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Do you suffer from any of the
following skin conditions? |
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Yes |
No |
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Guttate psoriasis [?]
— red or salmon-pink droplike lesions on the skin |
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Plaque psoriasis [?]
— the most common type of psoriasis: red inflamed
skin covered with silvery scales |
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Pustular psoriasis [?]
— an uncommon form of psoriasis: clearly defined,
raised bumps on the skin that are filled with pus |
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Inverse psoriasis [?]
— found in the armpits, under the breasts, around
the groin and genitals, around the buttocks and in other
skin folds |
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Erythrodermic psoriasis
[?]
— a particularly inflammatory form of psoriasis
that often affects most of the body surface |
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Scalp psoriasis [?]
— slight fine scaling, to severe, with thick red plaques affecting the entire scalp |
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Severe dandruff [?] — Manifested as flaky, dry, sometimes oily and most often itchy |
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Seborreheic dermatitis [?] — itchy flaky scales on the scalp |
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Eczema [?] — chronic, itchy inflamed skin |
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Adult acne [?] — outbreaks of tender, red, pus-filled bumps over the face, neck, back or chest |
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Rosacea [?] — redness, inflammation and pimple-like bumps on the face |
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Yes |
No |
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Have you visited a primary care
physician, dermatologist or rheumatologist for your
skin condition in the last year? |
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What primary areas
of your body are affected by your skin conditions? |
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Palms |
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Fingernails |
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Soles of feet |
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Arms |
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Skin folds (armpits/backs of knees) |
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Legs |
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Knees |
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Elbows |
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Back |
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Scalp |
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Face |
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Chest / torso |
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Genitals |
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Buttocks |
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What percentage of
your body is affected by your skin condition? |
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Less than 2% |
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2% to 10% |
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11% to 20% |
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21% to 40% |
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41% to 80% |
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More than 80% |
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Do you have any of the following
skin concerns? |
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0 |
1 |
2 |
3 |
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I experience itching. |
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I experience scaling. |
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I experience redness. |
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I experience flaking. |
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I experience dry skin. |
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I experience bumpy skin. |
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I experience irritation. |
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I experience cracking and bleeding. |
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I have scaly, patchy, white or red raised areas of inflammation on the skin — often on my scalp, elbows, knees or lower back. |
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I have pain, stiffness, or swelling in one or more joints. |
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I have nail pitting or lesions of the fingernails or toenails.. |
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I experience prolonged morning stiffness or tiredness. |
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The severity of my symptoms during flare-ups is severe. |
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How long have you had your skin
condition? |
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Less than 1 year |
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1–2 years |
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3–9 years |
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10 or more years |
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Yes |
No |
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Does your skin condition lapse
for periods of time? |
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