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Patient form: Complications
1. Have you experienced any other health problem which was caused by hidradenitis suppurativa?
Yes
No
Which one(s)?
2. Have you ever been hospitalized because of your disease?
Yes
No
How many times?
3. How much do you suffer from your skin disease?
0 = not at all
10 = maximum
4. Which words best represent your disease?
Pain
Embarrassment
Chronicity
Handicap
Shame
Other
5. Do you feel something in the involved skin lesions during the remission period?
Yes
No
Pruritus
Other
6. Please quantify the impact of HS on your sleep cycle:
0 = no impact whatsoever
10 = the worst possible impact
7. Please quantify the impact of HS on your behavior:
0 = no impact whatsoever
10 = the worst possible impact
8. Which words would best define an ideal treatment for hidradenitis suppurativa?
Fast
Reimbursed by health insurance
Effective
Low occurrence of side effects
Other
9. Have you ever met other people suffering from hidradenitis suppurativa?
Yes
No
Describe in which context(s) you met them:
Confirm