Chart 1.

Data collection instrument related to sociodemographic and clinical variables of psoriasis and some lifestyles

SOCIODEMOGRAPHIC DATA
Initials:_____________		Date of birth:____/____/____	Gender: [1] female [2] male
City of birth:		City of residence:
Educational level:    [1] Illiterate [2] Incomplete primary school [3] Complete primary school [4] Incomplete secondary school [5] Complete secondary school [6] Incomplete higher education [7] Complete higher education [8] Not informed
Skin color: ___________________		Occupation: ___________________	Profession: ___________________
Marital status: [1] married [2] single [3] divorced [4] widower/widow [5] stable union
Family income:		[1] ≤ 1 miminum wage [2] > 1 to ≤ 2 miminum wages [3] > 2 miminum wages
DATA RELATED TO PSORIASIS
Time of diagnosis:
First appointment: [ ] yes [ ] no		Subsequent appointment: [ ] yes [ ] no	Age of onset of psoriasis:___________
Time of treatment: ___________________		Exacerbation: ___________________	Psoriatic arthritis: [ ] yes [ ] no
Global medical evaluation (PGA):		Number of hospitalizations: ___________________
Place of hospitalization: ___________________
LIFESTYLE
Smoker: [1] yes [2] no	Time in years: _______	Ex-smoker: [1] yes [2] no	Time from stopping smoking in years: ________
Type of smoke:	[1] cigarette [2] pipe [3] straw cigarette [4] cigar [5] other: __________
Alcohol consumption? [1] yes [2] no
Amount and duration: