Oral Contraception Risks in Perspective

(Great Britain—The Practitioner, October 1997, p. 571.) Oral contraceptives are effective in preventing pregnancy and are associated with many health benefits, such as protection against ovarian and endometrial cancer, improvement of menstrual disorders and reduced risk of endometriosis, ovarian cysts, fibroids, benign breast disease and pelvic inflammatory disease. Use of contraceptives is, however, also associated with adverse health risks in certain patients. The statistical observed increased risk of breast cancer is equivalent to one additional case in 1,000 women 45 years of age who stopped taking contraceptives at 35 years of age. The risk of venous thromboembolism is related to patient factors and to the type of progesterone used. The highest estimates of risk of venous thromboembolism related to oral contraceptive use (15 to 30 cases per 100,000 women per year) are significantly lower than the rates in pregnancy (60 cases per 100,000 women). The annual risk of venous thromboembolism in women who do not use oral contraceptives is five to 11 cases per 100,000 women. A British estimate of the risk of death related to use of oral contraceptives ranges from one death in 500,000 women to one death in 1 million women. In comparison, the annual risk of death from smoking 10 cigarettes daily is one death in 200 women; from influenza, one death in 5,000 women; from road accidents, one death in 8,000 women; from an accident at home, one death in 26,000 women, and from an accident at work, one death in 43,500 women.

Management of Minor Burns

(Australia—Australian Family Physician, September 1997, p. 1023.) The extent of skin damage caused by heat ranges from erythema (such as occurs in cases of sunburn) to extensive destruction of the dermal layers. If the basal layer of the epidermis is preserved, normal epidermal tissue may regenerate rapidly. Surviving nests of cells may facilitate reepithelialization of deeper and more extensive burns, but this healing is always slow and accompanied by scarring. The traditional use of gauze, tulle gras and supportive crepe bandaging for superficial burns over a limited body surface is being replaced by less cumbersome self-adhesive, semipermeable films and dressings to provide physical protection during natural healing. Dressings for blistering burns must accommodate exudate while providing physical protection and minimizing contamination. Semipermeable membranes, hydrocolloid dressings or perforated adhesive dressings may be used to achieve a dry, uninfected wound that is likely to heal without scarring. Burns involving pressure points are best covered with self-adherent, soft, absorbent, waterproof, pliable hydrocolloid dressings. All patients with burns of the face, feet, hands and perineum (even minor injuries) should be considered for specialist consultation, since minor scarring in these areas can cause significant functional problems.

Tinea Unguium (Onychomycosis)

(Great Britain—The Practitioner, December 1997, p. 744.) Dermatophyte infection of the nail plate (tinea unguium, or onychomycosis) is usually associated with fungal infection of the associated hand or foot. The infection usually begins in the distal or lateral edges of the nail and spreads, causing thickening, crumbling and discoloration of the nail. The most common causative organisms are Trichophyton rubrum, Epidermophyton floccosum and Trichophyton interdigitale. Nail clippings and scrapings should be obtained to confirm the diagnosis and exclude conditions such as psoriasis, eczema and other nail dystrophies. Systemic therapies include terbinafine, 250 mg daily for six weeks to three months, and pulsed itraconazole, 200 mg twice daily for seven days, repeated after 21 days. Topical therapies (tioconazole or amorolfine) are generally less effective than systemic treatment.

Reducing Hypertrophic or Keloid Scars

(Australia—Australian Family Physician, September 1997, p. 1097.) Hypertrophic or keloid scars may produce an unacceptable cosmetic result despite good healing after trauma or surgery. These scars are more likely to form in the deltoid region and over the upper one third of the sternum than in other parts of the body. Patients of Asian or African descent are most likely to produce hypertrophic or keloid scarring, and this form of scarring is likely to repeat. The two forms of therapy are based on use of irradiation or injectable corticosteroids. Therapy with corticosteroids is used after excision of the previous scar and resuturing of the wound. Triamcinolone, 10 mg per mL, is injected into the entire recess of the wound, and normal techniques of wound care are followed. Sutures are left in place approximately 50 percent longer than usual to ensure healing in presence of the corticosteroid.