HRT may help prevent pressure ulcers and venous leg ulcers

By Anthony J. Brown, MD

NEW YORK (Reuters Health) – Elderly women who receive hormone replacement therapy (HRT) are about 30% to 40% less likely to develop pressure ulcers and venous leg ulcers than nonusers, according to a report published in the February 23rd issue of The Lancet.

Dr. David J. Margolis and colleagues from the University of Pennsylvania in Philadelphia, conducted a case-cohort study involving 44,195 women, over 65 years of age, to determine the impact of HRT use on ulcer development.

After adjusting for age, HRT users were 35% less likely than nonusers to develop venous leg ulcers, the authors note. Furthermore, HRT use was associated with a 32% reduction in the risk of developing pressure ulcers.

"We decided to investigate HRT's effect on these types of ulcers primarily based on previous evidence that suggested estrogen use may accelerate wound healing," Dr. Margolis told Reuters Health.

"Both types of ulcers have precursor phases where repetitive insult, typically to the dermis, occurs," Dr. Margolis noted. "HRT may help prevent dermal breakdown or help the dermis repair itself," he added.

"Based on the current findings, I think a randomized trial is warranted, but it would be difficult to do," Dr. Margolis said. Because both types of ulcers are relatively rare in elderly individuals, "a huge study group would be needed to do a primary prevention trial," he noted. "Another possibility, which wouldn't require as many subjects, would be to do a more mechanistic study, looking for dermal changes."

Lancet 2002;359:675-677.

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