Dermal Diagnosis - 2025 [Sept]

# demographics
Demographics

MY PERSONAL DETAILS

We require this information to track your progress and provide you with the best advice and insight.
My First Name*
My Last Name*

Demographics

MY PERSONAL DETAILS
My Date Of Birth*

DayMonthYear
Date
Birthdate
My Age
To ensure your results are accurate, please make sure the age value is correct*

I confirm my age is correct
Age Verification

Thank you for entering your birth date. It appears that you are under the age of 18. As a minor, registration must be completed by an adult (parent or legal guardian).

Please confirm in the checkbox below that you are an adult filling out this form on behalf of a minor.
I confirm that I'm an adult filling out this form on behalf of a child or teenager.
Age Verification

Thank you for entering your birth date. Based on the information provided, the age appears to be under 7. Unfortunately, our Dermal Diagnosis form are not designed for children age 7 and below.

Please verify the information if the date was entered incorrectly. Alternatively, please get in touch with our support team for services tailored to younger children.

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Demographics

MY GENDER
I was born with a*

male genetic identityfemale genetic identity

WHEN NOT EXPOSED TO THE SUN

MY NATURAL SKIN COLOR IS

WITH NO CONTACT LENSES

MY NATURAL EYE COLOR IS

WITH NO ARTIFICIAL COLORANT

MY NATURAL HAIR COLOR IS

Medical Background

My Gynecological History
I am pregnant*

yesno
I am

perimenopausal (menopausal transition)postmenopausalnone of the above
I am taking a birth control pill

yesno
I use an IUD such as Mirena

yesno

Medical Background

My Hormone Therapy History
My history of gender-affirming treatment in the form of Hormone Replacement Therapy (HRT)

I'm currently on hormone therapyI underwent hormone therapyI'm not and have never been on hormone therapy
My history of Hormone Replacement Therapy (HRT)

I'm currently on hormone therapyI underwent hormone therapyI'm not, and have never been on hormone therapy

Medical Background

My Steroid Use History
Please answer the below question for prescription as well as non-prescription steroids:
My steroid use history is:*

noneI have used steroids in the pastI'm currently on steroid treatment
The last time I received steroid treatment was*

in the last 6 months6 to 12 months agomore than a year ago

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Medical Background

My Allergenic History

* Select all that apply and click next
I develop allergies when I... *

I don't have any known allergieseat certain foodstake certain medicationsam exposed to certain environmental factors e.g. cat hair or dustam in contact with certain substances e.g soap or washing powderam in contact with certain elements e.g gold or nickel
allergen selected

yes
Error! You indicated that you don't have any allergies, but also selected an allergen. Please rectify the error to proceed.

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# sensitivity pre-screening calculations
+ calc: pre-screen sensitive
# pre-screen sensitive count
% pre-screen sensitive
# score: sensitive [text]

Inflammatory Conditions

My Skin's Dermatitis Risks
The itching I experience on my face or scalp*

only occurs when triggered by allergensoccurs even when I attempt to avoid all allergensI don't experience any itching on my face or scalp
I notice scaly, rough patches on my skin or scalp that are sometimes itchy or flaky*

yesno
The above symptoms on my face or scalp are*

small and infrequentoften present and cover a moderate areaextensive and almost always present

Inflammatory Conditions

My Skin's Dermatitis Risks
The best description for the scaly patches / flakes / broken skin areas on my skin is:

Please select the image closest to the symptoms you experience - even if it's only a tiny area.
Dry Skin Patches: Areas with dry skin with white or ashy flakes. Mild or no itchiness and redness.

Dry, Itchy Skin Scales:Extremely itchy, dry scales with thickened skin.

Oily, Itchy Skin Scales: Red skin with oily, itchy skin scales. The scales may be yellow or white.

Inflammatory Conditions

My Skin's Acne Risks
I have the following type/s of breakouts:

Important: Read the description of each breakout type to ensure your selection is accurate. Select all the images that apply to you.
- Blackheads: Small, dark spots
- Whiteheads: Small, flesh-colored or slightly red bumps, and not painful
- Papules: Red, slightly raised bumps, and sometimes tender
- Pastules: Larger, clearly visible bumps, filled with pus, and may be painful
- Nodules / Cysts: Large, pus-filled, painful lumps, deep under the skin
I typically have the following amount of comedones (blackheads/whiteheads) at any one time*

Few (less than 50)Several (50-100)Many (more than 100)

Inflammatory Conditions

My Skin's Acne Risks
I have breakouts or congested pores in the following area/s:

Please select the images of all the applicable areas.
The acne / breakouts on my face are located on my:

Please select all the images where most of your breakouts are located.

Inflammatory Conditions

My Skin's Redness and Rosacea Risks

Rosacea is a hypersensitive skin condition that appears as inflamed and mostly dry patches. Unlike acne, there are no blocked pores, and no scarring is left.
I experience skin redness in the following regions:

Please select all the images that apply.

SKIN PIGMENTATION

My Skin & Pigmentation

Skin's tendency to form melanin, the skin pigment that produces darker skin tones and dark patches, freckles, and dark areas after trauma.
I have hyperpigmentation on my skin that I would like to soften*

yesnono, but I want to evaluate my risk of developing it
I have hyperpigmentation on the following areas:

Please select all the areas that apply to you.

Healthy Skin Aging

My Eye Concerns
I struggle with the following eye concerns*
Error! "None" can't be selected with one of the eye concerns. Please correct the error before proceeding.
The dark circles under my eye is*

bluish (slightly blue)pigmentedhollowed
Bluish: The skin is thinnest below the eye area making the underlying color more visible.
Late nights, allergies or nasal congestion can indicate that there is sluggish circulation in the area, resulting in bluish-toned dark circles

Pigmented: The delicate area under the eye can be affected by hyperpigmentation due to sun damage.
Genetics also play a role; medium to darker skin tones are the most susceptible skin types.

Hollowed: Loss of volume in the face can cause hollowing under the eye area.
Whilst this is not discoloration, it can create a dark Shadowy area and is due to the natural. process of aging.
I have hollowed dark circles since childhood*

yesno
Eye concerns

Track and monitor your progress

YOUR PERSONALIZED SKINCARE JOURNEY

The Dermal Diagnosis™ Assessment is integrated with your Dermalhealthstore™ account to enhance your experience.

The result calculations will be shared with you via email and linked to your Dermalhealthstore™ account if applicable.

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We will send your Dermal Diagnosis result to the email address below:
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Please provide the email address where you'd like to receive your results*
example@example.com

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Terms and Conditions*

I agree to and accept the terms and conditionsView the terms and conditions

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Dermal Diagnosis™

TERMS AND CONDITIONS

Nature of Assessment: The term "diagnosis" used here does not constitute a medical diagnosis. It is not intended to replace, alter, or equate to a medical diagnosis provided by a licensed medical practitioner. The term "dermal diagnosis" specifically refers to an online skin assessment based on the information you, as an online customer, provide.

Accuracy and Reliability: The effectiveness of your online skin assessment is entirely dependent on the accuracy and completeness of the answers you provide. Dermal Health Science™; bears no responsibility for outcomes that do not align with your expectations or perceptions.

Reassessment Option: You are welcome to resubmit your online assessment at any time if you wish to update, revise, or correct your responses.

No Replacement for Professional Advice: Please be aware that our online skin assessment does not substitute for a proper consultation with a healthcare professional or dermatologist. We highly recommend seeking professional advice for your skin concerns.

Interpretation of 'Prescription': Within this context, the term "prescription" is not an official medical directive from Dermal Health Science™, authorizing issuance of medication or treatment. It is merely a recommendation based on your online assessment. Without an in-person consultation, no formal patient-practitioner relationship is established.

Consultation Requirement for Prescription: An actual written prescription requires a physical, one-on-one consultation with a medical practitioner. Online customers who have not had such a consultation cannot claim to have received a formal prescription.

Product Use and Liability: All products should be used strictly according to their application instructions. Dermal Health Science™; is not liable for any misuse or deviation from these instructions. Furthermore, no liability falls upon a medical practitioner in the absence of a direct, physical consultation.

By participating in this online skin assessment, you acknowledge and agree to these terms and conditions.
I agree to and accept the terms and conditions

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# demographic calculations

# sensitivity pre-screening calculations

# allergy calculations

# acne calculations

# rosacea calculations

Data: Rosacea

# calculations: hydration

# pigmentation calculations

# diagnosis calculations