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Herbs & Plants

Prunus bokharensis

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Botanical Name : Prunus bokharensis
Family: Rosaceae
Genus: Prunus
Subgenus: Prunus
Section: Microcerasus
Species: P. bokharensis
Kingdom: Plantae
Order: Rosales

Common Name: Bokhara Plum

Habitat ;Prunus bokharensis is native to E. Asia – Himalayas. It grows in woodland Garden Sunny Edge.

Description:
Prunus bokharensis is a deciduous Tree. The flowers are hermaphrodite (have both male and female organs) and are pollinated by Insects.Suitable for: light (sandy), medium (loamy) and heavy (clay) soils and prefers well-drained soil. Suitable pH: acid, neutral and basic (alkaline) soils. It can grow in semi-shade (light woodland) or no shade. It prefers moist soil.

CLICK & SEE THE PICTURES
Cultivation:
We have very little information on this species and do not know if it will be hardy in Britain, though judging by its native range it should succeed outdoors in most parts of this country. It is possibly no more than a cultivated form of P. salicina. It is sometimes cultivated in N. India for its edible fruit, there is at least one named variety. ‘Early Large Red #8’ is a large red-fruited cultivar. The following notes are based on the general needs of the genus. Thrives in a well-drained moisture-retentive loamy soil. Prefers some lime in the soil but is likely to become chlorotic if too much lime is present. Succeeds in sun or partial shade though it fruits better in a sunny position. Most members of this genus are shallow-rooted and will produce suckers if the roots are damaged. Plants in this genus are notably susceptible to honey fungus.
Propagation:
Seed – requires 2 – 3 months cold stratification and is best sown in a cold frame as soon as it is ripe. Sow stored seed in a cold frame as early in the year as possible. Protect the seed from mice etc. The seed can be rather slow, sometimes taking 18 months to germinate. Prick out the seedlings into individual pots when they are large enough to handle. Grow them on in a greenhouse or cold frame for their first winter and plant them out in late spring or early summer of the following year. Cuttings of half-ripe wood with a heel, July/August in a frame. Softwood cuttings from strongly growing plants in spring to early summer in a frame. Layering in spring.
Edible Uses:
Edible Parts: Fruit; Seed.

Fruit – raw or cooked. They are used in pies, preserves etc and can also be dried for later use. The fruit contains a single large seed. Seed – raw or cooked. Do not eat the seed if it is too bitter – see the notes below on toxicity.
Medicinal Uses
Although no specific mention has been seen for this species, all members of the genus contain amygdalin and prunasin, substances which break down in water to form hydrocyanic acid (cyanide or prussic acid). In small amounts this exceedingly poisonous compound stimulates respiration, improves digestion and gives a sense of well-being.

Other Uses:…….Dye……..A green dye can be obtained from the leaves. A dark grey to green dye can be obtained from the fruit.

Known Hazards: Although no specific mention has been seen for this species, it belongs to a genus where most, if not all members of the genus produce hydrogen cyanide, a poison that gives almonds their characteristic flavour. This toxin is found mainly in the leaves and seed and is readily detected by its bitter taste. It is usually present in too small a quantity to do any harm but any very bitter seed or fruit should not be eaten. In small quantities, hydrogen cyanide has been shown to stimulate respiration and improve digestion, it is also claimed to be of benefit in the treatment of cancer. In excess, however, it can cause respiratory failure and even death.

Disclaimer : The information presented herein is intended for educational purposes only. Individual results may vary, and before using any supplement, it is always advisable to consult with your own health care provider.

Resources:
http://www.pfaf.org/User/Plant.aspx?LatinName=Prunus+bokharensis
https://en.wikipedia.org/wiki/Prunus

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Categories
Herbs & Plants

Prunus alabamensis

 

Botanical Name: Prunus alabamensis
Family: Rosaceae
Genus: Prunus
Species: P. alabamensis
Kingdom: Plantae
Order: Rosales
Synonyms:
*Padus alabamensis (C.Mohr) Small
*Prunus serotina var. alabamensis (C.Mohr) Little

Common Names: Alabama cherry or Alabama black cherry

Habitat : Prunus alabamensis is native to the southeastern United States (Alabama, Florida, Georgia, South Carolina. It grows rare and local on the summits of low mountains.

Description:
Prunus alabamensis is a shrub or small tree up to 15 feet (450 cm) tall. Leaves are thick, broadly egg-shaped dull green on the upper surface, light green on the underside. It is in flower from May to June, and the seeds ripen from Sep to October. Flowers are in an elongated raceme up to 6 inches (15 cm) long.

CLICK & SEE THE PICTURES

The flowers are hermaphrodite (have both male and female organs) and are pollinated by Insects.Suitable for: light (sandy), medium (loamy) and heavy (clay) soils and prefers well-drained soil. Suitable pH: acid, neutral and basic (alkaline) soils. It can grow in semi-shade (light woodland) or no shade. It prefers moist soil.
Cultivation:
Thrives in a well-drained moisture-retentive loamy soil. Prefers some lime in the soil but is likely to become chlorotic if too much lime is present. Succeeds in sun or partial shade though it fruits better in a sunny position. Most members of this genus are shallow-rooted and will produce suckers if the roots are damaged. Plants in this genus are notably susceptible to honey fungus.

Propagation:
Seed – requires 2 – 3 months cold stratification and is best sown in a cold frame as soon as it is ripe. Sow stored seed in a cold frame as early in the year as possible. Protect the seed from mice etc. The seed can be rather slow, sometimes taking 18 months to germinate. Prick out the seedlings into individual pots when they are large enough to handle. Grow them on in a greenhouse or cold frame for their first winter and plant them out in late spring or early summer of the following year. Cuttings of half-ripe wood with a heel, July/August in a frame. Softwood cuttings from strongly growing plants in spring to early summer in a frame. Layering in spring.
Edible Uses
Edible Parts: Fruit; Seed.

Fruit – raw or cooked. The fruit is about 10mm in diameter, it has a thin acid flesh and contains a single large seed.
Medicinal Uses:
Although no specific mention has been seen for this species, all members of the genus contain amygdalin and prunasin, substances which break down in water to form hydrocyanic acid (cyanide or prussic acid). In small amounts this exceedingly poisonous compound stimulates respiration, improves digestion and gives a sense of well-being.

Other Uses :.…Dye……A green dye can be obtained from the leaves. A dark grey to green dye can be obtained from the fruit.

Known Hazards: Although no specific mention has been seen for this species, it belongs to a genus where most, if not all members of the genus produce hydrogen cyanide, a poison that gives almonds their characteristic flavour. This toxin is found mainly in the leaves and seed and is readily detected by its bitter taste. It is usually present in too small a quantity to do any harm but any very bitter seed or fruit should not be eaten. In small quantities, hydrogen cyanide has been shown to stimulate respiration and improve digestion, it is also claimed to be of benefit in the treatment of cancer. In excess, however, it can cause respiratory failure and even death.

Disclaimer : The information presented herein is intended for educational purposes only. Individual results may vary, and before using any supplement, it is always advisable to consult with your own health care provider.
Resources:
https://en.wikipedia.org/wiki/Prunus_alabamensis
http://www.pfaf.org/user/Plant.aspx?LatinName=Prunus+alabamensis

Categories
Herbs & Plants

Ilex vomitoria

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Botanical Name : Ilex vomitoria
Family: Aquifoliaceae
Genus: Ilex
Species: I. vomitoria
Kingdom:Plantae
Order: Aquifoliales

Common Names: Yaupon or Yaupon holl (The word yaupon was derived from its Catawban name, yopún, which is a diminutive form of the word yop, meaning “tree”. )

The ceremony included vomiting, and Europeans incorrectly believed that it was Ilex vomitoria that caused it (hence the Latin name). The active ingredients, like those of the related yerba mate and guayusa plants, are actually caffeine and theobromine, and the vomiting either was learned or resulted from the great quantities in which they drank the beverage coupled with fasting. Others believe the Europeans improperly assumed the black drink to be the tea made from Ilex vomitoria when it was likely an entirely different drink made from various roots and herbs and did have emetic properties.

Habitat : Ilex vomitoria is native to North America from Maryland south to Florida and west to Oklahoma and Texas. A disjunct population occurs in the Mexican state of Chiapas. It generally occurs in coastal areas in well-drained sandy soils, and can be found on the upper edges of brackish and salt marshes, sandy hammocks, coastal sand dunes, inner-dune depressions, sandhills, maritime forests, nontidal forested wetlands, well-drained forests and pine flatwoods.

Description:
Yaupon holly is an evergreen shrub or small tree reaching 5–9 meters tall, with smooth, light gray bark and slender, hairy shoots. The leaves are alternate, ovate to elliptical with a rounded apex and crenate or coarsely serrated margin, 1-4.5 cm long and 1–2 cm broad, glossy dark green above, slightly paler below. The flowers are 5–5.5 mm diameter, with a white four-lobed corolla. The fruit is a small round, shiny, and red (occasionally yellow) drupe 4–6 mm diameter containing four pits, which are dispersed by birds eating the fruit. The species may be distinguished from the similar Ilex cassine by its smaller leaves with a rounded, not acute apex.
CLICK & SEE THE PICTURES :

Cultivation:
Succeeds in most soils so long as they are not water-logged. This species is not fully hardy in Britain, the plants are incapable of withstanding our hardest winters. A slow-growing species in the wild, often forming dense thickets from root suckers. The leaves remain on the plant for 2 – 3 years, falling just before the appearance of new leaves in the spring. Flowers are produced on the current year’s growth. Resents root disturbance, especially as the plants get older. It is best to place the plants into their permanent positions as soon as possible, perhaps giving some winter protection for their first year or two. Dioecious. Male and female plants must be grown if seed is required.

Propagation:
Seed – best sown as soon as it is ripe in the autumn in a cold frame. It can take 18 months to germinate. Stored seed generally requires two winters and a summer before it will germinate and should be sown as soon as possible in a cold frame. Scarification, followed by a warm stratification and then a cold stratification may speed up the germination time[78, 80]. The seedlings are rather slow-growing. Pot them up into individual pots when they are large enough to handle and grow them on in light shade in a cold frame for their first year. It is possible to plant them out into a nursery bed in late spring of the following year, but they should not be left here for more than two years since they do not like being transplanted. Alternatively, grow them on in their pots for a second season and then plant them out into their permanent positions in late spring or early summer. Give them a good mulch and some protection for their first winter outdoors. Cuttings of almost ripe wood with a heel, August in a shaded position in a cold frame. Leave for 12 months before potting up. Layering in October. Takes 2 years
Edible Uses: Native Americans used the leaves and stems to brew a tea, commonly thought to be called asi or black drink for male-only purification and unity rituals.

A mildly stimulating beverage containing caffeine is made from the dried and roasted leaves. The tea is stimulating and intoxicating. The leaves are first steeped in cold and then in boiling water. They are also used to flavour ice cream and soft drinks.

In 2013 a company in Cat Spring, Texas began selling yaupon tea online for people interested in the local food movement. Other companies have opened in Florida and Georgia

Medicinal Uses: A decoction of the leaves is emetic. The plant was used ritually by several N. American Indian tribes. The leaves were toasted over a fire and then boiled for several hours. The resulting thick black liquid was then drunk and this was followed by immediate vomiting. This was often used a a purification rite prior to hunting.

Other Uses: Ornamental
Ilex vomitoria is a common landscape plant in the Southeastern United States. The most common cultivars are slow-growing shrubs popular for their dense, evergreen foliage and their adaptability to pruning into hedges of various shapes. These include:

* ‘Folsom Weeping’ — weeping cultivar
* ‘Grey’s Littleleaf’/’Grey’s Weeping’ — weeping cultivar
* ‘Nana’/’Compacta’ — dwarf female clone usually remaining below 1 m in height.
* ‘Pride of Houston’ — female clone similar to type but featuring improvements in form, fruiting, and foliage.
* ‘Schilling’s Dwarf’/’Stokes Dwarf’ — dwarf male clone that grows no more than 0.6 m tall and 1.2 m wide.
* ‘Will Flemming’ — male clone featuring a columnar growth habit.

This species is occasionally used for hedging in the southern states of America. Wood – hard, heavy, strong, close grained. It weighs 46lb per cubic foot. Too small for commercial exploitation, the wood is used locally for turnery, inlay work, woodenware etc.

Known Hazards:
Although no specific reports of toxicity have been seen for this species, the fruits of at least some members of this genus contain saponins and are slightly toxic. They can cause vomiting, diarrhoea and stupor if eaten in quantity. The fruit is poisonous.

Disclaimer : The information presented herein is intended for educational purposes only. Individual results may vary, and before using any supplement, it is always advisable to consult with your own health care provider.
Resources:
https://en.wikipedia.org/wiki/Ilex_vomitoria
http://www.herbnet.com/Herb%20Uses_UZ.htm
http://www.pfaf.org/user/Plant.aspx?LatinName=Ilex+vomitoria

Categories
News on Health & Science

Too Close for Comfort

The scientific study of a person’s sense of personal space may one day lead to ways of treating neurological diseases such as autism.
………..
Have you been annoyed by people standing too close to you? Do you feel uncomfortable when people stare at you? If you are offended by excessive proximity, you are among the billions of normal people on this planet. If you are not, there may be something abnormal in your brain.

A person’s sense of private space is considered so important that scientists have given a name to its formal study — proxemics. The subject is already throwing up interesting theories and practical applications.

Studies show that our sense of personal space determines a large part of our public behaviour. It is this sense that stops us from staring at others in crowded places, opt for unoccupied rows in a train or bus, or not stand close to another person in a urinal. Also, it enables us to sense danger in people’s expressions. Our sense of personal space — or more accurately, lack of it — could even be linked to some neurological diseases such as autism.

At the California Institute of Technology (Caltech) in the US, professor of psychology and neuroscience Ralph Adolphs recently found that our sense of personal space resides in a part of the brain called amygdala. This almond-shaped structure is in the medial temporal lobe, equidistant from either ear. The amygdala has been known for over a century but neuroscientists were not interested in it until recently. The region was known to be associated with emotions, but scientists are now learning that it also plays a role in a number of brain disorders.

Adolphs and his team had come across a woman who they prefer to call SM. SM had no sense of personal space, because of which she had got into potentially dangerous situations. She participated in an experiment at Caltech where people were asked to walk towards the experimenter but stop at a distance where they felt comfortable. SM got very close to the experimenter, far closer than anyone else did. The other 20 volunteers stopped at about two feet; SM stopped at one foot. She did not feel uncomfortable even when the noses were about to touch. “She had earlier got into relationships with people whom normal people would not associate with,” says Adolphs.

Obviously, SM cannot decide whom to trust and is uniformly friendly with everybody she meets. Adolphs then used imaging techniques to determine what part of the brain lit up when people felt uncomfortably close to the experimenter. It was undoubtedly the amygdala. SM had lesions on both sides of the amygdala. Now the team is investigating the relationship of the amygdala, our sense of space and autism. Autistic people have difficulties with personal space and have to be taught its importance.

The experience of SM clearly suggests that our sense of personal space is also a necessary part of a defensive mechanism. She could not recognise fear in the faces of others and could also not judge whether someone is trustworthy, both being abilities that could be related to our sense of personal space. So important and so ingrained is our sense of this space that we carry it even to cyberspace. In experiments performed at Stanford University, scientists had found out that people maintain their sense of personal space even in virtual worlds. Says Nick Yee, former Stanford PhD student and now research scientist at the Palo Alto Research Centre, “When avtars gather in Second Life, they tend to maintain a distance as they do in the real world.”

Second Life is a 3D virtual world where people can create “avtars” who interact just as in the real world. The Stanford Virtual Reality Lab research team, of which Yee was a part, had created algorithms that could analyse the behaviour of avtars in Second Life. The aim of this project was to study virtual environments and not our sense of personal space, but it clearly demonstrated that personal space was important even in virtual worlds.

Around 10 years ago, at the University of California, Santa Cruz, professor Dane Archer videotaped several individuals in situations where they felt their sense of personal space was being violated. These situations involved urinals, libraries and other public places. The videos are now sold by Berkeley Media LLC, a leading distributor of documentaries in the US. The clips show that though people feel their personal space is being violated, their response is to move away rather than confront the aggressor.

Although the term proxemics is only a few decades old (its originator, Edward Hall, passed away this July), the scientific study of personal space is just beginning. It is providing fascinating insights into non-verbal communication. And scientists hope it would one day also lead to ways of treating neurological diseases.

Source:The Telegraph (Kolkata, India)

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Categories
Ailmemts & Remedies

Scleroderma

Definition:
Scleroderma (sklere-o-DER-muh) is a rare, progressive disease that leads to hardening and tightening of the skin and connective tissues    the fibers that provide the framework and support for your body. Scleroderma usually starts with a few dry patches of skin on the hands or face that begin getting thicker and harder. These patches then spread to other areas of the skin. In fact, scleroderma literally means “hard skin.”

Click to see the pictures> ….(1)…….. .(2)..…..

Scleroderma is a chronic disease characterized by excessive deposits of collagen in the skin or other organs. The localized type of the disease, while disabling, tends not to be fatal. The systemic type or systemic sclerosis, the generalized type of the disease, can be fatal as a result of heart, kidney, lung or intestinal damage

In some cases, scleroderma also affects the blood vessels and internal organs. Scleroderma is one of a group of arthritic conditions called connective tissue disorders. In these disorders, a person’s antibodies are directed against his or her own tissues.

Researchers haven’t established a definitive cause for scleroderma. It’s more common in women than in men and more common in adults than in children. Scleroderma can run in families, but in most cases it occurs without any known family tendency for the disease. Scleroderma isn’t considered contagious or cancerous, but this chronic condition can greatly affect self-esteem and the ability to accomplish everyday tasks.

Skin symptoms
Scleroderma affects the skin, and in more serious cases it can affect the blood vessels and internal organs. The most evident symptom is usually the hardening of the skin and associated scarring. The skin may appear tight, reddish or scaly. Blood vessels may also be more visible. Where large areas are affected, fat and muscle wastage may weaken limbs and affect appearance.

The seriousness of the disease varies hugely between cases. The two most important factors to consider are the level of internal involvement (beneath the skin) and the total area covered by the disease. In general, the more skin that is involved, the more severe the case of scleroderma.

For the systemic form of the disease, almost all patients(over 80%) have vascular symptoms and Raynaud’s phenomenon. During an attack, there is discoloration of the hands and feet in response to cold. Raynaud’s normally affects the fingers and toes.

Systemic scleroderma and Raynaud’s can cause painful ulcers on the fingers or toes which are known as digital ulcers.

Calcinosis is also common in systemic scleroderma, and is often seen near the elbows, knees or other joints.

Other organs
Diffuse scleroderma can cause musculoskeletal, pulmonary, gastrointestinal, renal and other complications.Patients with larger amounts of cutaneous involvement are more likely to have involvement of the internal tissues and organs.

Musculoskeletal
The first joint symptoms that patients with scleroderma have are typically non specific joint pains, which can lead to arthritis, or cause discomfort in tendons or muscles. Joint mobility, especially of the small joints of the hand, may be restricted by calcinosis or skin thickening. Patients may develop muscle weakness, or myopathy, either from the disease, or its treatments.

Lungs
Some impairment in lung function is almost universally seen in patients with diffuse scleroderma on pulmonary function testing;[4] however, it does not necessarily cause symptoms, such as shortness of breath. Some patients can develop pulmonary hypertension, or elevation in the pressures of the pulmonary arteries. This can be progressive, and lead to right sided heart failure. The earliest manifestation of this may be a decreased diffusion capacity on pulmonary function testing.

Other pulmonary complications in more advanced disease include aspiration pneumonia, pulmonary hemorrhage and pneumothorax.

Digestive tract
Diffuse scleroderma can affect any part of the gastrointestinal tract. The most common manifestation in the esophagus is reflux esophagitis, which may be complicated by peptic stricturing, or benign narrowing of the esophagus. This is best initially treated with proton pump inhibitors for acid suppression, but may require bougie dilatation in the case of stricture.

click to see..(2)

Scleroderma can decrease motility anywhere in the gastrointestinal tract. The most common source of decreased motility involvement is the esophagus and the lower esophageal sphincter, leading to dysphagia and chest pain. As Scleroderma progresses, esophageal involvement from abnormalities in decreased motility may worsen due to progressive fibrosis (scarring). If this is left untreated, acid from the stomach can back up into the esophagus causing esophagitis, and GERD. Further scarring from acid damage to the lower esophagus many times leads to the development of fibrotic narrowing, also known as strictures which can be treated by dilitation, and Barrett’s esophagus. The small intestine can also become involved, leading to bacterial overgrowth and malabsorption, of bile salts, fats, carbohydrates, proteins, and vitamins. The colon can be involved, and can cause pseudo-obstruction or ischemic colitis.

Rarer complications include pneumatosis cystoides intestinalis, or gas pockets in the bowel wall, wide mouthed diverticula in the colon and esophagus, and liver fibrosis. Patients with severe gastrointestinal involvement can become profoundly malnourished.

Scleroderma may also be associated with gastric antral vascular ectasia (GAVE), also known as watermelon stomach. This is a condition where atypical blood vessels proliferate usually in a radially symmetric pattern around the pylorus of the stomach. GAVE can be a cause of upper gastrointestinal bleeding or iron deficiency anemia in patients with scleroderma.

Kidneys
Renal involvement, in scleroderma, is considered a poor prognostic factor and not infrequently a cause of death in patients with scleroderma…..click & see

The most important clinical complication of scleroderma involving the kidney is scleroderma renal crisis. Symptoms of scleroderma renal crisis are malignant hypertension (high blood pressure with evidence of acute organ damage), hyperreninemia (high renin levels), azotemia (kidney failure with accumulation of waste products in the blood) and microangiopathic hemolytic anemia (destruction of red blood cells). Apart from the high blood pressure, hematuria (blood in the urine) and proteinuria (protein loss in the urine) may be indicative.

In the past scleroderma renal crisis was almost uniformily fatal. While outcomes have improved significantly with the use of ACE inhibitors the prognosis is often guarded, as a significant number of patients are refractory to treatment and develop renal failure. Approximately 10% of all scleroderma patients develop renal crisis at some point in the course of their disease.Patients that have rapid skin involvement have the highest risk of renal complications.

Treatments for scleroderma renal crisis include ACE inhibitors, which are also used for prophylaxis, and renal transplantation. Transplanted kidneys are known to be affected by scleroderma and patients with early onset renal disease (within one year of the scleroderma diagnosis) are thought to have the highest risk for recurrence.

Types
There are three major forms of scleroderma: diffuse, limited (CREST syndrome) and morphea/linear. Diffuse and limited scleroderma are both a systemic disease, whereas the linear/morphea form is localized to the skin. (Some physicians consider CREST and limited scleroderma one and the same, others treat them as two separate forms of scleroderma.) There is also a subset of the systemic form known as “systemic scleroderma sine scleroderma”, meaning the usual skin involvement is not present.

Diffuse scleroderma…..click & see
Diffuse scleroderma (progressive systemic sclerosis) is the most severe form – it has a rapid onset, involves more widespread skin hardening, will generally cause much internal organ damage (specifically the lungs and gastrointestinal tract), and is generally more life threatening.

Limited scleroderma/CREST syndrome……click & see
The limited form is much milder: it has a slow onset and progression, skin hardening is usually confined to the hands and face, internal organ involvement is less severe, and a much better prognosis is expected.

In typical cases of limited scleroderma, Raynaud’s phenom…striction of the small arteries of exposed peripheries – particularly the hands and feet – in the cold. It is classically characterised by a triphasic colour change – first white, then blue and finally red on rewarming. The scleroderma may be limited to the fingers – known as sclerodactyly.

The limited form is often referred to as CREST syndrome. “CREST” is an acronym for the five main features:

1.Calcinosis
2.Raynaud’s syndrome
3.Esophageal dysmotility
4.Sclerodactyly
5.Telangiectasia

CREST is a limited form associated with antibodies against centromeres and usually spares the lungs and kidneys.

Morphea/linear scleroderma….…click & see
Morphea/linear scleroderma involves isolated patches of hardened skin – there generally is no internal organ involvement.

Diagnosis
Diagnosis is by clinical suspicion, presence of autoantibodies (specifically anti-centromere and anti-scl70/anti-topoisomerase antibodies) and occasionally by biopsy. Of the antibodies, 90% have a detectable anti-nuclear antibody. Anti-centromere antibody is more common in the limited form (80-90%) than in the systemic form (10%), and anti-scl70 is more common in the diffuse form (30-40%) and in African-American patients (who are more susceptible to the systemic form).

In 1980 the American College of Rheumatology agreed upon diagnostic criteria for scleroderma

Causes
There is no clear obvious cause for scleroderma and systemic sclerosis. Genetic predisposition appears to be limited: genetic concordance is small; still, there often is a familial predisposition for autoimmune disease. Polymorphisms in COL1A2 and TGF-β1 may influence severity and development of the disease. There is limited evidence implicating cytomegalovirus (CMV) as the original epitope of the immune reaction, and organic solvents and other chemical agents have been linked with scleroderma.

Click to see>Gene clue to fatal skin disease

One of the suspected mechanisms behind the autoimmune phenomenon is the existence of microchimerism, i.e. fetal cells circulating in maternal blood, triggering an immune reaction to what is perceived as “foreign” material.

A distinct form of scleroderma and systemic sclerosis may develop in patients with chronic renal failure. This entity, nephrogenic fibrosing dermopathy or nephrogenic systemic fibrosis, has been linked to the exposure to gadolinium-containing radiocontrast.

Bleomycin (a chemotherapeutic agent) and possibly taxane chemotherapy may cause scleroderma, and occupational exposure to solvents has been linked with an increased risk of systemic sclerosis.

Pathophysiology
The overproduction of collagen is thought to result from an autoimmune dysfunction, in which the immune system would start to attack the kinetochore of the chromosomes. This would lead to genetic malfunction of nearby genes. T cells accumulate in the skin; these are thought to secrete cytokines and other proteins that stimulate collagen deposition. Stimulation of the fibroblast, in particular, seems to be crucial to the disease process, and studies have converged on the potential factors that produce this effect.

A significant player in the process is transforming growth factor (TGFβ). This protein appears to be overproduced, and the fibroblast (possibly in response to other stimuli) also overexpresses the receptor for this mediator. An intracellular pathway (consisting of SMAD2/SMAD3, SMAD4 and the inhibitor SMAD7) is responsible for the secondary messenger system that induces transcription of the proteins and enzymes responsible for collagen deposition. Sp1 is a transcription factor most closely studied in this context. Apart from TGFβ, connective tissue growth factor (CTGF) has a possible role.

Damage to endothelium is an early abnormality in the development of scleroderma, and this too seems to be due to collagen accumulation by fibroblasts, although direct alterations by cytokines, platelet adhesion and a type II hypersensitivity reaction have similarly been implicated. Increased endothelin and decreased vasodilation has been documented.

Jimenez & Derk describe three theories about the development of scleroderma:

The abnormalities are primarily due to a physical agent, and all other changes are secondary or reactive to this direct insult.
The initial event is fetomaternal cell transfer causing microchimerism, with a second summative cause (e.g. environmental) leading to the actual development of the disease.
Physical causes lead to phenotypic alterations in susceptible cells (e.g. due to genetic makeup), which then effectuate DNA changes which alter the cell’s behavior.

Therapy
There is no cure for every patient with scleroderma, though there is treatment for some of the symptoms, including drugs that soften the skin and reduce inflammation. Some patients may benefit from exposure to heat.

A range of NSAIDs (nonsteroidal anti-inflammatory drugs) can be used to ease symptoms, such as naproxen. If there is esophageal dysmotility (in CREST or systemic sclerosis), care must be taken with NSAIDs as they are gastric irritants, and so a proton pump inhibitor (PPI) such as omeprazole can be given in conjunction.[citation needed]

Immunosuppressant drugs, such as mycophenolate mofetil (Cellcept), cyclophosphamide or methotrexate are sometimes used to slow the progress. Digital ulcerations and pulmonary hypertension can be helped by prostacyclin (iloprost) infusion. Iloprost being a drug which increases blood flow by relaxing the arterial wall.

While still experimental (given its high rate of complications), hematopoietic stem cell transplantation is being studied in patients with severe systemic sclerosis; improvement in life expectancy and severity of skin changes has been noted.

Treatment

Scleroderma has no known cure    there’s no treatment to stop the overproduction of collagen. Your doctor may recommend a number of medications to make it easier for you to live with scleroderma by treating its symptoms. Your doctor may also suggest medications to prevent complications of scleroderma that may affect various organs. Here are some of the many treatments prescribed for the symptoms and complications of this condition.

Skin changes
If you have localized scleroderma, your doctor may recommend a topical treatment, such as a moisturizer or corticosteroid medication that you apply to your skin. Corticosteroid medications impede your body’s ability to make substances that can cause inflammation.

If your condition involves a large area of skin, your doctor may recommend additional treatments. Doctors sometimes prescribe minocycline (Minocin, Dynacin) to control the skin-related (cutaneous) symptoms of scleroderma, although no studies have addressed its long-term effectiveness. In preliminary studies, light therapy (phototherapy) also has proved effective in treating the lesions that are associated with scleroderma, but more research is needed.

Cosmetic treatments are another consideration. Some people with scleroderma are discouraged or embarrassed by lesions and marks on the skin, including tiny dilated blood vessels that often appear on the face (telangiectasia). Specialized brands of foundation makeup and pulsed dye laser surgery can help camouflage or eliminate these lesions. Consult a dermatologist about treatments for skin changes.

Circulation problems
Your doctor may also prescribe medications to dilate blood vessels and promote circulation. These medications can prevent high blood pressure and kidney problems and help treat Raynaud’s phenomenon.

Medications that help with blood circulation include:

  • Calcium channel blockers.
  • Alpha blockers
  • Angiotensin-converting enzyme (ACE) inhibitors
  • Angiotensin II receptor blockers
  • Low-dose enteric-coated aspirin

Creams containing nitroglycerin also may help promote circulation.

Joint stiffness, pain and inflammation
Your doctor may prescribe anti-inflammatory medications such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or low-dose corticosteroids to relieve joint pain and stiffness.

Often, along with NSAIDs, doctors prescribe certain medications called disease-modifying antirheumatic drugs (DMARDs). These medications seem to do their job by having an effect on immune systems that have gone out of control, but doctors don’t understand exactly how DMARDs work. Common DMARDs include:

  • Hydroxychloroquine (Plaquenil). This drug has relatively few side effects, and it’s also effective for the arthritis that can be associated with scleroderma. Apart from hydroxychloroquine’s apparent ability to affect the way immune cells work, scientists don’t completely understand how it helps tame the disease process.
  • Penicillamine (Cuprimine, Depen). Similar to other DMARDs, penicillamine can reduce inflammation. Its full effect may require many months to develop, but its beneficial effects may be longer lasting. However, because of a relatively high incidence of adverse reactions to this drug and studies casting doubt on its effectiveness, its use has declined in recent years.
  • Methotrexate (Rheumatrex, Trexall). This drug does its job by affecting cells that are responsible for some of the pain, inflammation and joint swelling that accompany scleroderma. Trials have shown conflicting results regarding the effectiveness of methotrexate in treating scleroderma.

Immunosuppresents are another class of medications that can help manage out-of-control immune systems. Cyclophosphamide (Cytoxan) is one example. This extremely potent medication works by damaging cells’ genetic information. In particular, it kills white blood cells called lymphocytes that are part of autoimmune disease.

Lung damage
If you have scleroderma that affects your lungs, you may need additional medications. Cyclophosphamide (Cytoxan) is sometimes used to treat pulmonary fibrosis. A 2006 study of people with scleroderma-related lung disease found cyclophosphamide modestly improved lung function and quality of life. The long-term effects of cyclophosphamide treatment in people with scleroderma are unknown. Bosentan (Tracleer) is an oral medication that has been approved for pulmonary hypertension in people with scleroderma.

Digestive difficulties
If scleroderma has affected your esophagus and you’re experiencing heartburn, your doctor may suggest prescription medications that decrease stomach acid production. These medications include H-2-receptor blockers and proton pump inhibitors. Your doctor may also suggest antibiotics, special diets and medications that improve your gut’s ability to contract.

Complications
Having systemic scleroderma may result in a number of other health conditions:

Gastrointestinal complications. In scleroderma, wasting occurs in the muscular walls of your intestine. This can reduce absorption of nutrients and movement within the intestine, resulting in weight loss and malnutrition. When scleroderma affects the muscular lining of your esophagus, heartburn can occur.
Lung complications. Scarring of lung tissue (pulmonary fibrosis) can result in reduced lung function, reduced ability to breathe and reduced tolerance for exercise. You may also develop high blood pressure in the arteries to your lungs (pulmonary hypertension).
Kidney complications. When scleroderma affects your kidneys, you can develop an elevated blood pressure and an increased level of protein in your urine. More serious effects of kidney complications may include renal crisis, which involves a sudden increase in blood pressure and rapid kidney failure.
Heart complications. Scarring of heart tissue increases your risk of heart arrhythmias and congestive heart failure, and can cause inflammation of the membranous sac surrounding your heart (pericarditis).

Self-care

You can take a number of steps to help manage your symptoms of scleroderma:

  • Stay active. Exercise keeps your body flexible, improves circulation and relieves stiffness. Range-of-motion exercises can help keep your skin and joints flexible.
  • Don’t smoke. Nicotine causes blood vessels to contract, making Raynaud’s phenomenon worse. Smoking can also cause permanent narrowing of your blood vessels. Quitting smoking is difficult — ask your doctor for help.
  • Manage heartburn. Avoid foods that give you heartburn or gas. Also avoid late-night meals. Elevate the head of your bed to keep stomach acid from backing up into your esophagus (reflux) as you sleep. Try over-the-counter antacids for relief of symptoms.
  • Protect yourself from the cold. Wear warm mittens for protection when your hands encounter cold temperatures   such as when you reach into a freezer. When you’re outside in the cold, cover your face and head and wear layers of warm clothing.

Coping skills

Depending on how you’re affected by scleroderma, you may benefit from physical therapy and occupational therapy. Therapists can help you manage pain, improve your strength and mobility, and work on performing essential daily tasks to maintain your independence. Ask your doctor to recommend a physical therapist or an occupational therapist.

As is true with other chronic diseases, living with scleroderma can place you on a roller coaster of emotions. Here are some suggestions to help you even out the ups and downs:

  • Maintain normal daily activities as best you can.
  • Pace yourself and be sure to get the rest that you need.
  • Stay connected with friends and family.
  • Continue to pursue hobbies that you enjoy and are able to do.

If scleroderma makes it difficult for you to do things you enjoy, ask your doctor about ways to get around the obstacles.

Keep in mind that your physical health can have a direct impact on your mental health. Denial, anger and frustration are common with chronic illnesses.

At times, you may need additional tools to deal with your emotions. Professionals, such as therapists or behavior psychologists, may be able to help you put things in perspective. They can also help you develop coping skills, including relaxation techniques.

Joining a support group, where you can share experiences and feelings with other people, is often a good approach. Ask your doctor what support groups are available in your community.

In addition, many chronic illnesses place you at an increased risk of depression. This isn’t a failure to cope but may indicate a disruption in your body’s neurochemistry that can be helped with appropriate medical treatment. Talk with your family, friends and doctor if you’re feeling depressed.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Scleroderma
http://www.mayoclinic.com/health/scleroderma/DS00362/DSECTION

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