Quality of Life - Vitiligo
(Zimbabwe)
Welcome!
Dear Friend,

Thank you for taking a little time to fill in this short questionnaire. It is aimed to measure how much vitiligo has affected your life over the last week. Please check one box for each question.

Your responses will be part of the comparative study Vitiligo Quality of Life conducted by a non-profit Vitiligo Research Foundation. We respect your privacy and don’t ask for any personal information – this questionnaire is completely anonymous.

If you have questions regarding this questionnaire or our organization in general, please visit our website or send us an email.

1, Penn Plaza, #6205, New York, NY 10119 USA
+1-855-966-3555
info@vrfoundation.org
www.VRFoundation.org

Copyright ©AY Finlay, GK Khan, April 1992. Used with permission. License ID CUQoL1665.

Questionnaire
1. Over the last week, how itchy, sore, painful or stinging has your skin been? *
2. Over the last week, how embarrassed or self conscious have you been because of your skin? *
3. Over the last week, how much has your skin interfered with you going shopping or looking after your home or garden? *
4. Over the last week, how much has your skin influenced the clothes you wear? *
5. Over the last week, how much has your skin affected any social or leisure activities? *
6. Over the last week, how much has your skin made it difficult for you to do any sport? *
7. Over the last week, has your skin prevented you from working or studying? *
If "No", over the last week how much has your skin been a problem at work or studying? *
8. Over the last week, how much has your skin created problems with your partner or any of your close friends or relatives? *
9. Over the last week, how much has your skin caused any sexual difficulties? *
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? *
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