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Rosacea Diary Booklet

Rosacea Diary Form

Date: ____________________
 

Check the weather conditions you were exposed to today:

_____ Sunny

_____ Windy

_____ Cloudy

_____ Humid

_____ Hot

_____ Cold

_____ Mild

_____ Dry

Check the foods and beverages you consumed today:

_____ Spicy foods

List: _________________________________

 

_____________________________________

_____ Alcohol

List: _________________________________

_____ Heated beverages

List: _________________________________

_____ Other

List: _________________________________

 

_____________________________________

 

 

Check the activities you experienced today:

_____ Emotional stress

Describe: _____________________________

 

_____________________________________

_____ Heavy exercise

Describe: _____________________________

_____ Hot bath/shower

Describe: _____________________________

_____ Indoor heat

Describe: _____________________________

_____ Other

Describe: _____________________________

 

 

List any products you used on your face:

__________________________________________________________

Did you comply with your medical therapy today?

_____ Yes

_____ No

 

 

 

What is the condition of your rosacea today?

_____ No flare-up

_____ Mild flare-up

_____ Severe flare-up

 

 

 

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Contact Us

Phone:
1-888-NO-BLUSH
Email:
rosaceas@aol.com
National Rosacea Society
196 James St.
Barrington, IL 60010

Our Mission

The National Rosacea Society is a 501(c)(3) nonprofit organization whose mission is to improve the lives of people with rosacea by raising awareness, providing public health information and supporting medical research on this widespread but little-known disorder. The information the Society provides should not be considered medical advice, nor is it intended to replace

consultation with a qualified physician. The Society does not evaluate, endorse or recommend any particular medications, products, equipment or treatments. Rosacea may vary substantially from one patient to another, and treatment must be tailored by a physician for each individual case. For more information, visit About Us.