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

    Will you be using this treatment for any of the following common fungal infections? If you are unsure then select ‘I don’t know’

    Athlete’s Foot
    - Itching, burning, redness, and cracked or peeling skin between the toes or on the soles. May cause blisters or thickened skin.

    Ringworm
    - Red, scaly, ring-shaped rash on the body. Itchy and can appear on any part of the body.

    Jock Itch (Sweat rash)
    - Itchy, red rash in the groin, inner thighs, or buttocks, often with a scaly (flakey) border.

    Fungal Infection of the Body Folds (Intertrigo)
    - Red, raw, itchy skin in body folds (under breasts, armpits, groin), with a moist appearance.

    Fungal Infection of the Scalp
    - Scaly patches of hair loss on the scalp, itching, and redness. May also cause swollen, painful areas.

    Pityriasis Versicolor
    - Small, discoloured patches on the chest, back, or upper arms. Patches may be lighter or darker than normal skin and can be slightly itchy.

    Other

    I don’t know

    0%

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

    Head and NeckUpper BodyLower BodyOther

    Head and Neck

    ScalpFaceBeard areaEarsEyebrowsEyelidsMouthNeck

    Scalp

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

    Face

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

    Beard Area

    All overSeveral PatchesOne patch

    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

    Neck

    CollarFrontBackLeft sideRight sideAll around

    Upper Body

    ChestShouldersBackUpper ArmsForearmsElbowsBreastsNipplesArmpitsStomach/AbdomenHandsWristsFingersFinger Nails

    Chest

    Entire chestLeft sideRight sideIn Between Breasts

    Shoulders

    LeftRightBoth

    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

    Nipples

    LeftRightBoth

    Armpits

    Left armpitRight armpitBoth armpits

    Stomach/ Abdomen

    StomachLower AbdomenBelly ButtonAll over

    Hands

    TopPalmLeft handRight handBoth hands

    Wrists

    TopInsideAll aroundLeft wristRight wristBoth wrists

    Fingers

    TopBottomSideFinger webs (skin folds)ThumbIndex fingerMiddle fingerRing fingerLittle fingerLeft handRight handBoth hands

    Finger Nails

    ThumbIndex fingerMiddle fingerRing fingerLittle fingerLeft handRight handBoth handsOther

    Lower Body

    GroinThighsButtocksLower LegsKneesFeetAnklesToesToe Nails

    Groin

    Left groinRight groinBoth groins

    Thighs

    Left thighRight thighBoth thighs

    Buttocks

    Butt CheeksBum fold (skin fold)Anus

    Lower Legs

    CalfShinLeft legRight legBoth legs

    Knees

    Behind KneesOutside knee surfaceLeftRight

    Feet

    TopSideSole (underneath)HeeLeft footRight footBoth feet

    Ankles

    Front/TopBackSideAll around ankleLeft ankleRight ankleBoth ankles

    Toe Nails

    Big toe2nd toeMiddle toe4th toeLittle toeLeft footRight footBoth feet

    Toe Nails

    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

    Do you have any of the following symptoms? Please select all that apply

    ItchRednessScaling(Flaky skin) BlisteringCrustingSwellingPain or sensitivityWarm to touch or hot skinStinging or burningTinglingBad smell(malodour) Discharge or oozingThickened skinDarkening of skin(increase in colour or pigment) Lightening of skin(loss of colour or pigment) DrynessNail changesChange in nail colourBrittle nailsNail breakdown or lossThickened nailsHair loss(if related to the area affected) None of the aboveOtherI don't know

    Please rate from 1-10 how painful it is (0= no pain, 10= worst imaginable):

    16%

    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:

    33%

    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

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    Does anything make it WORSE? Please select all that apply

    Sweating or excessive moistureTight or non-breathable clothingWarm, humid environmentsNot drying the affected area properly after washingSharing towels, clothing, or personal itemsScratching or rubbing the affected areaPoor hygiene in the affected areaSun exposureOily skin or hairUsing harsh soaps or hair productsMedicationsOtherNone of the aboveI don’t know

    Does anything make it BETTER? Please select all that apply

    Showering after exercise or sweatingKeeping the affected area clean and dryWearing loose, breathable clothingAvoiding shared personal items (e.g., towels, brushes)Regularly washing the affected area with mild soapAvoiding warm, humid environmentsCertain products e.g. tea tree oil, aloe vera, coconut oil Certain supplements e.g. probiotics, vitamins, zinc OtherNone of the aboveI don’t know

    50%

    Have you already tried any of the following treatments?

    Antifungal Creams or Gels
    e.g. Canesten (Clotrimazole), Daktarin (Miconazole), Daktacort (MIconazole & Hydrocortisone), Lamisil (Terbinafine), Ketoconazole

    Antifungal Powders or Sprays
    e.g. Lamisil (Terbinafine), Daktarin, Mycota, Scholl Athletes Foot Powder

    Antifungal Shampoos
    e.g. Nizoral (Ketoconazole), Selsun (Selenium Sulphide)

    Antifungal Tablets or Capsules
    e.g. Fluconazole, Itraconazole, Terbinafine

    Antibacterial or Antiseptic Washes
    e.g. Hibiscrub, Dermol 500, Cetaphil Antibacterial

    Steroid Creams or Ointments
    e.g. Daktacort, Hydrocortisone, Eumovate (Clobetasone), Betnovate (Betamethasone)

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

    Moisturisers
    e.g. E45, Aveeno, Aloe vera

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

    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

    66%

    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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    83%

    Do you understand and agree with the following?

    You are aware that you should complete the full course of antifungal treatment, even if your symptoms improve, to prevent the infection from coming back.

    You are aware that oral antifungal medications, such as fluconazole, itraconazole and terbinafine, can affect liver function and should not be used if you have current or previous liver disease. You should seek urgent medical help if you take these medications and notice symptoms of liver damage such as yellowing of the skin, dark urine, abdominal pain or nausea. These medications can interact with other drugs, such as blood thinners or antidepressants, so it’s important to read the patient information leaflet before use and speak to a medical professional for advice. You should also be aware that these medications can affect the heart’s rhythm (prolonged QT), especially if taken with other medications that affect the heart, so it’s important to inform the prescriber of any medications you are currently taking and read the patient information leaflet before using the product to check it is safe for you to use.

    You are aware that long-term use of steroid creams, ointments, lotions and other forms can cause permanent skin damage and skin thinning and should be applied sparingly and not be used continuously.

    You are aware paraffin containing preparations (emollients/creams/ ointments etc) can soak into clothing and bedding and cause a fire hazard. You should wash clothing and bedding frequently and avoid smoking and naked flames. You are aware that for any scalp applications they can be flammable and it is not recommended to blow dry your hair after using them.

    You are aware that if you have or develop 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 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 are not 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.

    100%

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