It's easy to start drug treatment for an elderly patient, but somehow much more difficult to stop it. As a result, many old people are taking multiple medicines. Dependency and cognitive impairment diminish elderly people's capacity to report symptoms that might be due to adverse effects of drugs or drug interactions. A randomised controlled trial of a review of medication by a pharmacist versus usual general practitioner care found that although the intervention resulted in substantial changes in medication, the number of drugs remained the same. The biggest benefit to the patients was that their risk of falling was reduced (Age Ageing 2006;35: 586-91).

Pemphigoid gestationis may be difficult to distinguish from polymorphic eruption of pregnancy, as both conditions often present in late pregnancy with an intensely itchy urticated eruption. Pemphigoid gestationis is important as lesions progress to frank blisters, and it is associated with premature delivery and recurrence in subsequent pregnancies. Clinical examination can often help differentiate the two diagnoses, as pemphigoid gestationis involves the umbilicus (top) whereas polymorphic eruption of pregnancy develops …