Ankylosing Vertebral Hyperostosis With Tylosis And Its Homoeopathic Approach

Introduction : 

Ankylosing vertebral hyperostosis with tylosis is a rare disease,with two pathological conditions, ankylosing vertebral hyperostosis and tylosis, both illness indicate a hereditary disorder.

Ankylosing vertebral hyperostosis known as Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a non-inflammatory condition with abnormal calcification of the vertebral column. It affects older adults, with stiffness, spinal immobility and dysphagia.

Tylosis :

Tylosis is a hyperkeratotic condition affecting palms and soles. Its hereditary with risk of squamous cell carcinoma of esophagus.

Ankylosing Vertebral Hyperostosis With Tylosis:

There are no types of ankylosing vertebral hyperostosis with tylosis. Based on clinical features, the few types are classified as:

1. Idiopathic:

No known genetic or syndromic cause.

Both conditions Diffuse Idiopathic Skeletal Hyperostosis and tylosis, due to metabolic risk factors like diabetes obesity or aging.

2. Hereditary/Syndromic Type:

Tylosis is part of a genetic syndrome, such as with esophageal cancer risk, requiring genetic evaluation.

3. Paraneoplastic or Secondary Type:

Tylosis is related with internal malignancies such as esophageal cancer and hyperostosis is a paraneoplastic process, which occurs due to metabolic disturbances.

4. Metabolic Type:

Both conditions are related with underlying metabolic syndrome, diabetes mellitus, or obesity. DISH is related to insulin resistance resulting in skin conditions.

Causes Of Ankylosing Vertebral Hyperostosis With Tylosis : 

The causes of ankylosing vertebral hyperostosis with tylosis occurs, due to the rarity of presentation.

1. Genetic Causes:

Tylosis is inherited in an autosomal dominant pattern such as Howel-Evans syndrome, with a risk for esophageal cancer.

2. Metabolic and Endocrine Factors:

DISH is related with:

• Obesity
• Type 2 diabetes mellitus
• Hyperinsulinemia
• Hyperlipidemia

These metabolic disturbances involve skin conditions triggering keratotic changes.

3. Age and Degeneration:

DISH primarily affects older adults, effecting ligamentous and bony structures, tylosis occurs as a part of non-genetic palmoplantar keratoderma.

4. Environmental and Lifestyle Factors:

Due to repeated mechanical stress, high fat diets, sedentary lifestyles,results in tylosis, metabolic and skin disorders.

5. Syndromic/Paraneoplastic Causes:

As a part of malignancies,paraneoplastic syndromes and tylosis with esophageal cancer leads to skin and skeletal issues.

Symptoms Of Ankylosing Vertebral Hyperostosis With Tylosis : 

The symptoms of two disorders, ankylosing vertebral hyperostosis and tylosis, a type of palmoplantar keratoderma. 

1. A. Symptoms of Ankylosing Vertebral Hyperostosis:
2. Spinal stiffness and pain on the thoracic and lumbar spine, which is worse on morning and after rest.
3. Decreased motion, around the neck and lower back.
4. If cervical spine is involved due to osteophyte formation, difficulty in swallowing present.

4.In advanced cases, spinal deformity is present 

5. If osteophytes compress spinal nerves,tingling or numbness happens.
6. Symptoms of Tylosis:
7. Thickened, dry skin, on the palms and soles
8. Cracking and fissures, cause pain, while using hands and walking.
9. In hereditary conditions, excessive sweating present.
10. In Nail changes, thickening, discoloration, and ridging present.
11. In hereditary tylosis, increased risk of esophageal cancer.
    
12. Syndromic Symptomes:

The Family history of tylosis and cancer present.

D.Symptoms of gastrointestinal discomfort or dysphagia:

Multiple system such as skin, skeletal and gastrointestinal is involved.

 General Approach With Side Effects Of Ankylosing Vertebral Hyperostosis With Tylosis:

General Management focuses on symptomatic relief, prevention of complications and monitoring malignant conditions.

1. General Management Approach:
2. Clinical Evaluation:

• Physical examination with detailed history taken focusing on spine stiffness, skin and cancerous symptoms.
• Radiological imaging X-ray or CT of the spine to confirm hyperostosis.
• To assess dermatological diagnosis and classification of tylosis.
• If hereditary tylosis suspected, esophageal screening and endoscopy is advised.

2. Symptomatic Treatment:

For Vertebral Hyperostosis: 

• NSAIDs is used to reduce pain and stiffness
• Physical therapy to maintain mobility and posture
• Weight management, improves symptoms and metabolic factors
• Surgery needed, if osteophytes cause dysphagia or spinal cord compression.

For Tylosis:

• Emollients and keratolytics such as urea or salicylic acid creams are used.
• Topical retinoids helps to reduce skin thickening
• Oral retinoids such as acitretin, is used for severe hereditary conditions.
• Monitoring is necessary for esophageal cancer, in familial tylosis syndromes.

1. Side Effects and Complications:
2. Medication-Related Side Effects:

• NSAIDs for Gastric ulcers, kidney dysfunction, cardiovascular risks.
• Topical treatments is for skin irritation and peeling.
• Oral retinoids is tetratogenic, should be avoided in pregnancy.

2. Disease-Related Complications:

For DISH:

• Spinal immobility and chronic pain
• Dysphagia or breathing issues by cervical osteophytes
• Spinal fractures 

For Tylosis:

• Painful fissures, hand and foot function is limited.
• Psychological impact by visible skin changes.
• Increased esophageal cancer risk in hereditary conditions 

Homoeopathic Approach And Remedies For Ankylosing Vertebral Hyperostosis With Tylosis :

In homeopathy, treatment is individualized, focusing on the totality of symptoms—physical, mental, and emotional. Few Homeopathic medicines are:

1. Rhus Toxicodendron: This medicine is chosen for, Stiffness and pain in the spine that improves with motion and worsens with rest.
2. Calcarea Fluorica: This medicine is used for bony overgrowths, ligamentous calcification, and hard,cracked skin in tylosis.
3. Silicea: This medicine is indicated for skin thickening, cracking soles and chronic inflammation in tylosis.
4. Bryonia Alba: This medicine is used for Joint and spine pain that worsens with motion and improves with rest. 
5. Petroleum: This medicine is indicated for deep, thick, cracked skin and itching on palms and soles.

Diet Plan For Ankylosing Vertebral Hyperostosis With Tylosis :

A fixed diet and nutritional support can help reduce inflammation, manage skin health and avoid metabolic risk factors:

Daily Meal Plan:

Breakfast: Oatmeal with flaxseeds, blueberries, and almonds + green tea

Mid-morning: A banana + a handful of walnuts

Lunch:Grilled salmon, quinoa, steamed broccoli with olive oil 

Snack: Carrot sticks with hummus

Evening: Warm chamomile tea, a few sunflower seeds.

Dinner: Lentil soup, mixed green salad with sweet potato.

FAQs Of Ankylosing Vertebral Hyperostosis With Tylosis

1. Is this a genetic disorder?

Tylosis can be genetic,in hereditary conditions related to esophageal cancer. DISH is not genetic, when both conditions occur together, a genetic involvement is possible.

2. How is it diagnosed?

a.Imaging such as X-ray and CT to detect spinal ossification.

b.Clinical skin examination and biopsy for tylosis.

c.Family and cancer history is important for hereditary evaluation.

3. Is there a cure for this condition?

There is no cure, but symptoms can be managed by lifestyle Changes, medications, skincare and physical therapy and exercise, reducing stiffness is advised. In hereditary conditions of tylosis, regular monitoring is essential.

4. Can diet help in managing the condition?

Yes. An anti-inflammatory, nutrient-rich diet  supports joints, manage skincare and metabolic risk factors like diabetes, which are related with DISH.

5.Should family members be screened?

If tylosis is hereditary, with a family history of esophageal cancer, genetic counseling and screening is advised.

Conclusion

It is a challenging disease, but by the intervention in early stages, good management, and combined treatments such as homeopathy, patients can improve their quality of life. Dr. Vaseem Choudhary and his experienced team of professionals at Homeo Care Clinic are homeopathic treatment specialists who treat children afflicted with neurological disorders by providing them with natural but effective individualized medicines.

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