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Psoriasis

MHCW-SKIN-001

Tell us what is bothering you

Skin Condition Questionnaire

Provide details about the skin changes, their course and treatment, and attach photographs or a short video when useful.

Emergency: Seek emergency medical care immediately for breathing difficulty, swelling of the face or tongue, mucosal involvement, extensive blistering, or sudden deterioration.
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1. About you

Other contacts

2. About your skin

What is present now?

3. Warning signs

If any of these warning signs are present, this remote questionnaire does not replace urgent in-person assessment.

4. About your health

Do you have any bowel disturbances?

Antiparasitic treatment history

5. What you are doing now

Add 2–4 recent photographs.
  1. One photograph showing the overall affected area
  2. The remaining photographs as close-up views
  3. If possible, include at least one photograph with a ruler placed next to the affected area so the doctor can assess its size

Take photographs in good lighting, without filters or image editing. You may upload up to 12 files. JPG, PNG, WEBP or PDF: up to 10 MB each; a short MP4, MOV or M4V video: up to 45 MB. Total selected files: up to 48 MB.

Newly selected files will be uploaded only when the questionnaire is finally submitted.

7. Before sending

After submission, the information will be stored in the center’s protected administrative system.