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Skin Guide
Fill in following medical information to proceed:
Detailed information will help us to provide better and more accurate results regarding your skin condition.
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1
Step
1
of 8
Where is/are the lesion located
*
Head
Neck
Thorax
Abdomen
Back
Pelvis
Upper extremity
Lower extremity
Size of the lesion
*
smaller than 3 mm
3 – 5 mm
5 – 10 mm
> 10 mm
What is the surface of the skin change like?
smooth
harsh
sublime
greasily
glossy
normal
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Symptoms associated with the lesion
*
Skin rash
Itching
Burning
Aches
Bleeding
Changes of color
Newly formed
How long have the symptoms existed?
*
Additional notes associated with the lesion
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Many skin diseases are caused by the professional environment. With your information you improve the diagnostic possibilities.
Your profession
Do you have contact with special substances, liquids or metals?
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Do you have other disease?
Asthma/COPD
Tumor disease
Gastrointestinal disease
Liver disease
Kidney or bladder disease
Cardiovascular disease
High blood pressure
Vascular calcification
Thrombosis
Diabetes
Thyroid disease
Rheumatism
Bone, muscle or joints disease
Tuberculosis
HIV
Other infection
Nerve disease
Depression
Psychiatric disease
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Do you smoke?
No
Less than 10/day
Less than 20/day
More than 20/day
How much alcohol you drink?
No
Less than 1 glass wine per week
Less than 1 glass wine per day
Less than 2 glasses wine per day
More than 2 glasses wine per day
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Are you currently taking any medication?
Did you stop taking medication recently?
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Age
*
Weight [kg]
Height [cm]
Gender
*
Man
Female
Other
Ethnicity
Caucasian
African
Asian
Mixed
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Depending on the result of the evaluation of the AI it may be necessary to contact you
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By submitting the form you allow us and third parties to use your data
*
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