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Rosacea Symptom and Treatment Tracking Chart

A Daily Progress Monitoring Tool for Rosacea Management

Dermatology

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Template Content

Last updated: Mar 24, 2025

Patient Information

Name: _________________ Date Started: ___________

Daily Symptom Severity Scale

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

Week of: ___________

Symptoms Mon Tue Wed Thu Fri Sat Sun
Facial Redness
Flushing Episodes
Burning/Stinging
Visible Blood Vessels
Bumps/Pimples

Trigger Tracking

Check any triggers experienced today:

□ Sun Exposure □ Hot Weather □ Cold Weather □ Spicy Foods □ Hot Beverages □ Exercise □ Stress □ Alcohol □ Skincare Products □ Other: _____________

Treatment Adherence

Morning Routine:

  • Gentle Cleanser □
  • Prescribed Medication: _____________ □
  • Sunscreen □

Evening Routine:

  • Gentle Cleanser □
  • Prescribed Medication: _____________ □
  • Moisturizer □

Notes

Side Effects: ________________________________ Improvement Observations: _____________________

Monthly Progress Review

Overall Improvement: □ Significant □ Moderate □ Minimal □ No Change

Next Appointment Date: ___________

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