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      Condition Questions

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      General Health Questions

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      Photo Upload

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      Terms & Conditions

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    Condition Questions

    Have you had this problem diagnosed by a healthcare professional before?

    YesNoOther

    Why do you need treatment today?

    I’ve had this problem before and need a REPEAT prescriptionI’ve had this problem before but want to try a NEW medicationI’ve NOT had this problem before and want to try a medication to helpOther

    Where on your body is the problem?

    FaceChestBackShouldersButtocksOther

    Face

    ForeheadBoth CheeksLeft CheekRight CheekNoseJaw lineChinCentre of face (down the middle)

    Chest

    Entire chestLeft sideRight sideIn Between Breasts

    Back

    UpperMiddleLowerAll over

    Shoulders

    LeftRightBoth

    Buttocks

    Butt CheeksBum Fold (skin fold)

    Do you have any of the following symptoms?

    Whiteheads (small pus-filled pimples)Blackheads (small black pimples)Papules (small hard pimples)Pustules (small pus-filled spots)Cysts (large fluid filled lumps)Greasy/ Oily skinDry skinRednessItchy/ flakey skin affecting the eyebrows, side of the nose or earsYellowish crusting of the skinStinging/ BurningSkin warm to the touchBleedingCrustingScarringSwellingPain/ SensitivityFlushing (sudden reddening of the face)Excessive hair growth on bodyChanges in your menstrual periodWeight gainEye Problems e.g. grittiness, dryness, irritation, sensitivity, bloodshotNone of the aboveOtherI don’t know

    Please rate your pain on a scale of 1-10, 1 being very little and 10 being the worst pain imaginable:

    Please tell us more about your flushing

    Please tell us more about your excessive hair growth

    Please tell us more about the changes to your periods

    Please tell us more about your weight gain

    Please tell us more about your eye problems

    When did the problem start?

    How quickly did the problem start?

    Suddenly (minutes)Quickly (hours)Gradually (days)Slowly (weeks)Very slowly (months)Over several yearsOtherI don't know

    Is it getting worse?

    NoYesOtherI don’t know

    How does the problem behave?

    It's always thereIt comes and goesOtherI don’t know

    How long does it last?

    MinutesHoursDaysWeeksMonthsYears

    Please tell us how the problem behaves:

    Have you been unwell in any other way recently or experienced any of the following symptoms?

    No- I have been wellI have been unwell recently due to another condition, illness or circumstanceTemperatureFeverNauseaVomitingNight sweatsWeight lossExcessive tirednessJoint pain/ swellingOther concerning symptomsI don’t know

    Please tell us more about how you've been unwell recently

    Please tell us more about your temperature

    Please tell us more about your fever

    Please tell us more about your nausea

    Please tell us more about your vomiting

    Please tell us more about your night sweats

    Please tell us more about your weight loss

    Please tell us more about your tiredness

    Please tell us more about your joint pain/swelling

    Please tell us more about your other concerning symptoms

    Have you had this problem diagnosed by a healthcare professional before?

    YesNoOther

    Why do you need treatment today?

    I’ve had this problem before and need a REPEAT prescriptionI’ve had this problem before but want to try a NEW medicationI’ve NOT had this problem before and want to try a medication to helpOther

    Where on your body is the problem?

    FaceChestBackShouldersButtocksOther

    Face

    ForeheadBoth CheeksLeft CheekRight CheekNoseJaw lineChinCentre of face (down the middle)

    Chest

    Entire chestLeft sideRight sideIn Between Breasts

    Back

    UpperMiddleLowerAll over

    Shoulders

    LeftRightBoth

    Buttocks

    Butt CheeksBum Fold (skin fold)

    Do you have any of the following symptoms?

    Whiteheads (small pus-filled pimples)Blackheads (small black pimples)Papules (small hard pimples)Pustules (small pus-filled spots)Cysts (large fluid filled lumps)Greasy/ Oily skinDry skinRednessItchy/ flakey skin affecting the eyebrows, side of the nose or earsYellowish crusting of the skinStinging/ BurningSkin warm to the touchBleedingCrustingScarringSwellingPain/ SensitivityFlushing (sudden reddening of the face)Excessive hair growth on bodyChanges in your menstrual periodWeight gainEye Problems e.g. grittiness, dryness, irritation, sensitivity, bloodshotNone of the aboveOtherI don’t know

    Please rate your pain on a scale of 1-10, 1 being very little and 10 being the worst pain imaginable:

    Please tell us more about your flushing

    Please tell us more about your excessive hair growth

    Please tell us more about the changes to your periods

    Please tell us more about your weight gain

    Please tell us more about your eye problems

    When did the problem start?

    How quickly did the problem start?

    Suddenly (minutes)Quickly (hours)Gradually (days)Slowly (weeks)Very slowly (months)Over several yearsOtherI don't know

    Is it getting worse?

    NoYesOtherI don’t know

    How does the problem behave?

    It's always thereIt comes and goesOtherI don’t know

    How long does it last?

    MinutesHoursDaysWeeksMonthsYears

    Please tell us how the problem behaves:

    Have you been unwell in any other way recently or experienced any of the following symptoms?

    No- I have been wellI have been unwell recently due to another condition, illness or circumstanceTemperatureFeverNauseaVomitingNight sweatsWeight lossExcessive tirednessJoint pain/ swellingOther concerning symptomsI don’t know

    Please tell us more about how you've been unwell recently

    Please tell us more about your temperature

    Please tell us more about your fever

    Please tell us more about your nausea

    Please tell us more about your vomiting

    Please tell us more about your night sweats

    Please tell us more about your weight loss

    Please tell us more about your tiredness

    Please tell us more about your joint pain/swelling

    Please tell us more about your other concerning symptoms

    Have you already tried any of the following treatments?

    Cleansers/ Exfoliators
    e.g. Cetaphil, CeraVe, Purifide, La Roche Posay Effaclar, Neutrogena

    Moisturisers
    e.g. CeraVe Aveeno, Aloe vera, La Roche Posay Effaclar, Neutrogena

    Benzoyl Peroxide gels/ creams//washes
    e.g. Clearasil, Acnecide gel, PanOxyl, Clean and Clear

    Retinoid creams/ gels
    e.g. Differin, Epiduo, Isotrex, Treclin, Aklief

    Azelaic acid creams/gels
    e.g. Skinoren, Finacea

    Combination creams/gels
    e.g. Duac, Epiduo, Treclin

    Antibiotic creams/ gels/ lotions
    e.g. Duac, Zineryt, Dalacin-T, Rozex, Metrogel

    Antibiotic tablets/capsules
    e.g. Lymecycline, Doxycycline, Clarithromycin, Erythromycin, Trimethoprim

    Specialist Acne treatments
    e.g. Spironolactone, Isotretinoin, Dianette contraceptive pill

    Immune Suppressing tablets/injections
    e.g. Methotrexate, Azathioprine, Hydroxychloroquine, Mycophenolate, Ciclosporin

    Biologics
    e.g Humira injection, Remicade injection

    Cosmetic procedures
    e.g. Chemical peels, Micro-needling, Dermal fillers, Botox

    Laser/ Light/UV therapy

    Herbal/ Supplements/ Alternative treatments
    e.g tea tree oil, zinc, vitamins

    Surgical Procedures

    Other

    None - I haven't tried any treatments.

    Is there anything else you feel is important for us to know that would prevent us from safely prescribing for you?

    NoYes

    Are you pregnant, breastfeeding or trying for a baby?

    YesNo

    Unfortunately, due to safety reasons we would be unable to prescribe any weight loss treatments for you. Please contact your GP for further help.

    Photo Upload

    • If this is a new problem then we require at least one photo of it (max 6 photos) using your phone or digital camera.

    • Take a "far away photo" (from 1 meter away) to show the location and size of the problem.

    • Take a close-up photo (10-12 cm away) to show the details.

    • If appropriate please include a size reference (e.g. a coin or ruler) in your photo for scale.

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    Do you understand and agree with the following?

    You are aware that most acne treatments take 8-12 weeks to work and if there is no improvement after 3 months then you should contact a healthcare professional to review treatment.

    You are aware you should not use more than one type of the same topical (creams/gels/lotions) treatments at the same time- such as two different topical antibiotics or retinoids.

    You are aware that if you have sensitive skin, it is important to start applying topical treatments such as retinoids, azelaic acid, or benzoyl peroxide every other day or once daily to allow your skin time to adjust and minimise irritation. A "purge" reaction, where breakouts temporarily worsen, can be normal and sometimes expected in the early stages of treatment. You can increase to twice daily if tolerated. If severe skin irritation occurs, you should reduce the amount or frequency of application, or temporarily stop using the product. Avoid contact with the eyes, mouth, and mucous membranes during application.

    You are aware oral antibiotics cannot be used with topical antibiotics at the same time and that when using an oral antibiotic you should use topical Benzoyl peroxide, Differin, Epiduo or Azelaic acid at the same time to reduce the risk of antibiotic resistance. You are aware that all antibiotic treatments should generally not be used continuously for longer than 3-6 months without review, due to the risk of antimicrobial resistance.

    You are aware that if you have or develop severe scarring, new or worsening symptoms or concerns, or psychological distress, or your condition is not responding to treatment then you should see your GP as soon as possible.

    You are aware that if you take the medications Isotretinoin (Roaccutane), Lithium or have been diagnosed with Kidney disease, Liver disease, SLE or Myasthenia Gravis then you should not take Lymecycline, Doxycycline, Minocylcine, Oxytetracycline or other Tetracycline antibiotics as this could cause you harm.

    You should not use Doxycycline (e.g. Efracea), Minocycline, Lymecycline (e.g. Tetralysal), or Oxytetracycline antibiotics if you are pregnant, breastfeeding, have a history of liver or kidney disease, taking antacids or have issues with stomach acidity or esophageal irritation or if you use sunbeds or expose your skin to strong sunlight (these antibiotics can increase the risk of skin reactions, and strong sunlight or sunbeds can also worsen conditions like rosacea)

    You will read the patient information leaflet supplied with any medication we send you and if you have any allergies to any of the ingredients or any contraindications, you will not take the medication and contact a DigiDerm clinician for further advice. You have informed us of any allergies you have by completing the general health questions.

    You have informed us of any current or previous medical conditions you have by completing the general health questions.

    You confirm you are not currently pregnant.

    You agree that if needed, a DigiDerm clinician may contact you via email, whatsapp or telephone in response to this consultation form to offer advice and suggest treatments where necessary, or if they feel they need more information to make an accurate diagnosis or assessment of your condition.

    You agree that if after reviewing your consultation, your skin problem is something we cannot treat or is not suitable for our service, then we will give you a full refund and suggest you visit your registered NHS GP for further advice.

    You are at least 16 years old and currently resident in the UK at the time of this consultation. This treatment is to be used only by you.

    You take responsibility to inform your own regular doctor/ NHS GP of this online consultation and any treatments supplied, or any changes in your circumstances.

    The answers provided to the above questions are true and accurate to the best of your knowledge.

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