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Eczema Self-Management Progress Tracker

Daily Monitoring and Treatment Response Chart

Dermatology

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Template Content

Last updated: Mar 24, 2025

Patient Information

Name: _________________ Date Started: //___

Daily Symptom Tracker

Severity Scale (0-3)

  • 0: None
  • 1: Mild
  • 2: Moderate
  • 3: Severe

Daily Assessment Chart

Date Itching Redness Dryness Flaking Treatment Used Notes

Trigger Tracking

Common Triggers Observed

  • Stress
  • Weather changes
  • Specific foods
  • Fragrances
  • Fabrics
  • Other: _________________

Treatment Response

Medications Used

Medication Name Time Applied Response

Moisturizer Schedule

Time Product Used Skin Response
AM
PM

Follow-up Appointments

Date Doctor Notes

Monthly Progress Summary

  • Overall improvement: □ Better □ Same □ Worse
  • Number of flare-ups: _____
  • Most effective treatments: ________________
  • Areas needing attention: __________________

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