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	Encuestas de Vitiligo English
	How old where you, when your first white spot appeared or was discovered ? over 40 or under 5 years old Over 5 years old and under 40 years Did any direct relative or distant ones developed grey hair before the age of 50? Yes No Does anyone in you family has or has had any of the following diseases: Thyroid disorders Diabetes None of the above Do you suffer or have you suffered from: Diabetes Allergies Throat Infections Herpes Fungus Psoriasis Hair loss Fragile Nails Nervousness Kidney Problems Digestive problems Liver Problems Articular Problems Thyroid problems Human Papillomavirus (HPV) You can not stand the cold You can not stand the heat Another disease Does someone in your family (direct or distant relative) has or has had Vitiligo? Yes No Does anyone in you family has or has had: Psoriasis Cancer None of the above Time of development between the first and second white spot: Less than 6 months Between 6 and 12 months More than 12 months Does not apply for having just one white spot Body zone were the first white spot appeared: Face Hands Feet Scalp Genitals Torso Back Upper Limbs Lower Limbs I am not sure where it appeared The beginning or expansion of the white spots was preceded by Some emotional trauma or shock An illness Physical injury (Burn, wound, stroke, etc.). If the patient is female: Ever been pregnant? None of the above Body Zone where other white spots are already installed: Face Hands Feet Genitals Hip Torso Back Upper Limbs Lower Limbs Neck Buttocks Mucosal (nostril, mouth, gums, etc.) None of the above or they have not appeared anymore Specify the location of the last white spot appeared: Face Neck Hands Feet Scalp Genital area Torso Back Hips Upper Limbs Lower Limbs Buttocks Only what you informed at the beginning None of the above What percentage of the body, knowing that your palm is 1 percent of your body, do you consider is occupied by the disease: Less than 10% 10% to 15% Over 15% Over 40% Do you believed that the majority of the white patches are : Very white Not so white Almost normal Do new white spots appear in areas where you have suffered some kind of trauma or injury Burn wound by rubbing Surgery Scar No During the last 6 months the white spots have decreased increased not changed Within the white spot does hair grow with color or white? Normal color White Does not apply for not having hair in those parts What do you wish to do about your white spots? Choose as many options as you want Know the cause Avoid white spots growing Remove white spots. Once removed avoid white spots return Cover the white spots with cover up corrective Know a budget...