|
| | Question | Possible answers | Scoring |
|
| (1) | How often did you feel pruritus within the last 3 days? | (i) All time | 3 points |
| (ii) All morning/afternoon/evening/night long itch episodes | 2 points |
| (iii) Occasionally, short itch episodes | 1 point |
|
| (2) | Did pruritus hinder your ability to do simply things, like watching TV, hearing music, etc.? | (i) Yes
(ii) No | 1 point
0 points |
|
| (3) | Did you feel irritated or nervous because of your itching? | (i) Yes
(ii) No | 1 point
0 points |
|
| (4) | Did your pruritus cause you depressed? | (i) Yes
(ii) No | 1 point
0 points |
|
| (5) | Did your pruritus impede your work or learning abilities? | (i) Yes
(ii) No | 1 point
0 points |
|
| (6) | Did you scratch your skin because of itching? | (i) Yes
(ii) No | 1 point
0 points |
|
| (7) | Did scratching bring you relief? | (i) Yes
(ii) No | 0 points
1 point |
|
| (8) | Were you able to refrain from scratching? | (i) Yes
(ii) No | 0 points
1 point |
|
| (9) | Did you wake up during last night because of pruritus? | (i) No
(ii) Yes, 1-2 times
(iii) Yes, 3-4 times
(iv) Yes, 5 and more times | 0 points
1 point
2 points
3 points |
|
| (10) | Could you assess the severity of your pruritus within last 3 days? | (i) Very mild
(ii) Mild
(iii) Moderate
(iv) Severe
(v) Very severe | 1 point
2 points
3 points
4 points
5 points |
|
| (11) | Could you indicate pruritus location? | (i) Single locations of pruritus
(ii) Large body areas
(iii) Generalized pruritus | 1 point
2 points
3 points |
|
| (12) | Are excoriations or other scratch lesions present? | (i) Yes
(ii) No | 1 point
0 points |
|
