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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

    What are you planning on using this treatment for?

    Itchy skin (pruritus)
    - A persistent urge to scratch the skin, which may be caused by allergies, dry skin, or an underlying skin condition like eczema, psoriasis, scabies or an insect bite

    Hives (urticaria)
    - Raised, red, itchy bumps (weals) on the skin that appear suddenly. They can be triggered by allergies, stress, or certain foods and usually disappear within hours or days

    Skin rash from an allergic reaction
    - A red, irritated rash that occurs after contact with something you're allergic to, such as certain foods, medications, or chemicals (like soaps or detergents)

    Swelling (angioedema)
    - Deep swelling beneath the skin, often around the eyes, lips, or throat, which can happen alongside hives and may be caused by an allergic reaction. It can sometimes feel painful or tight

    Unfortunately it is unsafe for us to offer you treatment for this condition online. We would recommend seeking urgent care from your GP, 111 or local A&E if you are experiencing these symptoms.

    Other

    Where on your body is the problem? Please select all that apply

    Head and NeckUpper BodyLower BodyOther

    Head and Neck

    ScalpFaceEarsEyebrowsEyelidsMouth

    Scalp

    All over scalpFrontBackSidesNape (back of neck where hair starts)Several PatchesOne Patches

    Face

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

    Ears

    Outside earInside earBehind earEar lobeLeft earRight earBoth ears

    Eyebrows

    BothLeftRightSingle patchMultiple patchesAll over

    Eyelids

    All overPatchSingle spotLeft eyelidRight eyelidBoth eyelids

    Mouth

    Around the moutCorner(s) of mouth

    Upper Body

    ChestBackUpper ArmsForearmsElbowsBreastsArmpitsStomach/AbdomenHands

    Chest

    Entire chestLeft sideRight sideIn Between Breasts

    Back

    UpperMiddleLowerAll over

    Upper Arms

    InsideOutsideLeft armRight armBoth arms

    Forearms

    InsideOutsideAll aroundLeft armRight armBoth arms

    Elbows

    Inside elbow foldOutside elbow surfaceLeftRight

    Breasts

    Underneath both breasts (in the skin folds)Underneath one breast (in the skin fold)Side(s)TopBottomIn between breasts

    Armpits

    Left armpitRight armpitBoth armpits

    Stomach/ Abdomen

    StomachLower AbdomenBelly ButtonAll over

    Hands

    TopPalmLeft handRight handBoth hands

    Lower Body

    GroinThighsLower LegsKneesFeetToes

    Groin

    Left groinRight groinBoth groins

    Thighs

    Left thighRight thighBoth thighs

    Lower Legs

    CalfShinLeft legRight legBoth legs

    Knees

    Behind KneesOutside knee surfaceLeftRight

    Feet

    TopSideSole (underneath)HeeLeft footRight footBoth feet

    Toes

    Big toe2nd toeMiddle toe4th toeLittle toeLeft footRight footBoth feet

    Other

    GenitalsJointsOtherI don't know

    Due to the sensitive nature of this area- DigiDerm does not treat skin problems related to the genitals. Please visit your NHS GP or local sexual health clinic.

    Joints

    When did the problems 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 explain:

    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

    Does anything make it WORSE? Please select all that apply

    HeatColdStressAlcoholExerciseSunlightCertain foodsCaffeineMedicationsOtherNone of the aboveI don’t know

    Does anything make it BETTER? Please select all that apply

    HeatColdExerciseSunlightSea WaterDietOtherNone of the aboveI don’t know

    Have you already tried any of the following treatments?

    Washes/ Cleansers
    e.g. Dermol, Oilatum, QV Gentle, Hydromol

    Moisturisers/ Emollients/ Anti-itch Creams
    e.g. Balneum plus, Dermol, Calamine, Aveeno, E45, Doublebase

    Antihistamine Creams or Gels
    e.g. Anthisan, Crotamiton, Eurax

    Antihistamine Tablets
    e.g. Loratidine, Cetirizine, Chloramphenamine (Piriton)

    Steroid Creams/ Ointments
    e.g. Hydrocortisone, Eumovate, Betnovate

    Antifungal or Antibiotic Creams
    e.g. Canesten, Daktarin, Fucidin

    Scabies treatments
    e.g. Lyclear (Permethrin) cream, Derbac (Malathion) lotion

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

    Other

    No - I haven't tried any treatments yet

    What is your biological sex?

    FemaleMaleOther

    Trans Female (Male at birth)Trans Male (Female at birth)

    Are you pregnant, breastfeeding or trying for a baby?

    Yes

    No

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

    Have you ever been diagnosed with any medical conditions?

    AneamiaAnxiety DisorderAsthmaAtrial Fibrillation (AF)Bipolar DisorderCancer (Past or Present)CholecystitisCOPDCrohnsDepressionEczemaEpilepsyFolic acid deficiencyMigraineMyasthenia GravisObsessive-Compulsive DisorderOsteoarthritisOsteoporosisPancreatitisPeripheral Vascular DiseasePsoriasisRaynaud’sRheumatoid Arthritis

    Gastric Reflux DiseaseGastric SleeveHay FeverHeart ArrhythmiaHeart Disease/ Heart AttackHeart FailureHigh Blood PressureHigh CholesterolInflammatory Bowel DiseaseIron deficiencyIrritable Bowel Syndrome (IBS)Kidney DiseaseLiver DiseaseStroke/ TIASurgeryThyroid DisordersType 1 DiabetesType 2 DiabetesUlcerative ColitisVitamin D deficiencySchizophreniaSjorgen’s syndrome

    None of the above

    Other

    Please provide details about your cancer diagnosis:

    Please provide details about any previous or upcoming surgeries:

    Please explain other medical conditions:

    Do you currently take any medications, vaccines, supplements, or recreational drugs?

    NoMedicationsOver the counter medications/ herbal medicationsSupplements

    Recreational drugsVaccinesOther

    Please tell us which medications you are currently taking:

    Please tell us what over-the-counter or herbal medications you are currently taking:

    Please tell us what supplements you are currently taking:

    Please tell us what recreational drugs you are currently using:

    Please tell us if you will be having any vaccines at the same time as using this medication:

    Please tell us what else you take:

    Do you have any allergies to any medications, supplements, herbs, chemicals, peanuts, soya or anything else we should be aware of?

    Yes

    No

    Please tell us more:

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

    Yes

    No

    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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    GP Details

    By providing these details, you consent to us sharing relevant information with your GP if necessary for safety purposes, accessing your NHS Summary Care Record, or obtaining further details about your medical history.

    Do you understand and agree with the following?

    You are aware that if you have or develop severe symptoms, 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 will read the patient information leaflet supplied with any medication we send you. 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 are not pregnant.

    You agree that if needed, a DigiDerm clinician may contact you via email 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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