TO DETERMINE THE TREATMENT TRENDS OF MELASME AMONG DIFFERENT AGE GROUPS IN OUR POPULATION

QUESTIONNAIRE
(Please fill in the following information carefully.)

Sr no.________________
AGE: SEX: Male Female 11-20 years 21-30 years 31-40 years 41-50 years 51 years or above

OCCUPATION: Student Housewife Working women Labourer Business if Others (please specify)_________________ INCOME: __________________ MARITAL STATUS: Married Unmarried

ADDRESS: ________________________________________________________________________

1.

How long have you been diagnosed with melasma? Less than 1 month 1-6 month Upto a year More than a year

2.

When did you plan to take some treatment for melasma? Immediately after developing it After few weeks after developing it After few months after developing it After few years after developing it Any other (specify)_____________

3. Why did you want to treat this:

Social pressure you wanted to look good you thought of it as a disease to be treated if any other(give details)__________

4.

Did you use home remedies for its treatment? Yes No If yes then: What type of things did you use Besan Yogurt Egg Mixture of these If any other(give detail) __________ For how long did you use this? Days Weeks Months If any other (specify)____________ Did you follow this treatment Regularly Irregularly What effect did it have? No effect Worsen Better Completely recovered

5.

Did you go to any beautician for its treatment? Yes No If yes then: What procedure did you get? Steam Facial If other (give details)________ How many times did you get that procedure? Once Twice Thrice 4 times If other (specify)____________ Did you follow this treatment Regularly Irregularly What effect did it have? No effect Worsen Better Completely recovered Did you go to any hakeem for its treatment? Yes No If Yes Give details __________ For how long did you use this? Days Weeks Months If any other (specify)____________ Did you follow this treatment Regularly Irregularly What effect did it have? No effect Worsen Better Completely recovered

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Did you use any special soap for it? Yes No If Yes Which type of soap did you use? Beauty soap Anti bacterial soap Face wash If any other (name please)__________ For how long did you use this? 1-3 week Less than 6 week 6 month- 1 year More than a year If any other (specify)____________ Do you think it was affective? Yes No Are you aware of the role of sun block or avoidance of direct sunlight in prevention of Melasma? Yes No Do you use any sun block for it? Yes No If yes: Regularly Irregularly Do you think it was affective? Yes No Did you use any fairness cream for it? Yes No If yes Name please______ For how long did you use this? Days Weeks Months If any other (specify)____________

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 Did you follow this treatment Regularly Irregularly What effect did it have? No effect Worsen Better Completely recovered

11.

Did you use any bleaching agent for it? Yes No If yes Give details___________ For how many times did you get it? once twice thrice 4 times If any other (specify)____________ Did you follow this treatment Regularly Irregularly What effect did it have? No effect Worsen Better Completely recovered

12.

Did you use any over the counter steroid cream like betnovate, dermovate etc for it? Yes No If yes: For how long did you use this? Days Weeks Months If any other (specify)____________ Did you follow this treatment Regularly Irregularly

 What effect did it have? No effect Worsen Better Completely recovered

13.

Did you use any mixture for creams for it? Yes No If yes Name please 1. _____________ 2. _____________ 3. _____________ 4. _____________ 5. _____________ For how long did you use this? Days Weeks Months If any other (specify)____________ Did you follow this treatment Regularly Irregularly What effect did it have? No effect Worsen Better Completely recovered Did you go to any General Medical Practitioner (MBBS) for its treatment? Yes No If yes Which type of treatment did you get? Topical Oral Name the drugs ( if you remember any)___________ For how long did you use this? Days Weeks Months If any other (specify)____________ Did you follow this treatment

14.

 Regularly Irregularly What effect did it have? No effect Worsen Better Completely recovered

15.

When did you first visit skin specialist after appearance of melasma? Immediately After few weeks After few months After few years

16.

Did you go to any skin specialist for its treatment? Yes No If yes Which type of treatment did you get? Topical Oral Name the drugs ( if you remember any)___________ For how long did you use this? Days Weeks Months If any other (specify)____________ Did you follow this treatment Regularly Irregularly What effect did it have? No effect Worsen Better Completely recovered Have you ever got a laser treatment for this? Yes No If yes: Give details________________ How many times did you get it? once

17.

 twice thrice 4 times If any other (specify)____________ Did you follow this treatment Regularly Irregularly What effect did it have? No effect Worsen Better Completely recovered

18.

Have you ever got Chemical Peeling? Yes No If yes : Give details________________ How many times did you get it? once twice thrice 4 times If any other (specify)____________ Did you follow this treatment Regularly Irregularly What effect did it have? No effect Worsen Better Completely recovered Did you follow your Melasma treatment plan regularly? Yes No What reason would you give for not completing your treatment course? None, Completed my treatment course Side effects of topical drugs Expense of treatment Long duration of treatment If any other (give details)____________

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With which type of treatment your compliance was more? Home remedies Hakeem Homeopath Beautician Self medication General practitioner Dermatologist Laser treatment Chemical peeling If any other (give details)____________ Which treatment has the best efficacy according to you? Home remedies Hakeem Homeopathic Beautician Self medication General practitioner Dermatologist Laser treatment Chemical peeling If any other (give details)____________

22.