Skip to main content
. 2021 Sep 17;38(4):636–643. doi: 10.5114/ada.2021.108896

Table 1.

VitiQoL questionnaire

The aim of these questions is to measure how much your skin has affected you over past month.
During the past month (0 – Not at all, 6 – All of the time):
Have you been bothered by the appearance of your skin condition? 0 1 2 3 4 5 6
Have you felt frustrated about your skin condition? 0 1 2 3 4 5 6
Has your skin condition made it hard to show affection? 0 1 2 3 4 5 6
Has your skin condition affected your daily activities? 0 1 2 3 4 5 6
When you were talking to someone, have you worried about what they may be thinking of you? 0 1 2 3 4 5 6
Have you been afraid that people will find fault with you? 0 1 2 3 4 5 6
Have you felt embarrassed or self-conscious because of your skin? 0 1 2 3 4 5 6
Has your skin condition influenced the clothes you wear? 0 1 2 3 4 5 6
Has your skin condition affected your social or leisure activities? 0 1 2 3 4 5 6
Has your skin condition affected your emotional well-being? 0 1 2 3 4 5 6
Has your skin condition affected your overall physical health? 0 1 2 3 4 5 6
Has your skin condition affected your grooming practices (i.e. hairstyle, use of cosmetics)? 0 1 2 3 4 5 6
Has your skin condition affected your sun protection efforts during recreation (i.e. limiting exposure time during peak sun hours, seeking shade, wearing hat, long sleeves or pants)? 0 1 2 3 4 5 6
Has your skin condition affected your chances for making new friends? 0 1 2 3 4 5 6
Have you worried about progression or spread of disease to new areas of the body? 0 1 2 3 4 5 6
Please check how severe you currently feel your skin condition is (0 - No skin involvement, 6 – Most severe case):
Severity of skin condition?
0 1 2 3 4 5 6