Pre-Screening Questions
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How did you hear about us?  

What is your date of birth?
Month Day Year
What is your gender?

Do you have a history or diagnosis of Atopic Dermatitis (eczema)?

Do you currently have areas of your skin that look similar to the images below?


Do you currently have at least 2 patches of eczema on your body, each the size of a soda can top (5cm2) that are inflamed, red, itchy, dry, cracked or flaking?

Using your handprint as a measuring tool like a ruler, in combining all areas of your body, how many handprints of eczema do you currently have?

Have you used any of the following medications/therapies in the last 3 months?
  • Creams/Ointments/Lotions/Gels: Eucerin, Cetaphil, Nutraderm, petroleum jelly, Aquaphor, Vaseline
  • Topical Corticosteroids: Clobex, (clobetasol propionate), fluocinonide (Vanos Cream, Halog Ointment, Lidex-E Cream), hydrocortisone (Nutracort Lotion, Synacort Cream)
  • Topical Non-Steroid: Eucrisa (crisaborole)
  • Oral Steroids: Prednisone, Hydrocortisone
  • Injection: Dupixent (dupilumab)
  • "Bleach Baths"
  • UV Light Therapy

Have you participated in a research study in the past?