Quality of Life - Vitiligo
(Nigeria)
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 much has your skin been itching you, paining you, stinging or biting you? *
2. Over the last week, how self conscious or ashamed have you been because of the way your skin is? *
3. Over the last week, how much has your skin problem affected your going to the market or taking care of your house or compound? *
4. Over the last week, how much has your skin problem determined the type of clothes you wear? *
5. Over the last week, how much has your skin problem affected your social outings and activities? *
6. Over the last week, how much has your skin problem made it difficult for you to play any sport? *
7. Over the last week, has your skin problem prevented you from doing your job or school work? *
If your answer is “No”, over the last week how much has your skin problem hindered your job or school work? *
8. Over the last week, how much has your skin caused problems between you and your spouse or boyfriend/girlfriend, or any of your relations or close friends? *
9. Over the last week, how much has your skin problem affected your `having fun’/`sleeping with’ your spouse/boyfriend/girlfriend? *
10. Over the last week, how much has the treatment for your skin inconvenienced you, for example by making your house messy, or by taking your time? *
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