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Healthcare Professionals
The information in this section is intended for U.S. Healthcare Professionals Only
Skin Rash Questionnaire
Diagnosing eczema is not easy since it is not based solely on the results of any specific test such as a blood test or skin biopsy (lab test of a piece of skin). Rather, it is a diagnosis that is made by a doctor based on a number of factors. These factors include the patient's recent medical history, family history, and physical examination.
It is important to remember that the diagnosis of skin rashes, such as eczema, requires a visit to a physician.
In order to help your doctor to diagnose whether the skin rash you or a loved one has is eczema, you can use this questionnaire.
Answer the following 4 short questions. If you do not know the answer to a question, leave it blank. Once you have completed the questionaire, you can email or print your instant results to make them easier to share with your doctor.
1.
Is the skin rash area itchy?
Yes
No
2.
Does the rash occur in repeated episodes?
Yes
No
3.
Does the affected person have a personal or family history of atopic disorders
(eczema, hay fever, asthma)
?
Yes
No
4.
How old is the person you are concerned about?
younger child
older child
adult
Please indicate affected areas by selecting from among the following
(check all that apply):
Neck
Arms
Elbows Inside
Hands
Legs
Knees Back
Ankles
Face
Trunk
(including Chest)
Elbows Outside
Knees Front
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