What Is Systematic Sclerosis?
We can define it as a rare but chronic disease, caused due to unknown reasons, which are characterized by vascular abnormalities and diffuse fibrosis of internal organs, joints and skin. Its diagnosis can be made on a clinical level only, through laboratory tests. Following a specific treatment after diagnosis is difficult, as each conventional medicine has its complications.
What Are The Types Of Systematic Sclerosis?
It is classified into three different categories:
1.) Limited systematic sclerosis – is also known as CREST syndrome. In this type of SSc, subjects experience tightening of the skin over the face and near the knees and elbows. The patient might also experience gastroesophageal reflux. It progresses slowly, but can later become complicated due to pulmonary hypertension.
2.) Generalized systematic sclerosis – patients develop GI complications and Raynaud phenomenon along with diffuse skin movement. It is a fast-progressing disease, which can later complicate scleroderma and interstitial lung disease.
3.) Systematic sclerosis sine scleroderma – does not lead to any sort of skin tightening symptoms, but patients experience the visceral manifestation of this disease and systematic sclerosis antibodies.
What Are The Symptoms Of Systematic Sclerosis?
Different symptoms or signs of this disease start surfacing after episodes of Raynaud phenomenon – develops a few weeks before fibrosis. Raynaud phenomenon causes fingers and toes of a patient to turn blue or white in response to stress or temperature changes. It is due to the reason that tiny blood vessels are damaged and their ability to carry blood to different extremities is affected. Other symptoms include:
- Puffy and swollen hands or feet
- Thickening and hardening of the skin (starts from the fingers first)
- Ulcers on fingers
- Painful bumps right under the skin
- Clusters of blood vessels under the skin that appear enlarged
- Pain, numbness, and stiffness in different joints
- Red spots on chest and face
- Muscular weakness
SSc leads to fibrosis, which can badly damage internal organs too and in some cases, complete failure or impairment of affected organs can take place. Fibrosis can affect kidneys, lungs, heart and the esophagus easily. Also, the disturbance caused to internal organs can further lead to diarrhea, shortness of breath, impairment of intestinal muscles, kidney problems, hypertension, dysphagia, and heartburn.
Bee Venom Acupuncture For Circumscribed Morphea in a Patient with Systemic Sclerosis
SSc, as told above, is a rare autoimmune disease of the connective tissues, which is associated with an internal organ, joint, and cutaneous involvement. Though medicine has evolved a lot, till now no proper curative treatment is available for this disease. Currently, topical vitamin D, phototherapy, oral steroids, and immunosuppressants are being used to treat symptoms of SSc. Though therapies help relieve general symptoms, each treatment has some sort of side effects like headache, itching and skin burn.
According to different clinical studies, it has been found that alternative treatments can alleviate symptoms of SSc. Pharmacopuncture is one of the most popular types of acupuncture treatments, adopted by the traditional Chinese and Korean medicine regimes. During this treatment, acupoints are stimulated through the injection of different herbal medicines. Among the herbal medicines used, bee venom acupuncture can be regarded as the best pharmacopuncture treatment.
Bee venom has been used since a very long time, as an alternative or complementary medicine, as it delivers strong anti-atherosclerotic, anti-fibrotic, anti-nociceptive, anti-apoptotic and anti-inflammatory effects.
A 64-year-old patient, weighing around 45kgs, was diagnosed with SSc. It all started when she noticed itching in right lateral iliac crest and no topical soothing creams helped control itching. Apart from itching, there were also white spots around the right lateral iliac crest, which were 1cm to 3 cm in diameter. Her symptoms were quite similar to that of a worm bite. Upon visiting the Gachon University Gil Korean Medical Hospital her medical history was further revealed.
It was found that she was already a patient of SSc, Takayasu’s arteritis and had undergone aortic surgery. She had used aspirin, antitussive expectorants, steroids and painkillers in the past. But this time along with that irritation patch, she also complained of weight loss and fatigue. It was also found that she was given bee venom pharmacopuncture in the past to deal with chronic shoulder pain and had experienced no sort of adverse effects.
So bee venom pharmacopuncture was chosen again. It was administered once it was confirmed, after several evaluations, that she is eligible for BV therapy. To conduct this study, a sterilized solution of bee venom was prepared by aseptic processing of 1gm of dried bee venom, which was at the end dissolved in 10,000cc of water. Jaseng Herbal Medicine Dispensary provided the bee venom pharmacopuncture solution. Bee venom acupuncture was injected subcutaneously along margins of patches (the superficial circumscribed lesion) through shallow surround needling method. 0.02mL of bee venom was injected into each site with the help of a 31gauge insulin syringe at a depth of 4mm maximum. It was made sure that the total injected volume of bee venom did not exceed 0.2mL. This treatment was given twice a week for 7 seven days and later it was reduced to one dose per week. This regime was followed for 3 weeks straight.
It was observed that after the first treatment, patients score related to average sleep disturbance and itch came down to a scale of 6 to 2 and 8 to 4 respectively. The score was measured on NRS11 (an 11 point numeric scale). After the third visit, it was reported that itching had nearly diminished after 2 regular treatments – there was only a weak reappearance on an intermittent basis. Score later came down to 0 and it remained the same till her fifth visit. After her fifth visit, it was found that there was no itching anymore and hence her sleep had improved. Once the itching disappeared her skin also became better. After a 3 month follows up, it was established that the appearance of affected skin had returned to normal. As the patient was completely satisfied with bee venom therapy there was no need to continue the treatment. No sort of adverse effects was recorded during this treatment apart from slight itchiness at the location of injection, which lasted for only 36 hours and then vanished completely.
Morphea is described as localized scleroderma, which is an inflammatory disease that involves the subcutaneous tissue and the skin and is characterized by abnormal collagen deposition that eventually leads to fibrosis. In comparison with SSc and Raynaud’s phenomenon, visceral involvement and typical antibodies are absent in LoS. LoS is more of dermatological disease, but it does overlap with other diseases (most of them are autoimmune diseases) or occurs as a symptom of some sort of evolution towards any systemic form. LoS and SSc are both distinct clinical entities but represent analogous histopathological findings. The presence of Raynaud’s phenomenon or antibodies has been found in LoS.
According to a clinical study made earlier, possible evolution or coexistence of LoS and SSc cannot be ruled out. Previous studies have also declared that the CAM therapy promotes physical and mental wellbeing in patients of SSc. But at the same time, the overall effect of these therapies on an active phase morphea in the patients having SSc has not been reported yet.
Bee venom is composed of different natural products that contain beneficial pharmaceutical elements that are composed of peptides, enzymes, and nonpeptide components. Using bee venom in some specific acupoints is known as; bee venom therapy or pharmacopuncture or bee venom acupuncture in TKM. It has been found that bee venom affects vascular endothelial growth factor, fibrosis, immune regulation, and anti-cancer outcomes. Efficacy of bee venom can be linked with the aforementioned reasons of morphea. Though bee venom is now being widely used for its beneficial traits, in some cases, adverse effects like swelling and itching have also been reported.
For conducting this clinical study, the shallow surround needling technique was adopted to focus circumscribed morphea that is localized to subcutaneous tissue and the skin. Bee venom acupuncture was given subcutaneously along with superficial circumscribed lesions. For the large patch, a surrounded needling technique was adopted, while for the small patch only a single point was chosen. It is an ancient needling method, which is used to treat skin problems by targeting the center of that point. Additional needling is done at the posterior, anterior, left and right of that point to address widespread pathogenic factors.
This clinical study is quite different from others, as it focuses on bee venom therapy for LoS. The association of SSc and morphea is labeled as a rare condition. This case represented an improvement in the local skin symptoms, which are associated with itching and sleep disturbance through bee venom therapy for a LoS patient already having SSc. It can be declared that bee venom therapy can be used as an alternative method to treat morphea – with or without systemic sclerosis. Though it requires to be used properly – the dose and needling method must be followed accurately to get the desired results. So, it was found that the local skin symptoms of the patient significantly improved after a regular treatment based on a period of 5 months – the outcome was maintained until a 3 month follow up schedule.
This case study has its limitations, as the study sample was small and there was no control group to carry out a comparison. There was also no histopathological observation carried out and overall improvement was determined from the improving skin symptoms only. But this case study can provide a base for using bee venom to treat the circumscribed morphea with SSc. Further experiments can make use of a visual analog scale or NRS to measure itching accurately.
BV acupuncture possesses the potential to be used as an effective therapy for circumscribed morphea. But extensive research in the future must be designed to explicate optimal modality of BV therapy.
Bee Venom Pretreatment Has Both an Antinociceptive and Anti-Inflammatory Effect on Carrageenan-Induced Inflammation
Bee venom injection helps evoke hyperalgesia and tonic pain, but there is slightly conflicting evidence available in the clinical literature that indicates bee venom can also lend anti-nociceptive and anti-inflammatory effects on inflammation. Bee venom has been used in different oriental medicines to treat chronic inflammatory diseases and to relieve pain. This study was conducted under normal conditions to test the role of bee venom for acute nociception.
The clinical experiment was designed to especially evaluate effects of bee venom pretreatment on thermal hyperalgesia and the CR induced acute paw edema. Quantitative analysis of the spinal cords Fos expression resulted due to peripheral inflammation. It was noticed that in the normal animals a subcutaneous bee venom injection administered into hind limb slightly increased Fos expression in the spinal cord. This was done without producing any sort of detectable hyperalgesia or nociceptive behavior.
While in contrast, a pretreatment carried out with bee venom at a dose of 0.8mg/ kg 30 minutes before a CR injection lead to suppression of thermal hyperalgesia and paw edema evoked by CR. A positive correlation was also found between the expression of Fos positive neurons in the spinal cord and the percent change in the paw volume.
According to these results, it can be said that bee venom treatment results in anti-inflammatory and anti-nociceptive effects in the CR induced inflammatory pain. Data obtained also suggests that a controlled bee venom treatment can be beneficial for curing edema and pain that arises due to any chronic inflammatory disease.
Bee venom acupuncture offers a befitting solution to treat different symptoms of systemic sclerosis and its additional manifestations. It can be used regularly for a couple of months until the symptoms fade away and the best thing is that; it does not lead to any sort of severe adverse effects that other conventional medicines can. But further clinical studies, which are based on huge samples and complex assessment criteria, are required to determine the exact dose and method of using bee venom acupuncture that would help deal with any specific symptom of systemic sclerosis.
1: Bee venom acupuncture for circumscribed morphea in a patient with systemic sclerosis
2: Bee venom has been reported to demonstrate antinociceptive and anti-inflammatory effects in experimental studies.