Questionnaire - Page 7 of 9 (1015 maximum possible questions)

Last updated: Dec 08, 2008

SYMPTOMS: SKIN: GENERAL
714.	Do you have calluses on your heels and, if so, are they cracked?	No / don't know Light callus without significant cracking Light callus with cracking Thick callus without significant cracking Thick callus, cracked
715.	Do you have a problem with cracking skin, typically on the fingers, toes or in skin creases? Do not include cracked heel calluses.	No / don't know Occasionally / moderate Often / severe
716.	Do you have small bumps on the backs of your arms?	No / don't know Yes, some/minor Diagnosed with keratosis pilaris Yes, many/definite
717.	What is your skin color prior to suntan, compared to others of your race, or family members?	Significantly lighter/paler A little lighter/paler Average / don't know A little darker/redder Significantly darker/redder
718.	What is your facial coloring prior to suntan, compared to others of your race, or family members?	Noticeably pale Slightly pale Average / don't know Slightly dark Noticeably dark, pink, flushed or ruddy
719.	Not counting blushing during embarrassing situations, do you experience facial blushing, flushing or redness more frequently or intensely than would be considered normal?	Don't know / I think I'm average No, definitely not Mild / occasionally Moderate / sometimes Major / often
720.	Does your skin seem to have a more yellowish (jaundiced) tone than previously? It may help to look at untanned areas.	Don't know No Probably Definitely
721.	Skin moistness. Without moisturizer, is your skin...?	Very dry A bit dry Average / don't know A bit oily/moist Definitely oily/moist
722.	Does your skin tend to itch often, perhaps worse at night?	No / don't know Moderately Severely
723.	Do you have a burning sensation on your skin?	Don't know No, definitely not Mildly / occasional Moderately / sometimes Severely / frequently
724.	Do you have a sensation of bugs crawling under or on top of your skin?	Don't know No Mildly / occasionally Moderately / sometimes Definitely / frequently
725.	Do you perspire/sweat...?	Very little / not easily Less than average About average / don't know More than average Lots / easily
726.	Do your palms sweat excessively?	No / don't know Moderate problem of less than 1 year Moderate problem of more than 1 year Major problem of less than 1 year Major problem of more than 1 year
727.	Does your perspiration/sweat have a strong odor?	Don't know No Somewhat Definitely
728.	Do you bruise easily?	No / don't know Mildly Moderately Seriously Severely - I usually have bruises somewhere
729.	Do you have palms and fingertips that are more red than average?	No / don't know Somewhat Definitely
730.	Is your skin temperature . . . ?	Very cold Colder than average Average / don't know Warmer than average Very warm
731.	Is your skin thickness . . . ?	Very thin / fragile Thinner than average Average / don't know Thicker than average Very thick / tough
732.	Is your skin yellow-tinged?	No / don't know Somewhat Definitely
733.	Beyond the questions already asked, do you have ANY skin problems? This would include diagnosed conditions like acne, eczema, psoriasis, dandruff, polyps, spots, rashes, infections, MRSA, etc..	Don't know No Yes    More questions later...
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SYMPTOMS: HAIR
734.	Do you have less hair or a bald patch on the front/side aspect of your lower leg(s)?	No / don't know Yes
735.	Have you had a recent change in body hair quantity?	Much recent loss Some recent loss No / don't know Some recent gain Much recent gain
736.	Do you have an urge or habit of pulling or plucking hairs from your body beyond the removal of selected hairs for cosmetic reasons?	Don't know No Yes, from time to time Yes, I habitually pull hairs out Yes, I habitually pull hairs out and eat them
737.	Do you have less pubic or underarm hair growth than previously?	I can't tell / don't know No, quantity is the same Yes, the quantity has decreased somewhat Yes, the quantity has decreased substantially
738.	Do you have male pattern hair loss? Male pattern hair loss (MPHL) is a common condition in which men, and sometimes women, experience a receding hairline and/or balding on the top of the head.	No / don't know Mildly / frontal loss only Moderately / partial loss on top only Moderately / complete loss on top only Severely / nearly or totally bald
739.	Is your scalp hair falling out, but not as part of male pattern baldness?	Don't know Normal loss History of serious loss / alopecia areota Moderate loss Much loss
740.	If you suffer from male pattern hair loss, at approximately what age did it start progressing significantly?	Not applicable / don't know 25 or under 26 to 35 36 to 45 Over 45
741.	How oily is your hair?	Dry Average / not applicable / don't know Oily
742.	Apart from graying, what color tone is or was the hair on your head?	Very light Light Average / not applicable / don't know Dark Very dark
743.	If you have gray hair, choose the answer that best describes the graying process in your case. Hair graying is both genetic and age-related.	I have no hair / no gray hair / don't know It retained its natural color longer than expected It has grayed normally for my age and race Somewhat prematurely (over half gray before 45) Very prematurely (over half gray before 35)
744.	Aside from male pattern baldness, how dense is the hair on your head?	Very sparse Somewhat sparse Average / not applicable / don't know Dense/abundant
745.	How strong are individual hairs from your head?	Brittle / break easily Somewhat brittle Normal / durable / don't know
746.	How thick are individual hairs on your head?	Thin / fine Average / don't know Thick
747.	How fast does your scalp hair grow? Hair normally grows about 1/2 inch (1.25cm) per month or 6 inches (15cm) per year.	Very slowly Slowly Average / don't know Quickly Very quickly
748.	How wavy is your hair naturally?	It is straight "Average" / don't know It is wavy / curly
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SYMPTOMS: NAILS
749.	Do your fingernails have white spots on them that are not due to nail trauma/injury?	No / don't know A few Several
750.	Do you have any white areas (not spots) on your nails that are not due to nail injury/trauma?	No / don't know Pink at the base, turning white towards the ends 80% or more of nail beds are white, including base White lines from side to side, do not move White lines from side to side, move as nails grow
751.	Are (parts of) your nails any unusual color other than white?	No / don't know Green Blue and brown Black / somewhat brown
752.	Do you experience inflamed cuticles (the skin over the base of your nails)?	No / don't know Occasionally / moderately Often / severely
753.	Do you suffer from hangnails/agnails (painful swelling around the fingernails or toenails) or ragged cuticles (occurring when cuticle or skin surrounding the nail is damaged or torn)?	No / don't know Occasionally / moderate Often / severe
754.	Are your fingernails brittle - do they chip, peel or break easily?