Psoriasis, or lichen planus, is a common skin disease that affects people of all ages. One type of pathology is drip psoriasis, which occurs mainly in school-age children and young people. About 4% of the entire world population has psoriasis, of which more than 2 million people suffer from guttate psoriasis.
What is the disease
Guttate, or droplet, psoriasis is a chronic type of psoriasis, the distinctive feature of which is the spontaneous appearance of itchy skin rashes throughout the body with the exception of the nail plates, soles and palms. The name itself arose because of the shape of the elements of the rash - they look like pink drops the size of a lentil grain. The disease is not contagious, practically unrelated to the time of year (has no seasonality), and affects both men and women. It is believed that the disease is of an autoimmune nature, with the trigger most often being somatic diseases, acute inflammatory processes or exacerbation of chronic infections. Bad habits, especially smoking, and the habit of eating unhealthy foods with excess cholesterol play an important role in the development of drip psoriasis.
Causes of the disease
There is still debate in the scientific world about the causes and pathogenesis (mechanism of development) of the disease. Most dermatologists are inclined to believe that the causes of guttate psoriasis are infectious in nature, that is, skin rashes are provoked by any infection (viral or bacterial) - sore throat, otitis media, sinusitis, pneumonia, influenza and ARVI, fungal diseases. The disease is most often caused by streptococci. This theory is supported by the fact that a pathogenic pathogen is always found in scrapings from the plaque. The infectious process either leads to the primary occurrence of the disease, or to the transformation of other types of scaly lichen into a drop-shaped form, previously causing their exacerbation.
Infection as a trigger for the development of the disease acts against the background of one or more provoking factors:
- nervous or physical stress;
- decreased immune defense;
- endocrine disorders;
- genetic predisposition;
- external irritants - constant contact with chemicals, medications, cosmetics;
- chronic microtrauma of the skin - friction, scratching;
- allergic conditions causing skin reactions.
Drip psoriasis is not contagious, despite the fact that pathogenic microorganisms are found in the plaques.
Complex autoimmune reactions underlie the development of the disease, which goes through three stages:
- The first stage of sensitization, at this moment the antigen-antibody mechanism is launched, with the antigen being the bacterial pathogen that enters the skin, or rather, the toxins it produces, and the antibodies being the lymphocytes and dermal cells responsible for skin immunity.
Sensitization is a process that underlies allergic diseases and means the body's increased sensitivity to foreign irritant substances (allergens).
- The second phase - latent (hidden) is characterized by excessive accumulation of antibodies, which begin to bind not only antigens (foreign bacterial agents), but also the cellular structures of the skin.
- The third phase, effector, begins with rashes.
The duration of each phase cannot be determined, since it depends on the strength of the pathogen, its quantity and the resistance of the body.
The key pathological process in psoriasis is epidermal hyperproliferation, that is, abnormal acceleration of division, reproduction (almost 10 times faster than normal) and insufficient maturation of epidermal cells, as well as impaired blood microcirculation in the layers of the dermis. In a healthy person, the upper dead layer of the epithelium peels off imperceptibly, but with psoriasis, this layer does not have time to be “utilized” and its cells accumulate, forming specific nodules and flaky plaques.
Symptoms of drip psoriasis
The disease progresses in waves, with relapses followed by more or less long-term remissions. Guttate psoriasis can occur at any time of the year, but most often exacerbations occur in cold weather (winter - autumn), when the risk of colds is high.
The onset or exacerbation of the disease goes through several stages in its clinical development:
- External manifestations of the disease mark the beginning of a progressive stage. The process develops acutely, usually 2–3 weeks after the infection.
A primary element appears - a small red papule (nodule) (3–10 mm) in the shape of a drop, covered with shiny scales. Then many such elements very quickly appear on the torso, arms and legs. Itchy papules can grow and merge with each other to form small psoriatic plaques. The disease rarely affects the face; the nail plates remain untouched. Any skin injuries (bites, scratches, abrasions, abrasions) during this period are resolved not by healing with scarring, but by the formation of psoriatic papules (Koebner phenomenon). When plaques are injured, they can ulcerate and transform into an exudative form of the disease. The progressive stage can last from one to four weeks. - The next stage is stationary. During this period, fresh rashes do not appear, and existing ones are covered with abundant shiny scales.
- The regression stage is characterized by the gradual disappearance of plaques, peeling decreases, the color of the rashes turns pale, and a change in skin color is observed at the borders of the rashes - hypopigmentation (discoloration). This period can last a long time - up to several months.
Then remission occurs, the disease enters the latent stage. It can last for different periods of time - from a month to a year and even several years. The duration of remission depends on the general condition of the patient, compliance with all prescriptions and recommendations of the dermatologist.
In some cases, the stationary period may not turn into a regression stage, but into a more severe form of psoriasis.
According to the severity, guttate psoriasis can be:
A mild course is characterized by the appearance of rashes affecting an area of less than 3% of the total skin surface. With a moderate course, multiple rashes tend to grow, affecting up to 10% of the entire skin. The patient suffers from itchy skin and requires hospital treatment. A severe course is characterized by damage to a large area of the skin surface - more than 10%. Rashes appear all over the body, the general condition of the patient is seriously impaired. This course requires urgent treatment in a specialized hospital according to an individual scheme.
Diagnosis of the disease
A dermatologist makes a diagnosis and prescribes treatment. The examination begins with examining the patient, assessing complaints and collecting anamnesis to determine whether there has been an infectious disease recently.
A characteristic sign of psoriasis is the psoriatic triad:
- Stearin stain - when the surface of the papules is scraped, the scaly peeling intensifies, the plaque itself looks like a crushed drop of stearin.
- Thermal film - after removing the scales, a layer of very thin pink skin is revealed.
- Blood dew - when exposed to a thin layer of exposed skin, individual small drops of blood appear.
A general blood test for a mild form of the disease is almost no different from the norm; severe and moderate forms show an increase in ESR, an increase in the number of eosinophils and leukocytes. A nasopharyngeal swab is cultured for the presence of streptococcus.
Histological analysis of a skin sample taken by biopsy shows characteristic changes:
- immaturity of young epidermal cells;
- accumulation of T lymphocytes;
- hyperkeratosis (increased development of the stratum corneum of the skin).
Differential diagnosis
Drip psoriasis must be distinguished from other forms of psoriasis, acute dermatitis, secondary syphilis, drug toxicoderma, pityriasis rosea and viral exanthema. The disease is especially easy to confuse with pityriasis rosea.
However, lichen differs from the droplet form of psoriasis in the maternal plaque, spots rather than papules, the absence of the psoriatic triad, and the specific nature of peeling.
Treatment
Guttate psoriasis, like all types of lichen planus, is difficult to treat. Treatment must be comprehensive and, depending on the severity of the course, can be carried out at home or in a hospital.
First of all, residual effects of an infectious disease are eliminated, foci of chronic infection are sanitized and, if possible, concomitant somatic pathologies are treated. An individual scheme of symptomatic therapy is selected for the patient and a dietary plan is drawn up.
Drugs for local and systemic use are prescribed in increasing strengths in order to minimize side effects.
- Antibacterial therapy is used in case of inoculation of streptococci or staphylococci; cephalosporins are most often chosen.
- Creams and ointments are prescribed locally; at the beginning of treatment, non-hormonal ones - these products soften the skin, relieve inflammation, and promote the resorption of infiltrates:
- Anthralin;
- Dritocrim;
- Akrustal;
- salicylic, naphthalan, sulfur ointment.
- If such ointments are ineffective, hormonal-based drugs are prescribed, for example, Hydrocortisone ointment - relieves swelling, inflammation, and itching. Stronger drugs have the same effect; they are used for severe forms of the disease:
- Flumethasone ointment;
- Dermovate cream;
- Powercourt ointment.
- A dermatologist can also prescribe ointments with calcitriol:
- Daivonex;
- Daivobet;
- Forcal ointment;
- retinoids (vitamin A derivatives) orally:
- Tigason;
- Neotigazon.
- Additionally, the patient must be prescribed:
- immunomodulators;
- vitamins (groups B, A, C E, D);
- sedatives:
- valerian in tablets, infusion or tincture;
- Seduxen;
- Tizercin;
- Nozepam;
- antihistamines:
- Cetrin;
- Tavegil;
- Loratadine;
- Desloratadine.
Gallery - drugs for the treatment of guttate psoriasis
Diet food
The diet for psoriasis is designed for a long term and is especially important during an exacerbation. Main principles: hypoallergenic and limited animal fats.
The following foods are definitely excluded from the diet:
- cocoa and products containing it (chocolate);
- eggs, citrus fruits;
- tomatoes;
- honey, strawberry;
- whole milk;
- alcohol in any form.
Products that need to be limited as much as possible:
- red berries and fruits;
- smoked meats, fatty, spicy dishes;
- sauces, mustard, mayonnaise;
- baking;
- horseradish, garlic, onion;
- sweet soda.
Considering that the patient has impaired lipid metabolism, it is recommended to minimize the consumption of fatty meat, offal, lard, sausage, butter meat, and fatty sea fish.
Food should be simple, varied, and fortified. You need to eat more vegetables, fruits, berries (just not red ones). Meat products include lean beef, turkey, and rabbit meat, stewed, baked or boiled.
During the acute period, it is worth switching to vegetarian cuisine; as the symptoms subside, you can add soups in weak meat broth, steamed cutlets, meatballs, and boiled river fish to the diet. It is better to prepare different porridges as a side dish, and limit potatoes and flour products. It is better not to drink coffee and tea; a decoction of dried fruits, light fruit compotes, clean water, and juices are much healthier. Seaweed, fresh herbs, fermented milk products, cheeses, nuts, and whole grain bread are not contraindicated.
It is useful to arrange fasting days on kefir, apples, and vegetables 1–2 times a week.
Physiotherapy
For guttate psoriasis, physiotherapy is very effective. In severe cases, dermatologists often prescribe photochemotherapy (PUVA therapy) - the use of ultraviolet irradiation with a photosensitizer drug (Methoxalen, Amifurin) orally. These medications increase the skin's sensitivity to sunlight, thereby increasing the effects of long-wave ultraviolet rays. Usually a course of 15–25 sessions is prescribed, 3–4 times a week until the rash disappears completely.
Selective phototherapy, laser treatment, electrosleep (to normalize the activity of the nervous system), magnetic therapy, ultrasound, hyperthermia (heating tissue up to 40 degrees to improve the functioning of the immune system), electrophoresis with bee venom are also used.
All these procedures are aimed at relieving inflammation, itching, normalizing the functioning of internal organs, metabolism and immunity.
In severe cases and to reduce the frequency of relapses, the patient undergoes plasmapheresis - a plasma purification procedure.
Folk recipes
Alternative medicine offers many recipes for the treatment of scaly lichen.
Folk remedies for psoriasis on the body
One of the common skin diseases is psoriasis, a skin disease characterized by the appearance of scaly red rashes. Unfortunately, modern medicine does not provide the possibility of effectively treating the disease with drugs. At the moment, treatment is mainly carried out with hormonal ointments, the use of which ensures a state of remission in the patient for a short period (from a month to several years). Side effects of such therapy can only worsen the condition of a patient with psoriasis in the future. Therefore, folk remedies for psoriasis on the body are also widely and effectively used.
The disease of psoriasis in the acute period is shown in the photo.
Traditional methods
In the treatment of psoriasis, traditional medicine provides many recipes and recommendations. Such methods are usually effective, and the duration of remission in patients is several years. Unlike pharmacological drugs, traditional methods do not have adverse reactions.
IMPORTANT! Before starting treatment, it is necessary to consult an experienced dermatologist to confirm the diagnosis.
- conduct a test for an allergic reaction - moisten a cotton swab with the product (ointment, infusion and other components), apply to the inner bend of the elbow and assess the condition of the skin after 30 minutes. If itching, redness or blistering occurs, treatment of psoriasis using this method is prohibited;
- after carrying out manipulations and observing the time interval, it is recommended to wash off the affected areas of the body with tar soap, which provides an antibacterial effect;
- carry out all procedures with clean, soap-washed hands;
- observe the rules of personal hygiene.
The following treatment options are available:
- Sea and sunbathing.
- Birch tar.
- Solid oil.
- Soda.
- Copper sulfate.
- Purslane seeds.
- Herbal collection of tricolor violet and celandine.
- A series.
- Propolis.
- Egg oil.
- Egg ointment.
- Wheatgrass.
- Essential oils.
- Birch buds.
Sea and sunbathing
The most popular and effective method of combating psoriasis is considered to be staying at sea and sunbathing. Swimming in salty sea water and sun rays together can help achieve a state of remission for a long period.
In the very first days on the sea coast, you should not be on the beach for more than 30-40 minutes; you need to give your skin the opportunity to get used to and adapt. To get a good result, a vacation by the sea should be at least 1 month.
Many people who have suffered from psoriasis for many years willingly share reviews about holidays by the sea and the results obtained. According to them, the waters and shores of the Dead Sea, Lake Sivash in Ukraine and Lake Tekirgel in Romania are considered the most effective for treating psoriasis.
Birch tar
The most common recipe for treating the disease, which can provide effective treatment in a short time. Patients using this method can achieve remission lasting several years. This treatment is especially effective for people who have just been diagnosed with psoriasis.
Tar can be purchased at a pharmacy. The method is suitable for almost everyone, the only contraindication is an allergy to tar.
The course of application is 2-6 weeks, depending on the condition of the skin. Apply tar to the affected areas of the body once a day with a cotton swab. The first time you need to wait 10 minutes and rinse with warm running water and tar soap. Gradually increase the time every day until the procedure lasts 30-40 minutes. It is advisable to carry out the manipulation in the evening, so that the smell of tar has time to disappear before the morning.
Positive dynamics will become noticeable within a few days; continue treatment until the skin is in complete remission.
Birch buds
They are used to prepare a decoction, which is used both internally and for taking baths and applying lotions. Collect birch buds, dry and chop. Take 100 g of dry ingredient for 1 liter of boiling water. Leave in a thermos for about 30 minutes.
Solid oil
It is considered a fairly popular method of combating the disease, especially with plantar psoriasis and damage to the nail plates. Effectively copes with both old forms of the disease and in the initial period.
Fatty grease is available for sale in auto parts stores. It is necessary to purchase only pure lubricant without any impurities.
The procedure is simple - generously lubricate all affected areas with grease. The first days the duration of the manipulation is 15-20 minutes, over the course of a week the time should be gradually increased to 40-60 minutes. Afterwards, wash the affected areas with tar soap and water. The course of treatment is 1-2 months.
Baking soda also has a high therapeutic effect; it is used internally and externally. The list of popular ways to use soda is presented as follows:
- bath - fill the bath with hot water and add 900 grams of baking soda. It is recommended to add infusions of string, chamomile or sea salt. Mix the water with your hand and take a bath for at least 30 minutes. Afterwards, do not use the shower, do not dry yourself with a towel, and allow the skin to dry. Taking baths every other day for several weeks. If the effect is positive, you can extend the course to 6-8 weeks;
- greasing – mix 2 tablespoons of baking soda with a small amount of warm water to the consistency of sour cream. Use a cotton swab dipped in the mixture to treat problem areas of the skin. After a couple of hours, rinse with water;
- cleansing soda solution - pour 2 teaspoons of soda into a glass of water, lubricate the skin twice a day;
- egg ointment - components: egg yolks (3 pcs.), 200 g of melted fat (chicken), birch tar (2 tbsp. spoons). Add grated laundry soap (2 tbsp), 1 tbsp. a spoonful of fir oil and 1 teaspoon of baking soda. Mix all ingredients thoroughly; as soon as the fat hardens, add bile (2 tablespoons, buy at the pharmacy). Store the prepared mixture in the refrigerator for a maximum of 3 weeks. Lubricate the body in the evening before bedtime 2-3 hours;
- medicine - the recipe is not suitable for people suffering from low acidity of gastric juice. You need to prepare the following components: vetch – 150 g, liquid honey – 300 g. You also need baking soda – 50 g, refined sulfur (powder) – 25 g. Lightly fry the vetch and grind it in a wooden mortar. Combine with other ingredients and mix. Every day, 3 times a day after meals, take 1 tablespoon of the mixture orally. Follow the course until complete remission;
- hot compress - dissolve 3 tablespoons of baking soda in 0.5 liters of hot water. Wring out gauze folded in several layers in water, cover the problem area and leave until the compress has cooled completely.
You need to prepare the following ingredients:
- copper sulfate – 50 g;
- yellow sulfur (powder) – 50 g;
- celandine (dry powder) – 25 g;
- birch tar – 25 g;
- pork (goose) fat – 150 g.
Combine the burnt copper sulfate with other ingredients, mix thoroughly, and place in a water bath for 15 minutes. Remove, stir again, cool. At night, once a day, treat the damaged areas of the body with the prepared gruel.
Purslane seeds
To prepare the infusion you will need:
- purslane seeds - 2 tbsp. spoons;
- hot boiled water.
Pour the seeds into a thermos, add boiling water, leave for an hour. Make lotions on the required areas, water the infusion periodically so that the skin is constantly wetted abundantly.
Herbal collection of tricolor violet and celandine
The recipe is easy to prepare and gives good results. You will need the following components:
- celandine – 20 g;
- tricolor violet – 20 g.
Pour dry or freshly cut ingredients into a thermos and pour boiling water (1 cup). Let it brew for 2-3 hours and cool. It is recommended to take the infusion orally before meals in a volume of 2 tablespoons three times a day. The herbal mixture should be stored in the refrigerator; the shelf life is 2 days.
Series
This plant has long been known for its medicinal effect in eliminating a variety of dermatological problems. Baths, infusions and lotions with it are used for urticaria, diathesis, and prickly heat. Bathing in a bath with a series of psoriasis will help cope with exacerbation of the disease.
Prepare the infusion as follows: in a thermos, brew a batch (4 tablespoons) with 1 liter of boiling water. Leave for 1.5 hours. When the solution has cooled, add fresh honey (5 tablespoons). Stir, storage is allowed only in the refrigerator.
Dosage: half an hour before meals, drink 100 g of infusion 3 times a day.
Propolis
Its therapeutic characteristics have long been known and are widely used in the treatment of many diseases; it is also effective in the fight against psoriasis. Based on propolis, you can prepare an ointment that will help significantly alleviate the patient’s skin condition.
Prepare 0.5 kilograms of butter (preferably homemade). Melt it in a container in a water bath, bring to a boil and add pre-grated propolis (50 g). Remove from heat, stir the mixture thoroughly until it cools completely (30-60 minutes). If stored in the refrigerator, the ointment can be used for 3 weeks.
Application: use a swab moistened with hydrogen peroxide to wipe the desired area on the body. Cover the area with a compress with ointment (preferably applied to gauze). Fix, apply daily for 10-12 hours.
Egg oil
It is considered an effective method of relieving the acute period of the disease. To prepare the oil, take 5 homemade eggs and boil for 20 minutes in boiling water. Cool, remove shells, separate yolks. Finely chop with a knife and fry the yolks over low heat in a frying pan until an oily red liquid appears.
Use this egg oil to treat problem areas once a day (preferably in the evening) until a lasting result is achieved in the form of improved skin condition.
Egg ointment
The recipe is known in many countries, where it is used quite widely and effectively.
The cooking method is as follows:
- Place a fresh chicken egg (raw) in a glass jar;
- pour vinegar until the egg is completely covered;
- cover with a lid, put in a dark place for a day;
- take out the egg and crush it in a mortar along with the shell;
- add goose or pork fat (1 tbsp);
- to stir thoroughly.
Applying the ointment to damaged skin can cause a burning sensation, so it is recommended to use a small amount at the initial stage. Gradually increase the volume of ointment, apply once a day, leave for up to 2 hours. After rinsing, it is recommended to apply regular baby cream.
Wheatgrass
For the decoction, prepare wheatgrass roots in advance (dig up, dry and chop). Store in a glass jar in a dry place. Take dry crushed wheatgrass into a 1-liter glass jar, pour into a large saucepan, and pour boiling water (6 liters). Leave in a warm place to infuse for 4 hours. Then put the pan on the stove and bring to a boil over low heat, simmer for 5 minutes. Strain the broth through cheesecloth or a sieve, add to a bath with warm water. It is recommended to carry out such bathing 1-2 times a week before bedtime.
Essential oils
Affected areas of the body are lubricated with the following types of oils:
They are also used as a base for ointments, tinctures for the treatment of psoriasis on the body and added when bathing.
Psoriasis - symptoms and treatment
Psoriasis (scaly lichen)– chronic recurrent skin disease.
Causes of the disease
Disorders of the nervous and endocrine systems, metabolism (especially the metabolism of amino acids - the main building material for cells, fat and carbohydrate metabolism), hereditary factor.
Symptoms of psoriasis
Pink-red nodules with a tendency to merge into plaques, covered with silvery-white, easily exfoliating scales; localization mainly on the elbows, knees, lower back, and scalp.
Treatment of psoriasis
Psoriasis is a disease that requires long-term treatment; passes with remissions of several months or years and continues until the end of life. Pharmacotherapy for psoriasis depends on the stage of the disease:
1. During the progressive period, the following is prescribed:
- Weak exfoliants: 1-2% salicylic ointment.
- Corticosteroid ointments: prednisolone, sinaflan, betamethasone.
- Vitamins: orally - folic and ascorbic acids, intramuscularly - vitamin B 12.
- Calcium gluconate or calcium chloride intravenously.
2. In the hospital period (during the main manifestations of the disease) the following is prescribed:
- Resolving agents (reflexively dilate blood vessels and help enhance metabolic processes in affected tissues): birch tar in a concentration of 2.5 to 10%. First it is used in the form of pastes, then in ointments. Tar baths are also prescribed - warm baths after rubbing pure tar into the affected areas of the skin.
- Pyrotherapy: intramuscular injections of pyrogenal or prodigiosan.
- Cytostatics: methotrexate.
- Glucocorticoids internally and externally.
- Non-hormonal drugs: excipial M lipolosion, psoriaten, skin cap.
- PUVA therapy is exposure of the skin to long-wave ultraviolet rays after ingestion of photosensitizing drugs.
- Spa treatment: sulfur baths, sun exposure, sea bathing.
3. During the period of symptom reduction, the following are also used:
- tar baths,
- skin softeners,
- if necessary, corticosteroid ointments.
4. To prevent relapses of psoriasis, it is recommended:
- Irradiation of all skin with ultraviolet rays.
- Spa treatment.
- Massage, physical therapy, mud therapy, ultrasound procedures.
- Diet with limited carbohydrate intake.
- If necessary, use sedatives.
Diet and nutrition
A predominantly plant-based diet with limited animal fats and carbohydrates is recommended, including butter, eggs, sugar, potatoes, white bread, refined and processed foods, all seasonings, tea, coffee. When the condition improves, you can add milk, kefir, and cheese to your diet. It is very useful to drink whey (in unlimited quantities). Alcohol abuse causes an exacerbation of the disease.
TRI-COLORED VIOLET (Viola tricolor L.)
(Viola tricolor L.)
An annual or biennial wild herbaceous plant of the violet family. It grows everywhere in the CIS. Medicinal raw materials - tricolor violet herb containing saponins, flavonoids, anthocyanin glycoside violanine, hydroxycinnamic acids, carotenoids, violaxanthin, a small amount of essential oil, ascorbic acid, alkaloid violaemetine, tannins, mucous polysaccharides.
Therapeutic effect. Tricolor violet has pronounced antiallergic and anti-inflammatory properties, which are associated with the presence in the aerial part of the plant of pharmacologically active essential oil and mucus-like substances that have an antiseptic effect in the digestive tract. Saponins have an expectorant effect, which is apparently enhanced by mucus and flavonoids. Under their influence, there is an increase in the secretion of the bronchial glands, dilution of sputum and its easier release. The herb also has a diuretic effect, disinfects the urinary tract, and improves metabolism in the skin. Both rutin and the flavone glycoside violaquercetin, with local and general action, promote compaction of cell membranes, slow down the absorption of various substances from inflamed tissues, which is characteristic of the anti-inflammatory effect of flavonoids and tannins.
When taking violet preparations, some antispasmodic and choleretic effects are observed. Violet preparations, like rutin, inhibit the development of traumatic edema in animal experiments, have an anti-inflammatory effect on the dextran edema model, reduce vascular permeability and provide a pronounced hyposensitizing effect.
Tricolor violet preparations are used independently in the form of infusions, decoctions, and also in mixtures with other medicinal plants for exudative psoriasis, psoriasis of childhood and old age, psoriatic erythroderma and psoriatic polyarthritis.
Drugs are also prescribed for respiratory catarrh, cough, bronchitis, urological diseases, whooping cough, rheumatism, gout, atherosclerosis, cystitis and exudative diathesis accompanying psoriasis.
In case of an overdose of galenic forms of violet, nausea and vomiting are possible. The emetic effect is attributed to the alkaloid violaemetine and saponins.
Dosage forms and route of administration
Infusion (3 g of raw material per 200 ml of water): 2 tablespoons 3-4 times a day.
Decoction (20 g of herb per 200 ml of water): for lotions and in the form of baths.
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