Index

CHILDREN DERMATOLOGY LIFE QUALITY INDEX

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

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

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

Very much Very much

Quite a lot Quite a lot

Only a little Only a little

Not at all Not at all

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

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

Very much Very much

Quite a lot Quite a lot

Only a little Only a little

Not at all Not at all

3. Over the last week, how much has your skin affected your friendships?

3. Over the last week, how much has your skin affected your friendships?

Very much Very much

Quite a lot Quite a lot

Only a little Only a little

Not at all Not at all

4. Over the last week, how much have you changed or worn different or special clothes/shoes because of your skin?

4. Over the last week, how much have you changed or worn different or special clothes/shoes because of your skin?

Very much Very much

Quite a lot Quite a lot

Only a little Only a little

Not at all Not at all

5. Over the last week, how much has your skin trouble affected going out, playing, or doing hobbies?

5. Over the last week, how much has your skin trouble affected going out, playing, or doing hobbies?

Very much Very much

Quite a lot Quite a lot

Only a little Only a little

Not at all Not at all

6. Over the last week, how much have you avoided swimming or other sports because of your skin trouble?

6. Over the last week, how much have you avoided swimming or other sports because of your skin trouble?

Very much Very much

Quite a lot Quite a lot

Only a little Only a little

Not at all Not at all

7. Last week, was it school time, or was it holiday time?

School time School time

Holiday time Holiday time

If school time: Over the last week, how much did your skin problem affect your school work?

Prevented school Prevented school

Very much Very much

Quite a lot Quite a lot

Only a little Only a little

Not at all Not at all

If holiday time: How much over the last week, has your skin problem interfered with your enjoyment of the holiday?

Very much Very much

Quite a lot Quite a lot

Only a little Only a little

Not at all Not at all

8. Over the last week, how much trouble have you had because of your skin with other people calling you names, teasing, bullying, asking questions, or avoiding you?

Very much Very much

Quite a lot Quite a lot

Only a little Only a little

Not at all Not at all

9. Over the last week, how much has your sleep been affected by your skin problem?

Very much Very much

Quite a lot Quite a lot

Only a little Only a little

Not at all Not at all

10. Over the last week, how much of a problem has the treatment for your skin been?

Very much Very much

Quite a lot Quite a lot

Only a little Only a little

Not at all Not at all

Please check that you have answered EVERY question. Thank you.

Done – show results

Your eCDLQI score is:

minimal impairment

maximal impairment

0 - 1 = no effect on child’s life

2 – 6 = small effect on child’s life

7 – 12 = moderate effect on child’s life

13 – 18 = very large effect on child’s life

19 – 30 = extremely large effect on child’s life

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