. Furthermore, applying sunscreen a half hour before going outside will help with dryness tremendously, especially during the warmer seasons.