Your browser does not support JavaScript
Please enable JavaScript to make sure proper function of the application
×
Close
Modal title
×
Close
Modal title
×
Close
Modal title
EN
EN
DE
ES
X
1
2
3
4
5
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. Please mark the appropriate box for each question.
1. Physical ailments
The following questions concern your physical well-being. Please place a √ in the appropriate box in each line.
How often did you experience the following in the past week…
never
rarely
sometimes
frequently
always
1) burning sensation of the skin
1) burning sensation of the skin
never
rarely
sometimes
frequently
always
2) shortness of breath, laboured breathing
2) shortness of breath, laboured breathing
never
rarely
sometimes
frequently
always
3) feeling of weakness
3) feeling of weakness
never
rarely
sometimes
frequently
always
4) sleeping problems
4) sleeping problems
never
rarely
sometimes
frequently
always
5) dry skin
5) dry skin
never
rarely
sometimes
frequently
always
6) discharge from the skin
6) discharge from the skin
never
rarely
sometimes
frequently
always
7) diarrhoea or constipation
7) diarrhoea or constipation
never
rarely
sometimes
frequently
always
8) itching
8) itching
never
rarely
sometimes
frequently
always
9) feeling of tightness in the skin
9) feeling of tightness in the skin
never
rarely
sometimes
frequently
always
10) feeling of having a lump in your throat
10) feeling of having a lump in your throat
never
rarely
sometimes
frequently
always
11) feeling a need to sneeze
11) feeling a need to sneeze
never
rarely
sometimes
frequently
always
12) dizziness
12) dizziness
never
rarely
sometimes
frequently
always
13) tingling sensation on the skin
13) tingling sensation on the skin
never
rarely
sometimes
frequently
always
14) headaches
14) headaches
never
rarely
sometimes
frequently
always
*FLQA-d - Fragebogen zur Lebensqualität bei Hauterkrankungen und Allergien" V. 1.1 Augustin et al. 1997, 2000
formula
Next Page