It's in the jeans

A Question Of Health

I HAVE developed a red, itchy rash below my navel. It disappeared when I was on holiday in the sun, but has now reappeared. What causes such a bizarre symptom?

Bizarre symptoms usually have bizarre causes, and I wonder if your rash is a skin allergy to nickel. If you wear jeans, the rash is almost certainly caused by an allergic reaction to the metal stud at the back of the button that fastens the waist. Try painting the stud with clear nail varnish and then sew a small piece of material over it. My bet is that the rash will disappear, though you may want to help it with some over-the-counter hydrocortisone cream for a few days.

How effective is the morning-after pill? I've used it three times and each time it has rescued me from a possible pregnancy. What is my chance of pregnancy if I use it again?

The morning-after pill (which is now correctly called "emergency contraception", because it can be taken up to 72 hours after unprotected intercourse) has a failure rate of about 2 per cent. That means that for every 100 women who use it, two of them end up pregnant. A new method of emergency contraception, using a single-hormone pill containing levnorgestrel, has a failure rate of less than 0.5 per cent, but is not yet licensed for emergency use, though doctors can prescribe it. It should be on the market within a year. Emergency contraception may soon become much easier to obtain without a prescription, perhaps direct from pharmacists. The Government is under strong pressure to change the law so that women do not need to see a doctor before they use the pill.

I have just recovered from a painful attack of gout in my big toe joint. How can I prevent it happening again?

Gout summons up images of crusty old men who drink port and eat large quantities of red meat. But, in fact, it is usually not caused by either dietary or alcohol over-indulgence, although it does affect men more than women. Microscopic crystals of uric acid, which form inside joints, cause acute pain and swelling and for some mysterious reason, the big toe is the commonest part of the body to be affected. Some drugs, such as diuretics, can cause gout, but frequently it just comes out of the blue. If you are getting frequent attacks, it can be prevented by taking allopurinol tablets, which reduce the amount of uric acid in the bloodstream.

My doctor says I have tennis elbow, even though I have not played tennis for 10 years. I can barely lift a saucepan without suffering a terrible pain up and down my arm. This has been going on for six weeks and the only advice I have been given is to rest the arm. Is there no other way of helping it get better?

In my experience, tennis elbow hardly ever affects tennis players. It is caused by an injury to the spot just above the elbow where the "back- hand" muscles attach themselves to the upper arm bone. It can be brought on by movements that put a stress on these muscles - painting, carrying briefcases, repetitive action. It usually gets better if you can avoid the activity that caused it. If that fails, and you get tired of waiting, it may be possible to have a steroid injection into the tender spot; even that is not a guaranteed cure.

The left side of my face has suddenly began to droop and I have been told that it is Bell's palsy. What is the cause of this?

There are plenty of theories about what causes Bell's Palsy - a paralysis of the muscles of one side of the face - but no one knows for sure. It may be a virus infection of the facial nerve. Most people recover completely, although it can cause permanent weakness or paralysis of the face muscles in a few people. Steroid tablets are sometimes used to treat the condition, but they have not been proved to be effective.

Please send questions to A Question of Health, `The Independent', 1 Canada Square, Canary Wharf, London, E14 5DL; fax 0171-293 2182. Unfortunately Dr Kavalier cannot respond to individual inquiries