💡 Help: This helps us identify the most appropriate strength of treatment.

💡 Help: Tick all areas that apply. Skin thickness varies across the body, which affects which steroid strength is safe to use.

💡 Help: Select one

💡 Help: This includes over-the-counter products, prescription creams, or oral antibiotics.

💡 Help: Include moisturisers/emollients, over-the-counter creams, and any prescription treatments.

💡 Help: Signs include weeping, yellow crusting, pus, golden scabs, or rapidly spreading redness. This is important because some treatments are not suitable when infection is present.

💡 Help: Potent topical steroids should be used with caution during pregnancy and breastfeeding.

💡 Help: In particular to topical steroids (hydrocortisone, betamethasone, clobetasone, mometasone), antibiotics (including tetracyclines), antifungals, or any other medication.

💡 Help: Please tell us about any conditions such as diabetes, immune system problems, skin conditions other than eczema (e.g. rosacea, psoriasis), or any other ongoing health issue.

💡 Help: Include prescription medicines, over-the-counter products, vitamins and supplements. Type N/A if none.

💡 Help: These can affect whether certain topical steroids are safe for you.

💡 Help: These may indicate something more serious that needs GP or urgent review. Select yes if you have any of: fever alongside the rash, a rapidly spreading rash, a rash with blisters or skin breakdown, cold sores or chickenpox near the affected area, a rash that is painful rather than itchy, or skin that looks darkly discoloured or bruised.

💡 Help: - The information I have provided in this assessment is accurate and complete to the best of my knowledge, and I understand that providing false information may result in my order being cancelled and could have serious health implications.
- I understand that acne treatments can cause side effects, most commonly skin dryness, redness, irritation, peeling and increased sun sensitivity with topical products, and stomach upset or photosensitivity with oral antibiotics. I have read the product information and understand how to use the treatment correctly
- I understand that if my acne does not improve within 8-12 weeks, worsens significantly, or I experience any severe side effects, I should stop treatment and contact a healthcare professional.
- I consent to my personal and medical information being used by Chesterfield Delivery Pharmacy clinical team to assess my suitability for treatment. My information will be kept confidential and used solely for this assessment.