Survey on Dietary Supplements for Rosacea

Please fill out the following survey about your personal experience with physical discomforts of rosacea. Results will be reported in the National Rosacea Society's newsletter and on rosacea.org.

Question Title

* 1. Do you take any of the following dietary supplements for your rosacea? (Check all that apply.)

Omega-3

Vitamin A

Vitamin B3

Vitamin C

Vitamin D

Vitamin K

Zinc

Selenium

Melatonin

Gamma-linolenic acid (GLA)

Methylsulfonylmethane (MSM)

Other (please specify)

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* 2. If so, how often?

Daily

Three times a week

Weekly

Occasionally

Rarely

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* 3. Do you also use prescription medication to treat your rosacea?

Yes

Sometimes

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* 4. What rosacea signs and symptoms do you have? (Check all that apply)

Persistent redness

Visible blood vessels (telangiectasia)

Bumps and pimples

Skin thickening (rhinophyma)

Eye irritation

Flushing

Burning/stinging

Swelling

Dryness

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* 5. Have you noticed an improvement in your signs and symptoms since starting the supplement(s)?

Yes

Somewhat

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* 6. Are you...

Male

Female

Non-binary/other

Prefer not to answer

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* 7. Are you...

Under 30

30-39

40-49

50-59

60-69

70 or older

Prefer not to answer

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* 8. Comment:

Question Title

* 9. Would you like to receive the latest information on rosacea? Join the NRS mailing list by providing your contact information below.

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address