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MRS

ACNE MRS 24-25

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Survey Questionnaire Form

An epidemiological survey among Dermatologist evaluating diagnosis and management of acne vulgaris in Indian population
Doctor’s details

Questionnaire

  1. Total number of patients visited in last 10 days for skin consultation *

  2. What % of patients visited in last 10 days for Acne consultation *

  3. Of total acne patients, what % is female population *

  4. How do you diagnose the case of acne vulgaris? *
  5. What are the most common causes of Acne in your patients (select top 5 causes) *

  6. Is there is any association between acne vulgaris and smoking? *

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

    Grade 2

    Grade 3

    Grade 4

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

    Blackheads

    Papules

    Pustules

    Cyst

    Crusting

    Scars

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

    Grade 2

    Grade 3

    Grade 4

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

    Grade 2

    Grade 3

    Grade 4

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

  12. How do you manage moderate to severe acne patient during pregnancy? *
  13. What is % of patients in which Acne face wash is prescribed *

  14. What are the current challenges you are facing during treatment of acne *