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Contact Dermatitis Symptom Tracking Log

Daily Monitoring Sheet for Skin Reactions

Dermatology

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Last updated: Mar 24, 2025

Patient Name: _________________________ Date Started: //___

Daily Symptom Record

Rate your symptoms on a scale of 0-10 (0 = none, 10 = severe)

Date Itching Redness Swelling Pain/Burning Exposure Notes

Exposure Tracking

List potential triggers encountered:

  • Products used: _______________________
  • New items/substances: ________________
  • Work/home exposures: ________________

Location of Reaction

  • Mark affected areas on body diagram
  • Note any pattern changes

Treatment Log

Medications Used:

  • Name: _____________ Time: _____ Response: _____
  • Name: _____________ Time: _____ Response: _____

Other Interventions:

  • Cool compresses: □ Yes □ No
  • Moisturizer used: □ Yes □ No Type: _________
  • Avoided trigger: □ Yes □ No

Notes for Doctor Visit

  • Changes since last visit: ________________
  • New triggers identified: ________________
  • Treatment effectiveness: ________________

Bring this log to your next appointment Date of next visit: //___

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