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Acne Treatment Progress Tracker

Daily Monitoring and Treatment Response Log

Dermatology

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Template Content

Last updated: Mar 24, 2025

Patient Information

Name: _________________ Date Started: //___

Daily Treatment Log

Week of: //___

Day AM Treatment PM Treatment Side Effects Skin Status
Mon □ □
Tue □ □
Wed □ □
Thu □ □
Fri □ □
Sat □ □
Sun □ □

Severity Scale

  • 0: Clear skin
  • 1: Almost clear (few minor blemishes)
  • 2: Mild acne (some papules/pustules)
  • 3: Moderate acne (many papules/pustules, few nodules)
  • 4: Severe acne (numerous nodules/cysts)

Current Treatment Plan

Topical Medications:

  1. AM: _________________ Instructions: _________________
  2. PM: _________________ Instructions: _________________

Oral Medications:

  1. Name: _________________ Dosage: _________________
  2. Name: _________________ Dosage: _________________

Monthly Progress Photos

  • Date: //___ Location: □ Forehead □ Cheeks □ Chin □ Other
  • Date: //___ Location: □ Forehead □ Cheeks □ Chin □ Other

Notes

Side Effects to Monitor:

  • Dryness: □ None □ Mild □ Moderate □ Severe
  • Redness: □ None □ Mild □ Moderate □ Severe
  • Peeling: □ None □ Mild □ Moderate □ Severe

Next Appointment: //___

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