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Skin Allergy Symptom Tracking and Management Chart

Daily Progress Monitoring Tool for Allergic Skin Conditions

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
Itching
Redness
Swelling
Rash

Trigger Tracking

  • □ Food exposure: _________________
  • □ Environmental factors: __________
  • □ Skin products: _________________
  • □ Medications: __________________
  • □ Other: _______________________

Treatment Log

Medications Used

Medication Dosage Time Notes

Topical Treatments Applied

  • Product: _________________ Time: ______
  • Product: _________________ Time: ______

Notes

Side effects observed: _________________ Improvement noticed: _________________

Emergency Contact Information

Doctor's Name: _________________ Phone: _________________________

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