Dry Skin | Easy Derm

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Please do not use a private browser or incognito mode as they disable functions that our medical form and checkout page require.

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Terms and Notices* This field is required.

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Name* This field is required.Please enter your legal name as shown on your driver license.

First Name

Last Name

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Email* This field is required.

example@example.com

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What is your biological sex?* This field is required.

Male

Female

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What is your birthdate?* This field is required.To change the year on a mobile device, click on the year in the calendar

Date

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Which state do you live in?* This field is required.Please select your state.

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Are you pregnant, planning on becoming pregnant, or breastfeeding?

YESNO

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Do any of the following apply to you?

None

Unintentional weight loss

Smooth and swollen tongue

Night sweats, or recurrent fevers

Kidney disease

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Do any of the following apply to you?

None

Constipation, feeling cold, and fatigue

Yellowing of the eyes

Dry mouth and dry eyes

Swollen lymph nodes

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Because you did not select "None" in both of the two previous questions.* This field is required.

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Do you have any of the following in the affected areas?

Rings, with central clearing

Scale between finger webs or toe webs

Thick plaques on elbows, knees, back, or scalp

None apply

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Do you have any of the following in the affected areas?

Itchy red bumps on hands or feet

Itchy purple bumps on wrists or ankles

None apply

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Do you have any of the following in the affected areas?

Blisters

Pustules

None apply

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In the next section upload pictures of the affected areas. Please also provide a photo of your face, and government-issued ID to comply with tele-health laws.

Your assigned provider is based on your state of residence. To see our list of providers visit EasyDerm.com/providers.

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Would you like to use your camera or upload photos?Camera not compatible with private browsers, pop-up blockers, and VPN.

Use CameraUpload Photos

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State Calculator

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Photo of affected areas.

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Upload images of all areas affected.Only your provider will see these pictures.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

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Provide a picture of your face. Please ensure that:

1. Your face is well lit and clear

2. Your entire face is visible

3. You're the only person in the photo

4. Nothing is covering your face

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Upload photo of facePlease ensure your entire face is visible to comply with tele-health laws and avoid delay in your treatment.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

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Photo of FacePlease ensure your entire face is visible to comply with tele-health laws and avoid delay in your treatment.

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Identity Verification. Please ensure that:

1. ID card is a valid driver license or passport

2. Photo is clear, and all edges are showing

3. Full name and DOB are visible

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Upload driver license or passportIf you wish to provide your ID at a later time, click "Next" and skip this step.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

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Driver license or passport

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Please list any medications, vitamins, and supplements you are taking.If none, move onto next question.

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Please list any allergies.If none, move onto next question.

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Please list any medical conditions you have been diagnosed with, and any surgeries you have had.If none, move onto next question.

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Attestation

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Congrats, you're a candidate for treatment for dry skin!

Click next to see your recommended treatment!

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Ammonium Lactate Lotion 12%Apply daily or every other day as tolerated to dry skin after showers.

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How does it work? Ammonium lactate acts to smoothen the skin and increase hydration.

Where can I use it? You can use the lotion to your body. It may be irritatating if used on the face, groin, or armpit.

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How do I use it? After showers apply the lotion to affected areas. Use daily, or every other day as tolerated.

Side effects? This medication is generally well tolerated. You may experience mild irritation if used too often, or if used on sensitive areas such as the face. If you experience any worrisome side effects stop usage.

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Dry Skin Hygiene:

Do not use soap in the shower on areas other than your "smelly areas" - armpits, groin, and buttocks. Soap will only strip your skin's natural barrier. Wash the other areas with water only. Avoid scented laundry detergeant, fabric softener, and dryer sheets. Chemicals from these can exacerbate skin dryness.

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Attestation:

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Unfortunately, based on the answers you provided you aren't a candidate for therapy through our tele-medicine platform.

We recommend following up with your primary care physician or a dermatologist.

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Currently our telemedicine platform not operating in your state. However, we are planning to launch to your state by the end of the year!

We will send you a notification as soon as we're in your area!

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Click submit and start dry skin therapy today!

*Prescriptions are not guaranteed, and are only issued after a provider determines that the prescription is medically indicated. We can either arrange for your prescription to be delivered to you, or provide you with the written prescription. If the medical provider determines that you are not a candidate for therapy, then you will be refunded!