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. Please mark the appropriate box for each question.

1. Physical ailments

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

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 never

rarely rarely

sometimes sometimes

frequently frequently

always always

2) shortness of breath, laboured breathing

2) shortness of breath, laboured breathing

never never

rarely rarely

sometimes sometimes

frequently frequently

always always

3) feeling of weakness

3) feeling of weakness

never never

rarely rarely

sometimes sometimes

frequently frequently

always always

4) sleeping problems

4) sleeping problems

never never

rarely rarely

sometimes sometimes

frequently frequently

always always

5) dry skin

5) dry skin

never never

rarely rarely

sometimes sometimes

frequently frequently

always always

6) discharge from the skin

6) discharge from the skin

never never

rarely rarely

sometimes sometimes

frequently frequently

always always

7) diarrhoea or constipation

7) diarrhoea or constipation

never never

rarely rarely

sometimes sometimes

frequently frequently

always always

8) itching

8) itching

never never

rarely rarely

sometimes sometimes

frequently frequently

always always

9) feeling of tightness in the skin

9) feeling of tightness in the skin

never never

rarely rarely

sometimes sometimes

frequently frequently

always always

10) 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

11) feeling a need to sneeze

11) feeling a need to sneeze

never never

rarely rarely

sometimes sometimes

frequently frequently

always always

12) dizziness

never never

rarely rarely

sometimes sometimes

frequently frequently

always always

13) tingling sensation on the skin

13) tingling sensation on the skin

never never

rarely rarely

sometimes sometimes

frequently frequently

always always

14) 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

formula