Russian traditional medicine in dermatology

Clinics in Dermatology Available online 13 March 2018 In Press, Accepted Manuscrip Author links open overlay panelOlga Y.OlisovaaElena S.SnarskayaaVictor V.GladkobEkaterina P.Burovaabc a First Moscow State Sechenov Medical University of the Russian Federation, 4 Bolshaya Pirogovskaya street, Moscow, Russia b 11 Volokolamskoe Shosse, Moscow, Russia c Department of Dermatology, Bedford Hospital, United Kingdom, South Wing, Kempston road, Bedford, UK, MK42 9DJ Available online 13 March 2018. https://doi.org/10.1016/j.clindermatol.2018.03.007 Get rights and content Abstract The use of herbal remedies for various medical issues is becoming increasingly commonplace in all fields of medicine, and dermatology is no exception. This review focuses on traditional dermatologic herbal remedies, commonly used in Russia, as the rich array of eleven different plant zones has resulted in a great variety of medicinal plants. Herbal remedies warrant deeper investigation and research, especially due to their active substance content, which may interfere with, or reinforce the effect of modern medications, something that medical professionals should be aware of when prescribing treatments. While there are a great number of traditional herbal treatments in Russia, only the most commonly used and known treatments and applications will be described as an introduction to the field, which has had many books of varying quality written about it. The preparation and application of treatments for vitiligo, pyodermas, parasitic and infectious skin diseases, acne, dermatitides, rosacea, hyperpigmentation, rhytides, psoriasis, and hyperhidrosis are discussed. Introduction The history of the use of herbal mixes, photorespirations, and biologically active additives produced from natural forms of plant and mineral raw materials extends over many centuries. The extraction of active medicinal substances from plants was already performed by Galen in the 2nd century BCE, leading to the conception of the idea of Galenic Medicines and the science of Galenic Formulations. The medicinal value of plants is the result of a wide range of ingredients that have a therapeutic effect – vitamins A, C, B, K, and E, organic acids (malic, lactic, citric, and linolenic acids, etc.), enzymes, flavonoids, salts, micro-elements, and phytoncides. Micronutrients (vitamins and minerals) are natural substances that are essential, in minute amounts, to the development and healthy function of a living organism. Micronutrients have a cumulative, mild and long-lasting clinical effect. The substances produced from medicinal herbs today are called Neo-Galenic Preparations and stand out by being highly refined.1,2 (See Figs. 1–5.) Fig. 1 Download high-res image (723KB)Download full-size image Fig. 1. Fig. 2 Download high-res image (625KB)Download full-size image Fig. 2. Fig. 3 Download high-res image (931KB)Download full-size image Fig. 3. Fig. 4 Download high-res image (801KB)Download full-size image Fig. 4. Fig. 5 Download high-res image (844KB)Download full-size image Fig. 5. Medicinal plants have been used in the lands that make up modern Russia since ancient times. The study of numerous written sources shows that herbal treatments had even been administered by the Scythians who lived in the Northern Territories by the Black Sea coast between the Dniester and the Don rivers (from the 7th century BCE to the 1st century CE). The Scythian experience in the use of herbal medicines was passed on to the Slavic pagan priests by generations of proto-slavic tribe of the Antes. Following the introduction of Christianity, herbal remedies were used by the clergy, who would mainly attend the wealthy, while the common people were served by shamans, wise men, and herbalists. One of the greatest medical events of that time was the appearance of the Anthology (1073) of Grand Kniaz Svyatoslav Yaroslavovich (1027-1076) which described plants that grew on the Russian territories and which were most commonly used for medical purposes. The chronicles of Novgorod also describe the use of “banya mold” to treat wounds and the way it would prevent infection from setting in, predating the discovery of penicillin in the United Kingdom by seven centuries. 21 In 1581, Tsar of All Russia, Ivan the IV(1530-1584), ordered the establishment of the first pharmacy that would supply the court of the Tsar, as well as the foundation of the Pharmacist’s House, which was responsible for the collection of medicinal plants that grew in the Russian lands. The collection and use of medicinal plants became particularly widespread during the reign of Peter I (1672-1725) who personally grew medicinal herbs in his private garden. During this period, eight private pharmacies were opened in Moscow by the decree of Peter I (1572-1625), and a large pharmacologic garden, which the Tsar considered his pride and joy, was planted in 1714.3 Phytotherapy is now recognized as an official medical field in Russia and herbal medicines are considered to be medical drugs. The Russian Federation has continued to use the State Pharmacopoeia of the USSR (11th edition) which contains 83 descriptions of plants with medicinal properties. The European Pharmacopoeia lists and discusses 51 of these plants; however, the properties of 32 of them are only described in the Pharmacopoeia of the USSR.Russia is the largest country in world, almost twice the size of Canada, the second largest state today. It extends across all of northern Asia and to the Far East and encompasses one third of Eastern Europe, covering a great range of varied environments and landscapes, including the Arctic tundra, taiga, steppes, deserts and forests. All types of vegetation zones are represented with the exception of tropical rain forests.4 Russian traditional medicines reflect the diversity of its soils, minerals, climates and flora. We present the rationale behind the use of several traditional Russian medicinal herbs along with personal recipes and anecdotal methods for their use. VITILIGO Vitiligo is considered to be an autoimmune disorder and associated with other autoimmune conditions, including diabetes mellitus type 1, alopecia areata, inflammatory bowel disease, pernicious anemia, rheumatoid arthritis, and thyroid disease. There is a higher incidence of anti-thyroid antibodies in patients with vitiligo. 5 St. John’s-Wort One of the herbs most frequently used in Russian traditional medicine for the treatment of vitiligo is St John’s-Wort (Hypericum perforatum). (Figure 1) The plant contains flavonoids, niacin, vitamins C and carotene, protein, calcium, zinc (highest in flowers), magnesium, sodium and potassium, tannins, anthraquinones, saponins, fats, oils and proteins.6 The most important quality of St John’s-Wort in the treatment of vitiligo is its photosensitizing effect. The herb should be taken with caution due to its multiple reported side effects, including cytochrome P450 activation which can interfere with the metabolism of many medications. It is also known to affect thyroid function, causing increased levels of thyroid stimulating hormone (TSH) and should be taken with caution by patients having a history of thyroid disease and those using thyroid preparations, especially hormones.7 Recipe 1: St. John’s-Wort Oil Preparation: Tightly pack a small glass jar with St John’s-Wort flowers and pat them down slightly. The number of flowers required must be sufficient to fill the jar, while leaving 4-5 cm of empty space on top. Add cold-pressed olive oil to the top of the jar and place in the sun (not in the shade, but in direct sunlight) for at least 2 weeks, giving it a shake every day. Following this period of time, press the mixture through a strainer so that the oil is clear and add a new portion of St John’s-Wort flowers. Then, leave the jar in the sun for an additional 2 weeks. This must be repeated 5 to 7 times. As St John’s-Wort flowers all summer, there should not be any issues with getting raw materials. The resulting St John’s-Wort oil should be red-brown in color, with a creamy consistency. Method of application: Make compresses using the St John’s-Wort oil by soaking a piece of gauze or a thin cloth napkin in the prepared oil and place upon the affected areas. The compress should be applied for approximately 30 minutes. Application is followed by exposing the treated areas to sunlight. Caution should be taken not to exceed 2 minutes with the first treatment; however, over time, sun exposure may be increased by a few minutes each following day until a maximum of 30 minutes is reached. This procedure should be carried out twice daily for a full course of 30 days. 2 to 3 monthly cycles are recommended with 2 week breaks between each cycle. To increase the effectiveness of the treatment of vitiligo when using St John’s-Wort oil, it is recommended that a St John’s-Wort infusion be taken internally at the same time. Recipe 2: St John’s-Wort Infusion Preparation: Cover 1 teaspoon of ground dry St John’s-Wort with approximately 200 ml of boiled water and let stand for 1 hour. Method of application: Take 1 tablespoon of the strained infusion 3 times a day after meals for 21 days. For the treatment to be effective 8 such courses should be repeated with one week breaks in between. Recipe 3: St. John’s-Wort Cream Preparation: Heat 50 ml of olive oil mixed with 5g of ground dry St John's-Wort in a water bath for half an hour. Once cooled, the mixture must be filtered through a piece of muslin. The resulting cream should be stored in a dark glass container in a cool place. Method of application: put the cream on a piece of dense fabric and apply it daily as a compress for 30-40 minutes to the area of skin affected by vitiligo. The course of treatment takes 40 days. Application of the cream must be combined with taking oral St John’s-Wort infusion prepared according to the recipe outlined above. Duckweed Another effective herb used in Russian folk medicine for the treatment of vitiligo is duckweed (Lemna minor, an aquatic freshwater plant). The medicinal properties of duckweed are the result of it containing a substantial amount of iodine, bromide and protein. It has antipyretic, powerful anti-inflammatory and mild analgesic and cholagogic properties.3 Information about the safety of using Duckweed medically in pregnancy or while nursing a child is insufficient, so it is recommended to avoid it in pregnancy or breastfeeding. Recipe 4: Duckweed Oral Infusion Drops3 Preparation: An infusion of duckweed is prepared using vodka as a base, mixing one spoon of the raw plant material with 50 ml of vodka. The necessary amount of the herb must be measured, washed under running water and then placed in a dark non-transparent glass vessel. Pour vodka or 40% medical spirit to cover the herb. Allow the liquid to stand for a week at room temperature in a dark place. The Duckweed infusion must then be filtered through medical gauze. This remedy must be stored in a cool, dark place. Method of application: Take 15 – 20 drops of infusion in a quarter of a glass of water three times a day. Recipe 5: Duckweed Oral Infusion Liquid2 Preparartion: Boil one teaspoon of ground herb in 250 ml of water for 15 minutes. Stand the infusion for an hour and then strain it. Method of application: Take one glass of the infusion 15 minutes before having a meal three times a day for four months. Recipe 6: Duckweed Oral Concoction Preparation: Grind one tablespoon of duckweed using a mincer and mix with an equal amount of honey. Mixed concoction needs to be placed into a glass jar with a lid and kept refrigerated. Method of application: Take one teaspoon daily at breakfast, lunch and dinner recommended for 2 years. It is difficult to achieve the desired effect with a shorter course. PYODERMAS Candelabra Aloe The strong antimicrobial effect of Candelabra Aloe (Aloe arborensis) makes it useful in the treatment of whitlows and furuncles. The leaves of the aloe plant contain complex glucosides, vitamins (especially vitamin C), phytoncides, enzymes and the elements of calcium and magnesium. The soft pulp of the aloe contains 96% water and 4% of polysaccharides and other substances. Candelabra Aloe can improve the immune reactions of the body due to its stimulation of phagocytosis, increasing the T-cell content of the blood while suppressing the synthesis of inflammatory interleukin-1a.1 Recipe 1: Aloe leaf pulp Preparation: Extract pulp for a fresh aloe leaf Method of Application: The pulp of the aloe leaves must be applied to the affected area of the skin for 6-8 hours under a bandage. Raspberry Raspberry leaves contain up to 300 g/L of ascorbic acid, phytoncides, tannins and the elements of potassium, magnesium, iron, copper, zinc and several others. Raspberry fruits and leaves have a very high salicylate and purine content, so they are contraindicated in patients with gout, urolithiasis, gastritis, duodenal and gastric ulcers and during pregnancy before 35 weeks. (Figures 2 and 3) Recipe 2: Fresh Raspberry leaf Preparation: Fresh raspberry leaves ground in a mincer must be mixed with melted butter at a ratio of 1:4. Method of application: Take orally for the treatment of pyodermas. Onion Onions have been used for the treatment of furuncles and carbuncles since ancient times. Apart from 86% of water, onions contain many phytoncides, vitamins C, B1, B2, B6 and E, as well as carotene, biotin, folic acid, and microelements and have strong anti-inflammatory and antimicrobial properties. Recipe 3: Baked onion Preparation: Bake a medium-sized onion Method of application: Cut baked onion in half and one of the halves should be applied over the furuncle and bandaged while still hot. The hot onion should be changed every 3-4 hours until the furuncle comes to a head and drains. Recipe 4: Onion paste Preparartion: Make a paste of raw or baked onion and milk Method of application: Apply paste on the furuncle or carbuncle every 3-4 hours until the furuncle comes to a head and drains. PARASITIC AND INFECTIOUS SKIN DISEASES Inula helenium (Elecampane) root Recipe 1: Inula helenium (Elecampane) root8 A 1:10 infusion of Inula helenium (Elecampane) root was traditionally used for the treatment of scabies in the form of compresses and washes. Inula root infusions have antimicrobial and anti-inflammatory properties. Caraway Oil (Carum carvi) Caraway oil has antiseptic, anti-histaminic, anti-spasmodic, carminative, digestive, disinfectant, diuretic, expectorant, astringent and other properties. Recipe 2: Caraway Oil Preparation: Dissolve the essential oil of caraway (Carum carvi) in olive, sunflower or other plant oil at a ratio of 2:100 Method of application: Rub it in as an insecticide. Pure fir (Abies) needle oil Recipe 3: Pure fir (Abies) needle oil9 Method of application: The most common location for epidermophytosis is the toe webs and groin. Gauze soaked with pure fir (Abies) needle oil must be applied in these areas for 10-20 minutes. The procedures must be carried out daily until full recovery (7-10 days are usually enough). Garlic According to Russian folk medicine, one of the effective ways to treat warts caused by the human papilloma virus is to use garlic (Allium sativum). Sulfides, which are one of the ingredients of garlic, seem to have an anti-viral effect, while the phytoncides contained in garlic have a varied bactericidal effect. It is considered to be the best antiseptic that protects from viruses and bacteria. A recent study showed the effectiveness of lipid garlic extract in the treatment of recalcitrant multiple viral warts within 4 weeks.10 Garlic has been used world-wide for a multitude of health issues for centuries. Recipe 4: Garlic paste. Preparation: A few cloves of garlic are ground into a paste, then a teaspoon of the resulting mass is mixed with an equal amount of melted pork lard and four teaspoons of apple vinegar are added. The resulting cream is placed in a dry and clean vessel. Method of application: Apply the paste directly to warts under a bandage or plaster and leave on overnight. Repeat treatment nightly until warts disappear. Recipe 5: Garlic infusion. Preparation: Soak three cloves of garlic in three glasses of wine or apple vinegar. The infusion should stand for three weeks. Method of application: Soak a small piece of cotton fabric in the infusion and apply directly to warts. Leave on as a compress overnight. Repeat the procedure daily until the warts disappear completely. Recipe 6: Garlic Clove. Preparation: Soak a clove of garlic in apple vinegar essence for two hours. Method of application: Bandaged the soaked clove directly onto the afflicted areas overnight. Repeat nightly until the warts disappear. A slice of garlic can also be attached to the wart with a plaster or the warts can be rubbed with garlic for a more potent therapeutic effect. Recipe 7: Fresh Garlic Juice. Preparation: Take 10 medium to large sized cloves of garlic to obtain 60-80 ml (¼ to 1/3 of a teacup) of juice. Squash each clove with a wide knife blade. Peel the skins. Wrap the garlic mash in a piece of gauze and squeeze it to extract the juice into a bowl. Keep the juice in a glass container in the refrigerator. Method of application: Apply fresh garlic juice directly to warts and then apply the inside of the skin of a ripe banana over the affected area and fix with a plaster. Keep on overnight. These compresses must be changed every morning for a week or more, until clearance is achieved. ACNE Viburnum berries Viburnum berries contain vitamins C and K, sugars, saponins, tannins and pectins. The juice is a powerful anti-inflammatory and wound-healing agent. High doses of Viburnum opulus may cause nausea and vomiting. It is contraindicated in pregnancy. Recipe 1: Viburnum berry gauze. Preparation: Squeeze the juice from ripe viburnum berries and wet a napkin with the juice. Method of application: Apply the napkin to the face for 10 minutes at least 8 times a day with 15 minute breaks. The procedure must be completed by applying a moisturizing cream to the face, which should be mixed with viburnum juice before application. The course of treatment must continue for at least 5 days. This should be used at the same time as taking the infusion Recipe 2: Viburnum berry infusion Preparation: To prepare the infusion, grind 5 tablespoons of viburnum berries in a mortar, cover with 0.7 litres of boiling water in a thermos flask, leave for 3-4 hours and then strain. Method of application: Drink 1/2 a glass 4 times a day 20-30 minutes before meals (this infusion has an anti-inflammatory effect). This berry infusion should be taken internally at the same time as using the topical guaze above. Camomile The medicinal effect of the camomile (Matricaria chamomilla; also know as Matricaria recutita and commonly know as German chamomile) is mainly the result of the presence of essential oil (0.2-0.8%). The plant has an antimicrobial, anti-inflammatory action and also improves connective tissue Recipe 3: Chamomile infusion Preparation: Make an infusion by covering chamomile flowers with boiling water for 30 minutes. Allow to cool. Method of application: Once the infusion is cooled, use it to wet a cotton wool ball and apply it to the areas affected by acne for 7 minutes. Repeat daily for a course of 25 days. Nettles Nettles are recommended as a treatment for acne and other chronic skin diseases. Nettles contain the formic, pantothenic, affeic, ferulic and p-coumaric acids, histamine, acetylcholine, ascorbic acid, carotene and other carotinoids, vitamins from the K and B groups, glycoside urticine, phytoncides, tannins and proteins, starch, iron, zinc and other microelements that make nettles have hemostatic, diuretic and estrogenic properties and improve the work of the digestive organs and lower the level of blood glucose and cholesterol. The anti-inflammatory properties and estrogenic effect of the nettle are used for the treatment of acne vulgaris. Recipe 4: Nettle juice. Preparation: Squeeze the juices from fresh stinging nettles (Urtica dioica). Method of application: After an hour, following a light breakfast, drink half a glass of nettle juice, and an hour later, drink the same amount of dandelion juice and after yet another hour drink half a glass of celery juice. Repeat the procedure 3 times every 3 days. Dandelion Root Dandelion root extracts may inhibit the production of the inflammatory cytokines interleukin IL-6 and tumor necrosis factor (TNF)-alpha, and this agent may have leukotriene-inhibiting activity.21 Topically, dandelion can cause contact dermatitis, erythema multiforme, or an anaphylactic reaction in sensitive individuals.22 Concomitant use of dandelion with potassium-sparing diuretics might increase the risk of hyperkalemia due to the high content of potassium in the plant. Dandelion can inhibit Cytochrome P450 3A4 and thereby affect the metabolism of drugs that metabolize via Cytochrome 450 3A4, such as quinolones, cyclosporine, sirolimus, and similar medicaments.23 DERMATITIS When suffering from various dermatidies, the herbs considered most effective are those that have a strong anti-inflammatory and anti-irritant effect. Among the most effective are the application of infusions and creams based on the young leaves and buds of the birch, the flowers of the black elder, oak barks, cinquefoil (Potentilla), and fir needle oil. The leaves and buds of the white birch have a strong anti-inflammatory and anti-irritant effect. The medicinal parts of elder (Sambucus nigra) are the flowers and flower buds that are used before they fall from the plant. They contain essential oils, organic acids and tannins that have a strong anti-inflammatory, analgesic and drying effect. Research studies have shown that an infusion of elderflowers has an antimicrobial and antiviral effect. Fresh and dry leaves are often used to make masks. Birch Recipe 1: Birch leaf infusion. Preparation: Take dry birch leaves (young leaves which are collected in May) and grind them into powder. 4 teaspoons of the powder must be covered with 0.5 liters of boiling water in a porcelain teapot, left to stand for 12-15 minutes. Method of application: Drink one glass daily when suffering from dermatitis. Recipe 2: Birch bud ointment Preparation: Mix 10 g of finely ground birch buds and 100 g of melted butter and cooking the mixture on a slow fire for 5-7 minutes while stirring constantly. The resulting substance must be strained while hot. The ointment must be cooled and stored in a glass vessel in a cool place. Method of application: Apply the ointment to treat exudative dermatitis, wounds, ulcers, fissured skin. The cream has an anti-inflammatory, analgesic and healing effect. Elderflower Recipe 3: Elderflower infusion Preparation: 10 g of dry elderflowers (2 tablespoons) must be covered with 200 ml (1 glass) of hot boiled water, left to stand for 24 hours and then strained and transferred to a dark glass vessel. The infusion must be stored in a cool dark place. Method of application: Apply infusion to the areas affected by inflamed dermatitis for 10 to 15 minutes, 2-3 times per day for 7 days. Oak Bark (Quercus robur) Infusions and creams made from oak bark have a great anti-inflammatory and drying effect on large areas of exudative dermatitis. Infusions that include propolis (bee glue) are considered to be one of the most effective traditional treatments for dermatitis. Recipe 4: Oak bark infusion Preparation: An oak bark infusion is prepared by taking 1 part of ground oak bark and 5 parts of cold water, boiling the mixture for 15 minutes on a slow fire and then letting the resulting solution stand for 24 hours before sieving it. 1 tablespoon of 30% propolis (bee glue) infusion has to be added to the solution. Methods of Application: Use mixture to moisturize the areas affected by dermatitis 1-2 times a day. Recipe 5: Oak bark Tincture Preparation: Take 1 glass of ground oak bark, cover with 1 liter of boiling water and boil for 15 minutes on a slow fire. Then add half a glass of dry ground burr marigold (Bidens tripartite L.) and the same amount of milfoil, boil on a slow fire for another 2-3 minutes, let stand for 20-30 minutes and then strain and add 2 tablespoons of 20% medical spirit propolis tincture. The resulting tincture is used to make compresses that are applied to the affected areas of the skin. Method of application: Compresses should be used 1-2 times a day, with the course or treatment taking 10 procedures. Bidens tripartite L A study evaluating the properties of the essential oil extracted from the roots of Bidens tripartite L against eight Gram-positive and 11 Gram-negative bacterial species and 10 fungal strains showed antibacterial and strong antifungal activity.11 Sea Buckthorn Oil A recipe based on sea buckthorn oil which is used to make creams has well recommended itself for the treatment of painful and deep fissures in the skin. Sea buckthorn oil has an epithelizing, analgesic and antiseptic effect. Recipe 6: Sea Buckthorn Oil Preparation: In order to prepare Sea Buckthorn oil, berries are collected in late autumn, put through a juicer or ground in a mortar. The juice is decanted and the remaining paste is used for the preparation of oil. In order to prepare the oil, the paste is dried, ground and mixed with sunflower oil at a ratio of 1:1.5, and the resulting solution is left to stand for three weeks in a cool, dark place. 3 weeks later, the oil is ready for use. Method of application: Sea Buckthorn oil can be applied to areas of dry or fissured skin. The epithelization of the fissures occurs after only 2-3 days of regular application. Recipe 7: Sea Buckthorn oil cream Preparation: To prepare 5% Buckthorn oil cream, take 5 g of sea buckthorn oil and 95 g of melted pork, chicken or goose fat. The components must be carefully mixed. Method of application: The cream is to be applied to the affected skin twice every 24 hours. Taking 2-3 ml of sea buckthorn oil can be of additional benefit if taken internally once per day at the same time as one of the cream applications. Fir needle oil Fir needle oil is also used for the treatment of edermatitis as its effects are not limited to being a powerful anti-inflammatory medicine - it is also a sedative, that mitigates itching and improves sleep. Recipe 8: Fir needle oil cream Preparation: In order to prepare this cream, pure fir needle oil must be used and mixed at a proportion of 1:1.5 with a melted pork, chicken or goose fat. Method of application: The resulting cream is rubbed in to the afflicted area of skin twice every 24 hours and covered with compress paper to treat dermatitis. If there is no improvement after 2 weeks, then fir needle oil is recommended to be used internally alongside the cream, 4-9 drops nocte depending on weight. ROSACEA The anti-inflammatory effects of marigolds (Calendula officianalis) are widely known. The marigold flower contains carotene, rubixanthin, lycopene, cryptoxanthin, violaxanthin, flavochrome, and flavoxanthin, among other substances. Apart from this, marigold flowers contain carbohydrates of the paraffin series (hentriacontane and sytosterine), saponin, amarines, jellies, saps, phytoncides, proteins, flavonoids, glycoside calendoside, traces of alkaloids, triterpenoids (arnidol and faradiol), organic acids (hydroxysuccinic, petadecynic and salycilic acids), ascorbic acid and essential oil. The green parts of the flower contain amarines, tannins and triterpene saponins. Medicines that have calendula as an ingredient are widely used in pharmacology due to the presence of biologically active compounds in the flowers of the plant, its low toxicity and the sedative effect of the Galenic forms. Recipe 1: Calendula tincture. Preparation: A 70% medical spirit based tincture of calendula is dissolved with cold boiled water (1:4). Then, a gauze folded 3-4 times is soaked with the solution. Method of application: Wring the gauze slightly to discard excess liquid and apply to areas afflicted with rosacea for 3 hours. It is preferable to carry out the procedure daily. Recipe 2: Marigold gauze Preparation: 150 ml of boiling water is poured into a glass containing 1 tablespoon of marigold flowers, stood for two hours and cooled. Then, a piece of gauze is folded 3-4 times and soaked in the solution. Method of application: After wringing slightly, the gauze is applied to areas afflicted with rosacea for 3 hours. It is preferable to carry out the procedure daily. Recipe 3: Marigold solution Preparation: Pour 300 ml of boiling water into a glass containing 1 tablespoon of ground marigold, stand for 7-8 hours, strain and cool. Method of application: A piece of gauze or a cloth napkin soaked with the solution is applied to the afflicted areas for half an hour. HYPERPIGMENTATION Hyperpigmentation has a multitude of causes. It can be focal or diffuse and in the majority of cases are due to an increased melanin production and deposition. Diffuse pigmentation indicates systemic disease, such as Addison's disease and hemochromatosis. Hyperpigmentation can be of a paraneoplastic nature. Post-inflammatory hyperpigmentation is the most common cause of focal pigmentation, while melasma and ochronosis have a more complex etiology. Folk medicine does not differentiate the types of hyperpigmentation and, therefore, needs to be used with caution. Russian folk medicine uses the bleaching properties of lemon, grapefruit, sauerkraut, radish, parsley, cucumber, egg white, oatmeal, dandelion juice, and milkweed. Dairy products, such as kefir, whey, and curdled milk, were used for centuries for making lotions to treat pigmented skin. Cucumber (Cucumis sativus) belongs to the genus of Cucumis from the Cucurbitaceae family. The later includes various types of melon, squash, pumpkin, zucchini amongst about 965 other species.12,13 Studies of Cucumis sativus showed high antioxidant activity, analgesic, and anti-inflammatory qualities (due to flavonol fisetin)14 compatible with diclofenac sodium.15 The cucumber plant had been used to relieve headaches, the seeds as a diuretic, the fruit juice as nutritive orally, and topically for acne and hyperpigmentation. The fruit contains K, Vitamins B and C, copper, potassium, manganese, proteolytic enzyme, rutin, oxidase, succinic and maleic dehydrogenases etc. Alpha- and Beta-amyrin, sitosterols, and cucurbitasides are found in seeds and cucurbitasides B and C and ferredoxin in leaves.15 The effectiveness of cucumber preparations in the treatment of hyperpigmentation had also be due to the suggested inhibitory tyrosinase activity of cucumber.14 Lemon also works as a treatment for hyperpigmentation due to its high concentration of vitamin C and also because it is a skin peeling agent. Other fruits with a high vitamin C content include tomatoes, red peppers, potatoes, blackcurrant, and those from the citrus fruit genus.16 Recipe 1: Lemon solution Preparation: Dilute freshly squeezed lemon juice with water in a proportion of one to ten. Method of application: Wpie the affected skin with the solution several times a day. Recipe 2: Starch and lemon juice mask Preparation: Starch and lemon juice mask for solar lentigo: Depending on the number of lentigines to be treated, one to half of a tablespoon of potato starch must be diluted in freshly squeezed lemon juice to form a thick mass. Method of application: Apply to the areas of pigmentation, and leave for 20-25 minutes. It important to remember that lemon juice can irritate the skin. Recipe 3: Cucumber peel for skin depigmentation Method of application: Skin can be bleached and toned using cucumber juice or by wiping fresh slices of cucumber over the affected areas. Fresh slices of cucumber can also be applied over closed eyelids to reduce puffiness. Recipe 4: Cucumber peel infusion Preparation: Peel off a cucumber skin. Place 3 tablespoons of finely chopped cucumber peel in a container, pour in 1 glass of 40% vodka or 40% medical spirit, close the container tightly and infuse until the content becomes greenish. Method of application: Apply the infusion to the pigmented areas. Recipe 5: Blackcurrant mask Preparation: A mask of blackcurrant is prepared from a tablespoon of unripe berries and tablespoon of honey. Method of application: The mask has to be carefully rubbed in to the face and left on for half an hour. Then the mask is removed, and the face is rinsed with a 1:10 solution of lemon juice and water. Recipe 6: Potato mask Preparation: A mask of grated raw potatoes is prepared with the addition of a few drops of vegetable oil, a tablespoon of milk and almond bran. Method of application: The mask is applied to the pigmented skin for twenty minutes. Recipe 7: Honey and fish oil mask A honey mask that includes fish oil is suitable for skin of any age. Preparation: All components should be mixed in equal proportions. Method of application: The mask should be applied for fifteen minutes. Recipe 8: Onion juice Onion juice for the treatment of freckles and lentigo. Method of application: The face is wiped with fresh onion juice. To reduce possible irritation, the skin is covered with a thin layer of sour cream, which is then removed with warm water. This method can be used for dry and normal skin. Recipe 9: Oatmeal soap Preparation: Oat flakes are processed in a meat grinder, and rolled in a piece of wet muslin. Method of application: This soap must be used for washing without unwrapping the oat flakes from the muslin instead of any other type of soap, shower gel or hand wash. Moisturizing cream can be applied after the wash if necessary. Recipe 10: White clay (Kaolin) mask Preparation: Add whate clay powder to freshly squeezed lemon juice until it reaches the consistency of a paste. Method of application: Apply only to the affected areas for about 20 minutes. Recipe 11: White clay (Kaolin) mask Preparation: Dilute white clay powder with cucumber juice, pressed parsley leaf juice, rowan juice, blackcurrant juice or sour cabbage juice. Method of application: Apply the paste for 20 min. Recipe 12: Marigold juice Method of application: Juice from fresh flowers or leaves of marigold can be used to wipe pigmented skin areas several times a day. Recipe 13: Guelder rose berry ice cubes Preparation: Juice from the fresh berries of the guelder rose (Viburnum opulus) must be frozen in small moulds. Method of application: The skin must be vigorously rubbed and massaged with the ice cubes of the preparation at least twice daily. Other folk remedies used for the treatment of pigmentation are grapefruit, pomegranate, birch sap, blackcurrant berry juice and ordinary mountain ash, as well as juice squeezed from fresh herbs of parsley and dandelion leaves. It is important to lubricate the pigmented areas with one of the above freshly squeezed juices several times a day. Recipe 14: Fermented milk products Method of application: Fermented milk products like kefir and curdled milk (prostokvasha) are recommended for the lubrication of unwanted pigmentation 2-3 times a day. Recipe 15: Elderberry infusion Preparation: Pour 1 glass of boiling water over about 5-6 dry buds of black elderberry, cover tightly and leave until completely cooled. Strain and dilute the resulting infusion with about half a glass of clean water. Method of application: Soak a piece of fleece in the prepared solution and apply to the pigmented areas. As soon as the fleece begins to dry, it must be moistened again, and the process must be repeated 3-4 times every day. Recipe 16: Cabbage juice mask A cabbage juice mask is believed to be a remedy which is effective for the treatment of freckles, solar lentigo, and fine wrinkles. Method of application: Cotton wool soaked in cabbage juice should be applied to the face for 10 -15 minutes and rinsed with cold water. It is recommended to be applied 2-3 times a week. RHYTIDES (WRINKLES) Recipe 1: Potato mask A potato mask for sensitive skin, prone to irritation, with puffiness of the face and wrinkles. Preparation: Peel raw potatoes, grate on a fine grater and place the resulting gruel between two layers of gauze. Method of application: Apply the gauze with gruel to the face for 15-20 minutes and rinse with warm water. The mask smooths, softens, moisturizes, and tones up the skin. To treat acne, keep a similar mask on for 1-2 hours. Recipe 2: Potato and cucumber mask A potato and cucumber mask to treat wrinkles. Preparation: Grate fresh potatoes and cucumbers on a fine grater and mix them together. Method of application: Apply the mixture to the face and neck for 20 minutes. Rinse with water containing a few drops of lemon juice. Dry the skin and massage gently with olive oil. Recipe 3: St John's-Wort tonic cleanser A St John’s-Wort tonic for the evening cleansing of fading skin. Preparation: Add 10 ml of 70% medical spirit to 100 ml of St John’s-Wort infusion. Then add 1 tablespoon of the tonic to a glass of boiling water and then cool it. Method of application: The tonic is used as a cleanser on fading skin. Recipe 4: Boiled potato mask A potato mask for oily and ageing skin. Preparation: Boil and mash potatoes and then apply as a mask to the skin. Recipe 5: Nettle leaf mask A nettle mask for dry and ageing skin. Preparation: Grind fresh nettle leaves and mash them together with an equal proportion of liquid honey. Method of application: Apply as a mask to the face. Recipe 6: Lime blossom cleansing infusion A cleansing infusion for acne, wrinkles and oily skin. Preparation: Place 1 tablespoon of dried lime blossom in a glass of boiling water, infuse until it cools down and strain. Method of application: Wipe the face with the infusion. The procedure softens and cleanses the skin and relieves irritation. It is particularly useful after intense sweating and being in a dusty environment. Recipe 7: Grape juice and raw milk mask A grape juice and raw milk mask to treat wrinkled skin. Preparation: Mix a quarter of a cup of grape juice with the same amount of raw milk. Method of application: Moisten a piece cotton wool with the concoction and apply it to the face, covering with a towel. Remove after 15-20 minutes, dry the skin gently and apply cream. Recipe 8: Grape juice and egg mask A grape juice and egg mask for the treatment of oily and wrinkled skin. Preparation: Add 2 teaspoons of grape pulp to whipped egg whites. Method of application: Lubricate the face with grape juice, then apply the mask. Wash the mask off with cold water 15-20 minutes later. PSORIASIS Psoriasis is a multi-factorial immune-mediated inflammatory systemic disorder with skin being one of the most affected organs. Russian traditional dermatology recognized three main stages of psoriasis: the progressive stage, with the appearance of new skin lesions and a possible increase in the size of the existing lesions, the stable stage, when no new lesions would appear or increase in size and the regressive stage where the lesions begin to resolve. In the past, dermatologists would recommend that no potential irritants or potent topical steroids (when they became available) were to be used during the progressive stage. The following herbal infusions and topical treatments were applied instead. Recipe 1: Infusion3 Preparation and ingredients: • Valeriana officinalis (Valerian) root 1 part • Althaea officinalis (Marsh mallow) root 1 part • Bidens tripartita (Tree-lobe beggarticks) stem and leafs 3 parts • Hypericum perforatum (St John’s-Wort) stem and leafs 1 part • Chelidonium majus (Greater celandine) stem and leaf 1 part Pour in 1 glass of boiling water. Leave to infuse and cool down in a tightly covered dish and then strain. Method of application: Half a glass is to be taken orally, 2 times a day after meals. Recipe 2: Infusion3 Preparation and ingredients: • Chelidonium majus (Greater celandine) stem and leafs ½ a tablespoon • Viola tricolor (Heartsease) stem and leafs ½ a tablespoon Pour 1 grass of boiling water over the mixture and infuse for 1 hour in a tightly covered porcelain or ceramic dish and strain Method of application: Take ½ a glass orally, 1 hour after a meal. It is also recommended to have a bath with an infusion of Chelidonium majus daily or alternate days: pour 4 liters of cold water over 100 grams, boil, infuse for one hour, strain and add to a bath (20-30 liters) at 40-45 0C ( no higher than 38-40 0C for children). Scalp psoriasis treatments Recipe 3: Infusion3 Preparation and ingredients: • Bidens tripartita (Tree-lobe beggartick) stem and leafs 4 parts • Hypericum perforatum (St John’s-Wort) stem and leafs 2 parts • Equisetum ravens (Field horsetail) stem and leafs 1 part Pour 1 glass of boiling water over 2 tablespoons of the mixed herbs, infuse for one hour and strain. Method of application: Massage the infusion into the scalp every 2-3 days after a hair wash. Stable stage of psoriasis Fresh stems and leafs of Greater celandine have mild analgesic, antimicrobial and sedative qualities.17 Greater celandine is one of the main remedies for the treatment of psoriasis. It is used in infusions, decoctions and tinctures by itself and in combination with other herbs. The plant is frequently used for a multitude of skin disorders. The yellow to orange colored latex of fresh stems is effective in the treatment of viral warts. It is applied daily to the affected areas. Due to the presence of indole alkaloids, Valerian and St John's-Wort act as antidepressants.18 Viola tricolor is well known for its anti-inflammatory properties. For centuries, it had been used for the treatment of pruritus, ulcers, dermatitis and psoriasis. The aqueous extract of Viola tricolor was shown to inhibit the proliferation of activated lymphocytes by reducing IL-2 cytokines, IFN-γ and TNF-α production.19 The Marsh Mallow plant (Althaea officinalis) is traditionally used for its wound healing properties, as an anti-inflammatory and in immunocompromised patients. A recent study has found that the root of Marsh mallow contains skin protecting polysaccharides and may also contain UV-absorbing compounds which significantly reduce UVA-induced DNA damage in cultured human lung and skin fibroblasts.20 Mustard paper (a type of therapeutic plaster) is an old and well-known treatment for thick psoriatic plaques. Mustard paper is a leaf of thick paper covered with fat-free mustard seed powder. (Figure 4) Traditionally, the “Russian mustard” used in the plaster is made from the seeds of Brassica junco, commonly known as brown, or vegetable mustard. The mustard paper is dipped in hot water (40-45 0C) for a few seconds and applied to a psoriatic plaque under the cover of a blanket. It is removed after 5-10 minutes. The skin is washed with warm water and moisturized with emollient, olive or sunflower oil. Mustard paper is commercially available in Russia. (Figure 5) Recipe 4: Mustard paper Preparation of “mustard paper” at home: 1 tablespoon of dry mustard powder is mixed with 1 tablespoon of potato starch or flour and diluted with warm water to the density of sour cream. After 30 minutes a thin layer of the mixture (0.5 cm) is applied on double layer of gauze, a thin cloth or thick paper (not a newspaper!). Homemade mustard is always stronger than commercially available one and should not be applied for longer than 5-7 minutes. Mustard powder and mustard paper (home-made or purchased) must be stored in a dry place, because the moisture absorbed by mustard reduces its effectiveness. HYPERHIDROSIS Recipe 1: Oak bark powder Method of application: Powder feet with finely ground oak bark and put on socks for a whole night. Wash the feet in the morning with chilled water. Recipe 2: Oak bark infusion Preparation: An oak bark infusion is prepared by placing 20 grams of powdered oak bark into an enameled saucepan and adding a glass of water at room temperature. The mixture needs to be boiled in the saucepan, covered with a lid on a slow fire for half an hour. The mixture must be strained straight away and the remainder of the bark squeezed into the infusion. The infusion needs to be diluted with boiling water until it reaches its previous volume (a glass). Method of application: The infusion is to be rubbed once daily into the feet or hands and left to dry by itself.3 CONCLUSIONS Medicinal plants and biologically active additives that are based on their becoming increasingly popular today. They are sold over the counter and patients self-prescribe them without consulting physician. The great issue with this is the fact that the active substances contained in medicinal plants and herbs are as powerful as many of the drugs produced by pharmaceutical companies. This can cause unforeseen complications, when active ingredients are combined, such as excessive amounts of some vitamins, elements, and substances, with the same active ingredients in pharmaceutical drugs. Medical professionals have a duty to inform and question patients about the natural remedies on the market that they might use, as there is a commonly held belief in natural remedies being something entirely separate from pharmaceutical medications. In this way, the patient is offered a scientifically and medically supported choice between natural and chemically produced medicines, avoiding inadvertent adverse effects and sometimes using the wide-spectrum attributes of medicinal plants to provide a therapeutic result superior to the targeted nature of chemical pharmaceuticals. References [1] Parshina, GV.: Plants and cosmetics. Urodzhaj (Moscow). 1993; 252. [2] S.V. Orlova Encyclopedia of biologically active food substances (v2) Moscow: M. (1998), pp. 137-228 [3] Ivanov, VI.: Remedies in traditional medicine. Military Publishing House of the Ministry of Defense of the Russian Federation; 1992:227-229. [4] Etty, J.: Russia’s climate and geography. History today; 2007:58. http://www.historytoday.com/john-etty/russia’s-climate-and-geography. [5] L. Gill, A. Zarbo, P. Isedeh, et al. Comorbid autoimmune diseases in patients with vitiligo: A cross-sectional study J Am Acad Dermatol., 74 (2016), pp. 295-302 ArticleDownload PDFView Record in Scopus [6] G. Dastangir, R. Ahmed, S. Shereen Elemental, nutritional, phytochemical and biological evaluation of Hypericum perforatum Linn. Pak J Pharm Sci., 29 (2016), pp. 547-555 [7] St John’s-Wort (Hypericum perforatum) Safety – Mayo Clinic. 2017; www.mayoclinic.org/drugs-supplements/st-johns-Wort/safety/hrb-20060053. [8] V. Gorodinskaya The Secrets of Herbal Remedies Moscow: Sovetskaya Rossiya, 135 (1989) [9] V.F. Korsun, V.K. Viktorov The unique medical properties of weeds Moscow : Tsentrpoligraf, 270 (2016) [10] S. Kenawy, G.F. Mohammed, S. Younes, et al. Evaluation of TNF-α serum level in patients with recalcitrant multiple common warts, treated by lipid garlic extract Dermatol Ther., 27 (2014), pp. 272-277 CrossRefView Record in Scopus [11] M. Tomczykowa, K. Leszczynska, M. Tomczyk, et al. Composition of the Essential Oil of Bidens tripartita L. Roots and Its Antibacterial and Antifungal Activities J Med Food., 14 (2011), pp. 428-433 CrossRefView Record in Scopus [12] Christenhusz, MJM, Byng, JW.: The number of known plants species in the world and its annual increase". Phytotaxa. 2016; 261:201–217. [13] A.G. Ghebretinsae, M. Thulin, J.C. Barber Relationships of cucumbers and melons unravelled: molecular phylogenetics of Cucumis and related genera (Benincaseae, Cucurbitaceae) Am J Bot., 94 (2007), pp. 1256-1266 CrossRefView Record in Scopus [14] R.K. Sahu, A. Roy, J. Dwivedi, et al. Promotion and computation of inhibitory effect on tyrosinase activity of herbal cream by incorporating indigenous medicinal plants Pak J Biol Sci., 17 (2014), pp. 146-150 CrossRef [15] Journal: Kumar, D, Kumar, S, Singh, J, et al.: Free Radical Scavenging and Analgesic Activities of Cucumis sativus L. Fruit Extract. J Young Pharm. 2010; 2:365–368. [16] Fact Sheet for Health Professionals - Vitamin C. Office of Dietary Supplements, US National Institutes of Health; 2016. https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/ [17] European Medicines Agency. Assessments report on Chelidonium majus L., herba; 2012. http://www.ema.europa.eu/docs/en_GB/document_library/Herbal_-_HMPC_assessment_report/2012/01/WC500120711.pdf. [18] Hamid, HA, Ramil, AN, Yousoff, MM.: Indole alkaloids from plants as potential leads for antidepressant drugs: a mini review. Front Pharmacol. 2017 (online); 28(8):96. doi:10.3389/fphar.2017.00096. [19] Hellinger, R, Koehbach, J, fedchuk, A, et al (2014).: Immunosuppressive activity of an aqueous Viola tricolor herbal extract. J Ethnopharmacol. 2014;151: 299-306. [20] Curnow, A, Owen, SJ.: An Evaluation of Root Phytochemicals Derived from Althea officinalis (Marshmallow) and Astragalus membranaceus as Potential Natural Components of UV Protecting Dermatological Formulations. Oxid Med Cell Longev (Epub). 2016;2016:7053897. doi:10.1155/2016/7053897. [21] V.A. Solovieva Traditional methods of health promotion St-Petersburg: Neva Publishing House, 352 (2005) © 2018 Elsevier Inc. All rights reserved.