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ePtGA-Vitiligo

1. Patient Global Assessment (PtGA) for severity

The following question concerns how you would describe the overall severity of your vitiligo.

By this, we mean your perception of your vitiligo when considering all factors such as the extent of your vitiligo, your skin type (skin colour), the influence of vitiligo on your daily life, the location of the spots, and the vitiligo's activity/stability.

a. How do you experience the severity of your vitiligo at this moment? Tick the appropriate box

very severe

severe

moderate

mild

not severe at all

2. Patient Global Assessment (PtGA) for extent

How extensive do you consider your vitiligo to be at this moment? (By extensive, we mean the amount of the skin's surface affected by vitiligo). Tick the appropriate box

very extensive

extensive

moderate extent

limited extent

no vitiligo any more

3. ImpactScore 0-10 (a) and Patient Global Assessment (PGA) for impact (b)

What influence (impact) does vitiligo currently have on your daily life? Please complete both (a) and (b)

a. Pick a number on a scale from 0 to 10, where 0 = no influence and 10 = a lot of influence:

0 - no influence 10 - a lot of influence

b.

very severe influence

severe influence

moderate influence

little influence

no influence at all

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