Survey questionnaire for skin health in adolescents

Adolescence is a critical period in a child's growth, physically and mentally, no matter for the child him or herself, or for the parents and even the whole society.

Adolescence is a critical period in a child's growth, physically and mentally, no matter for the child him or herself, or for the parents and even the whole society. As we all know, skin is the first and major protection of the body, and skin health sometimes matters in interpersonal communication. So adolescents who suffer from skin problems likely have low self-esteem and negative emotions, which might affect their normal life.

Through this survey, we aim to enhance the awareness of skin health among adolescents, and call on the general public and parents to pay extra attention to this issue. How much do you know about this topic? We sincerely invite you to participate in our survey! (The information collected in the survey will only be used for research and analysis. Please rest assured that your information will be strictly kept confidential.)


1. How old is your child?`1.请选择您孩子的年龄:

  • 12-14 years old`12-14岁
  • 15-17 years old`15-17岁

2. Does your child have or has he/she had the following skin problems? (Multiple-choice)`2. 您孩子的皮肤是否存在或曾经存在以下相关症状?(多选)

  • Allergy during the change of seasons`换季时皮肤过敏
  • Erythema, papules or oozing`红斑、丘疹或渗出
  • Rough, thickened or flaky skin`皮肤粗糙、增厚或脱屑
  • Dryness and peeling`皮肤干燥、脱皮
  • Itching`瘙痒
  • Wheal`风团
  • Scratch marks, skin breaks and scabs`抓痕、皮肤破损和血痂
  • None of the above`无以上任何症状

3. Is or was your child diagnosed with the following disease(s)? (Multiple-choice)`3. 您的孩子是否被确诊或曾经确诊过以下疾病?(多选)

  • Eczema`湿疹
  • Urticaria`荨麻疹
  • Psoriasis`银屑病
  • Atopic Dermatitis`特应性皮炎
  • Itchy nodular rash`结节性痒疹
  • Neurodermatitis`神经性皮炎
  • Seasonal dermatitis`季节性皮炎
  • Others: (Please specify): $input`其他:(请注明): $input
  • No skin problems`没有皮肤问题

4. Has your child had any of the following conditions due to skin problems? (Multiple-choice)`4. 您的孩子是否因皮肤问题,产生过以下情况?(多选)

  • No obvious change`无明显变化
  • Sleeping difficulty`睡眠困难
  • Growth and development affected`成长发育受影响
  • Decline in academic performance`学习成绩下降
  • Heavy mental burden, e.g. lack of self-confidence, social anxiety, reluctant to go to school, stress and depression, and even with suicidal intent, etc.`精神负担较大,如不自信、社交困难、不愿上学、焦虑抑郁、甚至产生自杀念头等
  • Ridiculed, discriminated, or alienated by classmates`被同学嘲笑、歧视或疏远

5. When a skin problem occurs, what measures do you take for your child? (Multiple-choice)`5. 若皮肤状况出现问题,您会对孩子采取哪些应对措施?(多选)

  • I won’t do anything but wait for symptoms to go away`忍忍就过去了
  • Search online (e.g. Baidu, Zhihu, Weibo and other social platforms) for solutions`上网搜索(如百度,或知乎、微博等社交平台),寻求解决办法
  • Try to use ointments or emollients`尝试抹药膏或使用润肤剂
  • Consult people who have similar situations or relatives and friends`询问身边有类似情况的人群或亲友
  • Go to a dermatology clinic for consultation`去专业皮肤科医院进行咨询

6. Atopic dermatitis is a refractory systemic immune-driven disease mostly caused by repeated episodes of infantile eczema. About 50% of children with atopic dermatitis have recurring symptoms in adolescence and adulthood. Have you heard of it before? (Single-choice)`6. 特应性皮炎是一种难治性的系统性免疫疾病,多数患者由婴儿湿疹反复发作迁延而成,大约50%的儿童特应性皮炎患者,在青少年和成人时期有复发症状产生。您此前听说过特应性皮炎吗?(单选)

  • Yes, I’ve heard of it.`听过
  • No, I’ve never heard of it.`没听过

7. If your child has been diagnosed with eczema, allergy, etc, before, did it later turn into atopic dermatitis? (Single-choice) If no, then go to the end of survey. `7. 若孩子曾经被确诊过湿疹、过敏等,后来是否也确诊了特应性皮炎?(单选)

  • Yes`是
  • No`否

8. Atopic dermatitis is not only a skin disease, but also a systemic immune-driven disease. Patients may suffer from other comorbidities. Has your child been diagnosed with the following disease(s)? (Multiple-choice)`8. 特应性皮炎不仅是皮肤病,也是一种系统性免疫性疾病,可能合并其他共病。您的孩子是否曾被确诊以下疾病?(多选)

  • Allergic rhinitis`过敏性鼻炎
  • Allergic conjunctivitis`过敏性结膜炎
  • Asthma`哮喘
  • Chronic rhinosinusitis with nasal polyps (CRSwNP)`慢性鼻窦炎伴鼻息肉
  • Food allergy`食物过敏
  • Eosinophilic esophagitis`嗜酸细胞性食管炎

9. If your child has atopic dermatitis, has any of the following situations happened? (Multiple-choice)`9. 若您的孩子已被确诊特应性皮炎,是否发生过以下情况?(多选)

  • Unable to sleep due to itching`因瘙痒无法入睡
  • Social anxiety due to skin lesions`因皮损而影响社交
  • Slower growth and development`生长发育受限
  • Unable to study normally due to the recurrence of the disease`因疾病反复发作而耽误学习

10. Did your child’s illness affect your family life? (Multiple-choice)`10. 您的孩子患病是否给家庭造成以下负担?(多选)

  • Economic pressure due to treatment cost`因治疗费用产生经济压力
  • Family relationship strained due to the conflicts on treatment options`因治疗意见冲突,引起家庭关系紧张
  • Lack of sleep with heavy mental stress because parents need to accompany your child`因孩子需陪伴,家长睡眠不足,精神压力大
  • Parent’s work and social activities affected as repeatedly going to hospital is needed`因反复就诊,影响家长的工作与社交活动

11. If your child lives with atopic dermatitis, which of the following two factors will be prioritized when seeking treatment? (Only 2 options allowed)`11. 若您的孩子患有特应性皮炎,为寻求治疗时,会优先考虑以下哪两个因素?(仅可选2个选项)

  • Ability to quickly relieve symptoms`快速缓解症状
  • A well-tolerated safety profile, with no impact on the child’s growth and development`安全副作用小、不影响生长发育
  • Ability to control the disease in the long term, without recurrence`长期控制不复发
  • Treatment costs`治疗费用
  • Treatment convenience`治疗便利性

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