Index

DERMATOLOGY LIFE QUALITY INDEX

The aim of this questionnaire is to measure how much your skin problem has affected your life OVER THE LAST WEEK. Please tick one box for each question.

Very much

A lot

A little

Not at all

1. Over the last week, how itchy, sore, painful or stinging has your skin been?

Very much

A lot

A little

Not at all

2. Over the last week, how embarrassed or self conscious have you been because of your skin?

Very much

A lot

A little

Not at all

Very much

A lot

A little

Not at all

Not relevant

3. Over the last week, how much has your skin interfered with you going shopping or looking after your home or garden?

Very much

A lot

A little

Not at all

Not relevant

4. Over the last week, how much has your skin influenced the clothes you wear?

Very much

A lot

A little

Not at all

Not relevant

5. Over the last week, how much has your skin affected any social or leisure activities?

Very much

A lot

A little

Not at all

Not relevant

6. Over the last week, how much has your skin made it difficult for you to do any sport?

Very much

A lot

A little

Not at all

Not relevant

Yes

Not relevant

7. Over the last week, has your skin prevented you from working or studying?

Yes

Not relevant

A lot

A little

Not at all

If "No", over the last week how much has your skin been a problem at work or studying?

A lot

A little

Not at all

Very much

A lot

A little

Not at all

Not relevant

8. Over the last week, how much has your skin created problems with your partner or any of your close friends or relatives?

Very much

A lot

A little

Not at all

Not relevant

9. Over the last week, how much has your skin caused any sexual difficulties?

Very much

A lot

A little

Not at all

Not relevant

10. Over the last week, how much of a problem has the treatment for your skin been, for example by making your home messy, or by taking up time?

Very much

A lot

A little

Not at all

Not relevant

Your DLQI Score

0 - 1 = no effect at all on patient’s life

2 - 5 = small effect on patient’s life

6 - 10 = moderate effect on patient’s life

11 - 20 = very large effect on patient’s life

21 - 30 = extremely large effect on patient’s life

description

© Dermatology Life Quality Index. A Y Finlay, G K Khan, April 1992
* Finlay A.Y., Khan G.K. Dermatology Life Quality Index (DLQI) - A simple practical measure for routine clinical use. Clinical and Experimental Derm 1994; 19:210-16.

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DERMATOLOGY LIFE QUALITY INDEX

The aim of this questionnaire is to measure how much your skin problem has affected your life OVER THE LAST WEEK. Please tick one box for each question.

Your DLQI Score

0 - 1 = no effect at all on patient’s life

2 - 5 = small effect on patient’s life

6 - 10 = moderate effect on patient’s life

11 - 20 = very large effect on patient’s life

21 - 30 = extremely large effect on patient’s life