Bullous pemphigoid and multiple sclerosis: a report of three cases and review of the literature.

Three patients with longstanding multiple sclerosis (MS) who developed bullous pemphigoid (BP) are reported. All patients had immunological features of typical BP as determined by immunofluorescence and Western immunoblotting studies. The clinical features, however, differed from those observed in typical BP. In two the BP started near an indwelling catheter and two had striking involvement of the soles. None of our patients, or a further nine cases reported in the literature, had mucous membrane involvement. In MS patients BP appears to develop at a younger age. Multiple drugs were taken by the MS patients; these, however, appear not to play a role in triggering their BP. The course of BP in patients with MS is moderate, although the majority require systemic treatment

EEMCO guidance for the assessment of hair shedding and alopecia.

Knowledge of the hair follicle anatomy and the dynamics of hair cycling is substantial. Recognizing the anagen, catagen and telogen phases as well as teloptosis and the hair eclipse phenomenon clearly characterizes the typical hair chronobiology. Physiological modulators include hormones, neuromediators, miscellaneous biomolecules, seasons, micro-inflammation and ageing. For individuals who present with the complaint of increased hair shedding or alopecia, a host of evaluation techniques are available in addition to history, physical examination and laboratory assessment. Various clinical hair techniques can help in assessing the efficacy of drugs and cosmetics on hair growth. The methods are quite similar to those used to establish a definite diagnosis in dermatological practice. Great strides have been made during the recent decades in the methodology of hair growth trials in dermatology and cosmetology. Clinical evaluations benefit from a few additional specific techniques that enhance the perception of hair (re-) growth, shedding and alopecia. These assessments include the determination of hair patterning and density that may be helped by the 'black-and-white felt' examination. Daily hair counts, the 'hair pull test' and the 'hair feathering test' are also available. Instrumental methods provide reliable quantitative information that is useful if there are adequate controls. Some photographic methods, the trichogram, hair weighing and variants of the hair growth window technique including the phototrichogram, videotrichogram and tractio-phototrichogram provide insight into the complexities of hair cycling and shedding. Skin biopsy is indicated for diagnostic purposes, especially when the hair loss is accompanied by scarring