Vitiligo Quality of Life Study

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* 1. During the past month:

	0 - Not at all	1	2	3	4	5	6- All of the time
1. Have you been bothered by the appearance of your skin condition?	1. Have you been bothered by the appearance of your skin condition? 0 - Not at all	1. Have you been bothered by the appearance of your skin condition? 1	1. Have you been bothered by the appearance of your skin condition? 2	1. Have you been bothered by the appearance of your skin condition? 3	1. Have you been bothered by the appearance of your skin condition? 4	1. Have you been bothered by the appearance of your skin condition? 5	1. Have you been bothered by the appearance of your skin condition? 6- All of the time
2. Have you felt frustrated about your skin condition?	2. Have you felt frustrated about your skin condition? 0 - Not at all	2. Have you felt frustrated about your skin condition? 1	2. Have you felt frustrated about your skin condition? 2	2. Have you felt frustrated about your skin condition? 3	2. Have you felt frustrated about your skin condition? 4	2. Have you felt frustrated about your skin condition? 5	2. Have you felt frustrated about your skin condition? 6- All of the time
3. Has your skin condition made it hard to show affection?	3. Has your skin condition made it hard to show affection? 0 - Not at all	3. Has your skin condition made it hard to show affection? 1	3. Has your skin condition made it hard to show affection? 2	3. Has your skin condition made it hard to show affection? 3	3. Has your skin condition made it hard to show affection? 4	3. Has your skin condition made it hard to show affection? 5	3. Has your skin condition made it hard to show affection? 6- All of the time
4. Has your skin condition affected your daily activities?	4. Has your skin condition affected your daily activities? 0 - Not at all	4. Has your skin condition affected your daily activities? 1	4. Has your skin condition affected your daily activities? 2	4. Has your skin condition affected your daily activities? 3	4. Has your skin condition affected your daily activities? 4	4. Has your skin condition affected your daily activities? 5	4. Has your skin condition affected your daily activities? 6- All of the time
5. When you were talking to someone, have you worried about what they may be thinking of you?	5. When you were talking to someone, have you worried about what they may be thinking of you? 0 - Not at all	5. When you were talking to someone, have you worried about what they may be thinking of you? 1	5. When you were talking to someone, have you worried about what they may be thinking of you? 2	5. When you were talking to someone, have you worried about what they may be thinking of you? 3	5. When you were talking to someone, have you worried about what they may be thinking of you? 4	5. When you were talking to someone, have you worried about what they may be thinking of you? 5	5. When you were talking to someone, have you worried about what they may be thinking of you? 6- All of the time
6. Have you been afraid that people will find fault with you?	6. Have you been afraid that people will find fault with you? 0 - Not at all	6. Have you been afraid that people will find fault with you? 1	6. Have you been afraid that people will find fault with you? 2	6. Have you been afraid that people will find fault with you? 3	6. Have you been afraid that people will find fault with you? 4	6. Have you been afraid that people will find fault with you? 5	6. Have you been afraid that people will find fault with you? 6- All of the time
7. Have you felt embarrassed or self-conscious because of your skin?	7. Have you felt embarrassed or self-conscious because of your skin? 0 - Not at all	7. Have you felt embarrassed or self-conscious because of your skin? 1	7. Have you felt embarrassed or self-conscious because of your skin? 2	7. Have you felt embarrassed or self-conscious because of your skin? 3	7. Have you felt embarrassed or self-conscious because of your skin? 4	7. Have you felt embarrassed or self-conscious because of your skin? 5	7. Have you felt embarrassed or self-conscious because of your skin? 6- All of the time
8. Has your skin condition influenced the clothes you wear?	8. Has your skin condition influenced the clothes you wear? 0 - Not at all	8. Has your skin condition influenced the clothes you wear? 1	8. Has your skin condition influenced the clothes you wear? 2	8. Has your skin condition influenced the clothes you wear? 3	8. Has your skin condition influenced the clothes you wear? 4	8. Has your skin condition influenced the clothes you wear? 5	8. Has your skin condition influenced the clothes you wear? 6- All of the time
9. Has your skin condition affected your social or leisure activities?	9. Has your skin condition affected your social or leisure activities? 0 - Not at all	9. Has your skin condition affected your social or leisure activities? 1	9. Has your skin condition affected your social or leisure activities? 2	9. Has your skin condition affected your social or leisure activities? 3	9. Has your skin condition affected your social or leisure activities? 4	9. Has your skin condition affected your social or leisure activities? 5	9. Has your skin condition affected your social or leisure activities? 6- All of the time
10. Has your skin condition affected your emotional well-being?	10. Has your skin condition affected your emotional well-being? 0 - Not at all	10. Has your skin condition affected your emotional well-being? 1	10. Has your skin condition affected your emotional well-being? 2	10. Has your skin condition affected your emotional well-being? 3	10. Has your skin condition affected your emotional well-being? 4	10. Has your skin condition affected your emotional well-being? 5	10. Has your skin condition affected your emotional well-being? 6- All of the time
11. Has your skin condition affected your overall physical health?	11. Has your skin condition affected your overall physical health? 0 - Not at all	11. Has your skin condition affected your overall physical health? 1	11. Has your skin condition affected your overall physical health? 2	11. Has your skin condition affected your overall physical health? 3	11. Has your skin condition affected your overall physical health? 4	11. Has your skin condition affected your overall physical health? 5	11. Has your skin condition affected your overall physical health? 6- All of the time
12. Has your skin condition affected your grooming practices (i.e. hairstyle, use of cosmetics)?	12. Has your skin condition affected your grooming practices (i.e. hairstyle, use of cosmetics)? 0 - Not at all	12. Has your skin condition affected your grooming practices (i.e. hairstyle, use of cosmetics)? 1	12. Has your skin condition affected your grooming practices (i.e. hairstyle, use of cosmetics)? 2	12. Has your skin condition affected your grooming practices (i.e. hairstyle, use of cosmetics)? 3	12. Has your skin condition affected your grooming practices (i.e. hairstyle, use of cosmetics)? 4	12. Has your skin condition affected your grooming practices (i.e. hairstyle, use of cosmetics)? 5	12. Has your skin condition affected your grooming practices (i.e. hairstyle, use of cosmetics)? 6- All of the time
13. Has your skin condition affected your sun protection efforts during recreation (i.e. limiting exposure time during peak sun hours, seeking shade, wearing hat, long sleeves or pants)?	13. Has your skin condition affected your sun protection efforts during recreation (i.e. limiting exposure time during peak sun hours, seeking shade, wearing hat, long sleeves or pants)? 0 - Not at all	13. Has your skin condition affected your sun protection efforts during recreation (i.e. limiting exposure time during peak sun hours, seeking shade, wearing hat, long sleeves or pants)? 1	13. Has your skin condition affected your sun protection efforts during recreation (i.e. limiting exposure time during peak sun hours, seeking shade, wearing hat, long sleeves or pants)? 2	13. Has your skin condition affected your sun protection efforts during recreation (i.e. limiting exposure time during peak sun hours, seeking shade, wearing hat, long sleeves or pants)? 3	13. Has your skin condition affected your sun protection efforts during recreation (i.e. limiting exposure time during peak sun hours, seeking shade, wearing hat, long sleeves or pants)? 4	13. Has your skin condition affected your sun protection efforts during recreation (i.e. limiting exposure time during peak sun hours, seeking shade, wearing hat, long sleeves or pants)? 5	13. Has your skin condition affected your sun protection efforts during recreation (i.e. limiting exposure time during peak sun hours, seeking shade, wearing hat, long sleeves or pants)? 6- All of the time
14. Has your skin condition affected your chances for making new friends?	14. Has your skin condition affected your chances for making new friends? 0 - Not at all	14. Has your skin condition affected your chances for making new friends? 1	14. Has your skin condition affected your chances for making new friends? 2	14. Has your skin condition affected your chances for making new friends? 3	14. Has your skin condition affected your chances for making new friends? 4	14. Has your skin condition affected your chances for making new friends? 5	14. Has your skin condition affected your chances for making new friends? 6- All of the time
15. Have you been worried about progression or spread of disease to new areas of the body?	15. Have you been worried about progression or spread of disease to new areas of the body? 0 - Not at all	15. Have you been worried about progression or spread of disease to new areas of the body? 1	15. Have you been worried about progression or spread of disease to new areas of the body? 2	15. Have you been worried about progression or spread of disease to new areas of the body? 3	15. Have you been worried about progression or spread of disease to new areas of the body? 4	15. Have you been worried about progression or spread of disease to new areas of the body? 5	15. Have you been worried about progression or spread of disease to new areas of the body? 6- All of the time

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* 2. Please check how severe you currently feel your skin condition is:

	0 - No skin involvement	1	2	3	4	5	6 - Most severe case
16. Severity of skin condition	16. Severity of skin condition 0 - No skin involvement	16. Severity of skin condition 1	16. Severity of skin condition 2	16. Severity of skin condition 3	16. Severity of skin condition 4	16. Severity of skin condition 5	16. Severity of skin condition 6 - Most severe case

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* 3. How old are you?

18-24 years

25-34 years

35-44 years

45-54 years

55-64 years

65-74 years

75 years or older

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* 4. Do you identify as male, female, or other? If other, please list.

Male

Female

Other

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* 5. What is your ethnicity? (Check all that apply)

American Indian/Native American

Asian

Black/African American

Hispanic/Latino

White/Caucasian

Pacific Islander

Other (please specify)

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* 6. How long ago were you diagnosed with vitiligo?

Less than 1 year ago

1 - 5 years ago

5 - 10 years ago

10 - 20 years ago

More than 20 years ago

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* 7. On what part of your body is your vitiligo most severe?

Arms/Legs

Chest/Stomach/Back

Hands/Feet

Face

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* 8. What is the highest degree or level of schooling that you have completed? If currently enrolled, highest degree received.

No schooling completed

Nursery school to 8th grade

Some high school, but no diploma

High school graduate, diploma, or the equivalent (example: GED)

Some college credit, but no diploma

Associate degree

Bachelor's degree

Master's degree

Doctorate degree (MD, PhD, etc)

Trade/Technical/Vocational Training

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* 9. Are you employed? If yes, please state your occupation.

Yes

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* 10. What treaments are you currently receiving for your vitiligo?

Phototherapy

Topical therapy (Topical steroids or other topicals)

No treatment

Other (please specify)