{{$DoctorName}} @if(isset(session()->get('doctor')['vCentralCode'])) {{session()->get('doctor')['vCentralCode']}} @endif
@if(isset(session()->get('doctor')['vCentralCode']))
Logout
@endif

{{$ActivityTypeName}}

{{$ActivityName}}

@csrf
@if(isset(session()->get('doctor')['vCentralCode']))
Back
@else
@endif

Prevalence, associations with lifestyle and management of acne in India: An epidemiological survey among dermatologists evaluating multiple factors

Survey Questionnaire Form
Doctor’s details

Questionnaire

  1. Out of total patients you consult in your clinic, what % of these patients are affected by acne *

  2. Which gender is most commonly affected with acne vulgaris? *

  3. Which age group is commonly affected by acne vulgaris? *

  4. What are the most common causes of Acne in your patients? (mention top 5 causes) *
    5. A
    B
    C
    D
    E
  5. Published literature suggest there may be an association of acne with smoking. Have you observed similar association in your clinical practice? *

  6. What factors related to lifestyle are associated with acne? (Mention any 3) *
    7. A
    B
    C
  7. Mean BMI of acne patients belongs which range? *

  8. What percentage of acne patients negatively effect on their self-esteem, mood and quality of life? *

  9. What is the % of acne patients that consult you for grade 1, 2, 3 and 4 *
    10. Grade 0-25% 26-50% 51-75% 76-100%
    Grade 1

    Grade 2

    Grade 3

    Grade 4

  10. What is % of patients having following manifestations of acne (0-100%) *
    11. Grade 0-25% 26-50% 51-75% 76-100%
    Whiteheads

    Blackheads

    Papules

    Pustules

    Cyst

    Crusting

    Scars

  11. What is the 1st, 2nd and 3rd line treatment for Grade 1,2,3 and 4 among topical application *
    12. Stages of acne 1st line treatment 2nd line treatment 3rd line treatment
    Grade 1

    Grade 2

    Grade 3

    Grade 4

  12. Do you use topical anti-bacterial formulation as monotherapy? *

  13. Which topical anti-bacterial formulation do you prefer as monotherapy? *

  14. Which topical anti-bacterial formulation do you prefer as FDC? *

  15. Which strength of FDC of clindamycin and BPO do you prefer? *

  16. What is the 1st, 2nd and 3rd line treatment for Grade 1,2,3 and 4 among systemic administration *
    17. Stages of acne 1st line treatment 2nd line treatment 3rd line treatment
    Grade 1

    Grade 2

    Grade 3

    Grade 4

  17. What is % of patients in which Isotretinoin is prescribed *

  18. What % of your female patients require hormonal therapy to treat acne? *

  19. What is the mean duration of treatment required to treat a patient with acne *

  20. What % of your completely treated acne patients show relapse? *