Where on the body are your symptoms?

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

How long have you had these symptoms?

Have you had eczema or dermatitis diagnosed before?

Have you tried any treatments for your skin before?

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

Is there any sign of skin infection?

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.

Are you pregnant, breastfeeding, or trying to conceive?

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

Do you have any allergies to medicines?

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

Do you have any medical conditions we should know about?

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.

Are you currently taking any medications?

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

Do any of the following apply to you?

These can affect whether certain topical steroids are safe for you. Tick all that apply.

Do you have any red flag symptoms?

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.

Declaration and Consent

By agreeing below, I confirm that:

- 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 topical steroids can cause side effects including skin thinning, stretch marks, changes in skin colour, and rebound flare-ups if used for longer than recommended. I have read the product information and understand how to use the treatment correctly, applying only to affected areas for the shortest time needed.

- I understand that if my skin does not improve within 7-14 days, 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 The Care Pharmacy clinical team to assess my suitability for treatment. My information will be kept confidential and used solely for this assessment.