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Contact Dermatitis Progress Tracking Chart

Daily Symptom and Treatment Monitoring Tool

Dermatology

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Template Content

Last updated: Mar 24, 2025

Patient Information

Name: _________________
Date Started: ____________

Daily Tracking

Symptom Severity Scale

0 - None | 1 - Mild | 2 - Moderate | 3 - Severe

Weekly Chart

Date Itching Redness Swelling Blisters Treatment Used Notes
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7

Trigger Tracking

Known or Suspected Triggers

  • □ Soaps/Detergents
  • □ Cosmetics
  • □ Jewelry
  • □ Plants
  • □ Medications
  • □ Other: _____________

Exposure Notes

Date: ________ Trigger: ________ Reaction Time: ________

Treatment Plan

Prescribed Medications

Self-Care Measures

  • □ Cool compresses
  • □ Moisturizer
  • □ Protective clothing
  • □ Avoided triggers

Follow-up Appointment

Next Visit: _________________

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