Answers: |
1 - Not bothered at all |
|
2. - Mostly not bothered |
|
3. - Sometimes not bothered |
|
4. - Neutral |
|
5. - Bothered sometimes |
|
6. - Bothered most of the time |
|
7. - Bothered all the time |
|
Considering
your disease, melasma, how do you feel about: |
|
1. The appearance of your skin condition |
( ) |
2. Frustration due to the appearance of your skin
condition |
( ) |
3. Embarrassment about the appearance of your skin
condition |
( ) |
4. Feeling depressed about your skin condition |
( ) |
5. The effects of your skin condition on your
interactions with others |
( ) |
(e.g.: interactions with family, friends, close relationships
etc.) |
|
6. The effects of your skin condition on your desire
to be with people |
( ) |
7. Your skin condition making it hard to show
affection |
( ) |
8. Skin discoloration making you feel unattractive to
others. |
( ) |
9. Skin discoloration making you feel less vital or
productive |
( ) |
10. Skin discoloration affecting your sense of freedom |
( ) |
TOTAL |
( ) |