Index

**Quality of life questionnaire for persons living with skin conditions and allergies (FLQA-d*)**

This questionnaire is intended to describe your quality of life living with a skin condition or allergy. It refers to various areas of life.

Please answer the questions carefully, yet spontaneously.

1. Physical ailments

The following questions concern your physical well-being. Please mark the appropriate box in each line.

How often did you experience the following in the past week…

never

rarely

sometimes

frequently

always

burning sensation of the skin

1) burning sensation of the skin

never never

rarely rarely

sometimes sometimes

frequently frequently

always always

shortness of breath, laboured breathing

2) shortness of breath, laboured breathing

never never

rarely rarely

sometimes sometimes

frequently frequently

always always

feeling of weakness

3) feeling of weakness

never never

rarely rarely

sometimes sometimes

frequently frequently

always always

sleeping problems

4) sleeping problems

never never

rarely rarely

sometimes sometimes

frequently frequently

always always

dry skin

5) dry skin

never never

rarely rarely

sometimes sometimes

frequently frequently

always always

discharge from the skin

6) discharge from the skin

never never

rarely rarely

sometimes sometimes

frequently frequently

always always

diarrhoea or constipation

7) diarrhoea or constipation

never never

rarely rarely

sometimes sometimes

frequently frequently

always always

itching

8) itching

never never

rarely rarely

sometimes sometimes

frequently frequently

always always

feeling of tightness in the skin

9) feeling of tightness in the skin

never never

rarely rarely

sometimes sometimes

frequently frequently

always always

feeling of having a lump in your throat

10) feeling of having a lump in your throat

never never

rarely rarely

sometimes sometimes

frequently frequently

always always

feeling a need to sneeze

11) feeling a need to sneeze

never never

rarely rarely

sometimes sometimes

frequently frequently

always always

dizziness

12) dizziness

never never

rarely rarely

sometimes sometimes

frequently frequently

always always

tingling sensation on the skin

13) tingling sensation on the skin

never never

rarely rarely

sometimes sometimes

frequently frequently

always always

headaches

14) headaches

never never

rarely rarely

sometimes sometimes

frequently frequently

always always

**Quality of life questionnaire for persons living with skin conditions and allergies (FLQA-d*)**

1. Physical ailments

*FLQA-d - Fragebogen zur Lebensqualität bei Hauterkrankungen und Allergien" V. 1.1 Augustin et al. 1997, 2000

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