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Passanisi S, Berg AK, Chobot A, Dos Santos TJ, Piona CA, Messer L, Lombardo F, ISPAD Jenious Group. First International Survey on Diabetes Providers' Assessment of Skin Reactions in Youth With Type 1 Diabetes Using Technological Devices. J Diabetes Sci Technol 2025; 19:666-672. [PMID: 37846755 PMCID: PMC12035172 DOI: 10.1177/19322968231206155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
BACKGROUND Advances in diabetes technological devices led to optimization of diabetes care; however, long-lasting skin exposure to devices may be accompanied by an increasing occurrence of cutaneous reactions. METHODS We used an open-link web-based survey to evaluate diabetes-care providers' viewpoint on prevalence, management practices, and knowledge related to skin reactions with the use of diabetes technological devices. A post hoc analysis was applied to investigate differences in the level of awareness on this topic in relation to the experience in diabetes technology. RESULTS One hundred twenty-five responses from 39 different countries were collected. Most respondents (69%) routinely examine patients' skin at each visit. All the preventive measures are not clear and, mainly, homogenously put into clinical practice. Contact dermatitis was the most frequently reported cutaneous complication due to diabetes devices, and its most common provocative causes are not yet fully known by diabetes-care providers. Almost half of the respondents (42%) had discussed the presence of harmful allergens contained in adhesives with device manufacturers. There is general agreement on the need to strengthen knowledge on dermatological complications. CONCLUSIONS Although diabetes-care providers are quite aware of the chance to develop skin reactions in people with diabetes using technological devices, there are still some unmet needs. Large follow-up studies and further dissemination tools are awaited to address the gaps revealed by our survey.
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Affiliation(s)
- Stefano Passanisi
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi,” University of Messina, Messina, Italy
| | - Anna Korsgaard Berg
- Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Agata Chobot
- Department of Pediatrics, Institute of Medical Sciences, University of Opole, Opole, Poland
| | | | - Claudia Anita Piona
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric Diabetes, University City Hospital of Verona, Verona, Italy
| | - Laurel Messer
- Barbara Davis Center for Diabetes, University of Colorado Anschutz, Aurora, CO, USA
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi,” University of Messina, Messina, Italy
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de Groot A, van Oers EM, Ipenburg NA, Rustemeyer T. Allergic contact dermatitis caused by glucose sensors and insulin pumps: A full review: Part 2. Case reports and case series, clinical features, patch test procedures, differentiation from irritant dermatitis, management of allergic patients and (proposed) legislation. Contact Dermatitis 2025; 92:164-175. [PMID: 39600134 PMCID: PMC11795346 DOI: 10.1111/cod.14697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 08/07/2024] [Accepted: 09/12/2024] [Indexed: 11/29/2024]
Abstract
During the past 8 years, a large number of reports have appeared on allergic contact dermatitis to glucose sensors and insulin pumps in paediatric and adult patients with type 1 diabetes mellitus. Isobornyl acrylate in one particular sensor sensitised many hundreds of (published) individuals, and many other allergens were discovered in a large number of sensors and pumps. Diagnostic procedures with patch tests proved very complicated, as manufacturers showed a serious lack of cooperation with dermatologists in providing information on the ingredients of their products and samples for patch testing. This two part article provides a full and detailed review of all aspects of the subject of allergic contact dermatitis to glucose sensors and insulin pumps. Part 1 provided a general introduction to sensors and pumps, a survey of the cutaneous adverse reactions that they have caused, a full account of the allergens in the diabetes devices and an overview of the glucose sensors and insulin pumps that have caused allergic contact dermatitis. This part 2 presents all published case reports and case series, clinical features of allergic contact dermatitis, patch test procedures, differentiation from irritant dermatitis, management of allergic patients and (proposed) legislation.
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Affiliation(s)
- Anton de Groot
- Dermato‐Allergology and Occupational DermatologyAmsterdam University Medical CentersAmsterdamThe Netherlands
| | | | - Norbertus A. Ipenburg
- Dermato‐Allergology and Occupational DermatologyAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Thomas Rustemeyer
- Dermato‐Allergology and Occupational DermatologyAmsterdam University Medical CentersAmsterdamThe Netherlands
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3
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de Groot A, van Oers EM, Ipenburg NA, Rustemeyer T. Allergic contact dermatitis caused by glucose sensors and insulin pumps: A full review: Part 1: Sensors and pumps, adverse cutaneous reactions, allergens, and diabetes devices causing allergic contact dermatitis. Contact Dermatitis 2025; 92:87-112. [PMID: 39600106 PMCID: PMC11710928 DOI: 10.1111/cod.14698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 07/14/2024] [Accepted: 09/12/2024] [Indexed: 11/29/2024]
Abstract
During the past 8 years, a large number of reports have appeared on allergic contact dermatitis to glucose sensors and insulin pumps in paediatric and adult patients with type 1 diabetes mellitus. Isobornyl acrylate in one particular sensor sensitised many hundreds of (published) individuals, and many other allergens were discovered in a large number of sensors and pumps. Diagnostic procedures with patch tests proved very complicated, as manufacturers showed a serious lack of cooperation with dermatologists in providing information on the ingredients of their products and samples for patch testing. This two-part article provides a full and detailed review of all aspects of the subject of allergic contact dermatitis to glucose sensors and insulin pumps. Part 1 begins with a general introduction to sensors and pumps, followed by the cutaneous adverse reactions that they have caused and a full account of the allergens in the diabetes devices. In addition, an overview of the glucose sensors and insulin pumps that have caused allergic contact dermatitis is presented. Part 2 presents all published case reports and case series, clinical features of allergic contact dermatitis to sensors and pumps, patch test procedures, differentiation from irritant dermatitis, management of allergic patients and (proposed) legislation.
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Affiliation(s)
- Anton de Groot
- Dermato‐Allergology and Occupational DermatologyAmsterdam University Medical CentersAmsterdamThe Netherlands
| | | | - Norbertus A. Ipenburg
- Dermato‐Allergology and Occupational DermatologyAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Thomas Rustemeyer
- Dermato‐Allergology and Occupational DermatologyAmsterdam University Medical CentersAmsterdamThe Netherlands
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4
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Velasco-Amador JP, Prados-Carmona Á, Navarro-Triviño FJ. [Translated article] Medical Devices in Patients With Diabetes and Contact Dermatitis. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T280-T287. [PMID: 38242434 DOI: 10.1016/j.ad.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 10/08/2023] [Indexed: 01/21/2024] Open
Abstract
The development and commercialization of glucose sensors and insulin pumps has revolutionized the management of diabetes. These devices have been linked to multiple cases of contact dermatitis in recent years, however, giving rise to a growing interest in identifying the sensitizing allergens. Isobornyl acrylate was clearly identified as one of the main allergens responsible for contact dermatitis among users of the FreeStyle glucose sensor and was subsequently removed from the product ingredients. Remarkably, however, it is still used in most other sensors on the market. The common adhesive ingredients colophony and abietic acid derivatives have also been shown to be sensitizing agents. New components under study, such as dipropylene glycol diacrylate, N,N-dimethylacrylamide, and triethylene glycol methacrylate have recently been identified as allergens, though they are not commercially available for clinical testing. The benefits offered by glucose sensors and insulin pumps may be offset by sensitization to product ingredients, in some cases forcing discontinuation and diminishing quality of life. Dermatologists should play a role in this clinical and research scenario, offering case-by-case guidance to endocrinologists on skin care and possible alternatives for patients with glucose sensors and insulin pumps who develop contact dermatitis. They should also collaborate with the manufacturers developing these devices.
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Affiliation(s)
- J P Velasco-Amador
- Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, Spain
| | - Á Prados-Carmona
- Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, Spain
| | - F J Navarro-Triviño
- Unidad de Eczema de Contacto e Inmunoalergia, Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, Spain.
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Velasco-Amador JP, Prados-Carmona Á, Navarro-Triviño FJ. Medical Devices in Patients With Diabetes and Contact Dermatitis. ACTAS DERMO-SIFILIOGRAFICAS 2023; 115:S0001-7310(23)00842-6. [PMID: 39491129 DOI: 10.1016/j.ad.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 09/11/2023] [Accepted: 10/08/2023] [Indexed: 11/05/2024] Open
Abstract
The development and commercialization of glucose sensors and insulin pumps has revolutionized the management of diabetes. These devices have been linked to multiple cases of contact dermatitis in recent years, however, giving rise to a growing interest in identifying the sensitizing allergens. Isobornyl acrylate (IBOA) was clearly identified as one of the main allergens responsible for contact dermatitis among users of the FreeStyle glucose sensor and was subsequently removed from the product ingredients. Remarkably, however, it is still used in most other sensors on the market. The common adhesive ingredients colophony and abietic acid derivatives have also been shown to be sensitizing agents. New components under study, such as dipropylene glycol diacrylate, N,N-dimethylacrylamide, and triethylene glycol methacrylate have recently been identified as allergens, though they are not commercially available for clinical testing. The benefits offered by glucose sensors and insulin pumps may be offset by sensitization to product ingredients, in some cases forcing discontinuation and diminishing quality of life. Dermatologists should play a role in this clinical and research scenario, offering case-by-case guidance to endocrinologists on skin care and possible alternatives for patients with glucose sensors and insulin pumps who develop contact dermatitis. They should also collaborate with the manufacturers developing these devices.
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Affiliation(s)
- J P Velasco-Amador
- Servicio de Dermatología. Hospital Universitario San Cecilio, Granada, Spain
| | - Á Prados-Carmona
- Servicio de Dermatología. Hospital Universitario San Cecilio, Granada, Spain
| | - F J Navarro-Triviño
- Unidad de Eczema de Contacto e Inmunoalergia. Servicio de Dermatología. Hospital Universitario San Cecilio, Granada, Spain.
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Diedisheim M, Pecquet C, Julla JB, Carlier A, Potier L, Hartemann A, Jacqueminet S, Vidal-Trecan T, Gautier JF, Dubois Laforgue D, Fagherazzi G, Roussel R, Larger E, Sola-Gazagnes A, Riveline JP. Prevalence and Description of the Skin Reactions Associated with Adhesives in Diabetes Technology Devices in an Adult Population: Results of the CUTADIAB Study. Diabetes Technol Ther 2023; 25:279-286. [PMID: 36763338 DOI: 10.1089/dia.2022.0513] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Objective: The use of continuous glucose monitoring (CGM) systems and continuous subcutaneous insulin infusion (CSII) devices adhering to the skin can lead to skin reactions. The objective was to determine the prevalence and consequences of skin reactions at CGM or CSII sites in a large unbiased population. Research Design and Methods: This is a cross-sectional multicenter study. All adult patients with diabetes seen in consultation over a period of 7 months and using or having used a system with skin adhesives (in the last 10 years) were included and filled out a self-assessment questionnaire. Results: Among 851 patients, skin reaction was reported in 28% with CGM and 29% with CSII. Patients reporting reactions were more frequently women using CGM and CSII, and CGM users had type 1 more often than type 2 diabetes (P < 0.001). Manifestations were similar for reactions to CGM and CSII: redness and pruritus in 70%-75% of patients with reactions, pain in 20%-25%, and vesicles and desquamation in 12%-15%. Manifestations occurred within the first 24 h of first use in 22%-24% of patients with reactions to CGM and CSII, but after more than 6 months in 38% and 47% of patients with reactions to CGM and CSII, respectively. Device use was definitively stopped in 12% of patients with reactions to CGM (3.2% of all users) and 7% with reactions to CSII (2.1% of all users). Conclusions: Skin reactions were common, with similar presentations in CGM and CSII users. Manifestations suggested skin irritation rather than allergies. These reactions rarely led to the definitive discontinuation of the use of the device.
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Affiliation(s)
- Marc Diedisheim
- Diabetology Department, Cochin Hospital, APHP, Paris, France
- Institut Necker Enfants Malades (INEM), INSERM U1151, CNRS UMR 8253, Université Paris Cité, IMMEDIAB Laboratory, Paris, France
| | | | - Jean-Baptiste Julla
- Institut Necker Enfants Malades (INEM), INSERM U1151, CNRS UMR 8253, Université Paris Cité, IMMEDIAB Laboratory, Paris, France
- Diabetology and Endocrinology Department, Lariboisière Hospital, Féderation de Diabétologie, APHP, Paris, France
| | - Aurelie Carlier
- Diabetology Department, Bichat Hospital, APHP, Paris, France
| | - Louis Potier
- Institut Necker Enfants Malades (INEM), INSERM U1151, CNRS UMR 8253, Université Paris Cité, IMMEDIAB Laboratory, Paris, France
- Diabetology Department, Bichat Hospital, APHP, Paris, France
| | - Agnès Hartemann
- Diabetology Department, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | | | - Tiphaine Vidal-Trecan
- Diabetology and Endocrinology Department, Lariboisière Hospital, Féderation de Diabétologie, APHP, Paris, France
| | - Jean-François Gautier
- Institut Necker Enfants Malades (INEM), INSERM U1151, CNRS UMR 8253, Université Paris Cité, IMMEDIAB Laboratory, Paris, France
- Diabetology and Endocrinology Department, Lariboisière Hospital, Féderation de Diabétologie, APHP, Paris, France
| | | | - Guy Fagherazzi
- Deep Digital Phenotyping Research Unit, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Ronan Roussel
- Diabetology Department, Bichat Hospital, APHP, Paris, France
| | - Etienne Larger
- Diabetology Department, Cochin Hospital, APHP, Paris, France
| | | | - Jean-Pierre Riveline
- Institut Necker Enfants Malades (INEM), INSERM U1151, CNRS UMR 8253, Université Paris Cité, IMMEDIAB Laboratory, Paris, France
- Diabetology and Endocrinology Department, Lariboisière Hospital, Féderation de Diabétologie, APHP, Paris, France
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7
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Alves da Silva C, Bregnhøj A, Mowitz M, Bruze M, Andersen KE, Sommerlund M. Contact dermatitis in children caused by diabetes devices. Contact Dermatitis 2022; 87:406-413. [PMID: 35634681 DOI: 10.1111/cod.14166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 05/16/2022] [Accepted: 05/27/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Insulin pump and glucose monitoring devices improve diabetes mellitus (DM) control and enhance patients' quality of life. However, a growing number of adverse cutaneous reactions related to the use of these devices has been reported. OBJECTIVE To investigate the culprits of localized contact dermatitis in pediatric patients with diabetes caused by insulin pump and glucose monitoring devices. METHODS Retrospective analysis of 15 pediatric patients patch tested as part of a clinical investigation for skin reactions associated with insulin pump and glucose monitoring devices RESULTS: Seven patients had positive patch test reactions to isobornyl acrylate (IBOA) and five had positive reactions to benzoyl peroxide (BP). Positive patch test reactions to materials from the glucose sensor and/or insulin pump were seen in 10 of the 15 patients. Three had positive reactions to adhesive remover wipe from Smith and Nephew Remove and four had reactions to EMLA plaster. CONCLUSION A high share of patients showed positive reactions to IBOA and/or their medical devices (insulin pumps or glucose devices). A third of patients showed positive reactions to benzoyl peroxide. The presence of additional unidentified allergens cannot be excluded, highlighting the importance of access to a full description of the chemical composition of the devices. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Anne Bregnhøj
- Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
| | - Martin Mowitz
- Department Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Magnus Bruze
- Department Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Klaus Ejner Andersen
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mette Sommerlund
- Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
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8
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Oppel E, Högg C, Oschmann A, Summer B, Kamann S. Contact allergy to the Dexcom G6 glucose monitoring system -role of 2,2'-methylenebis(6-tert-butyl-4-methylphenol) monoacrylate in the new adhesive. Contact Dermatitis 2022; 87:258-264. [PMID: 35503433 DOI: 10.1111/cod.14141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 04/15/2022] [Accepted: 04/30/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Skin reactions to the glucose monitoring systems Dexcom G5 and G6 have been rare. In 2019, the components of the adhesive were exchanged for better skin fixation. Since then, more and more patients experienced severe skin reactions. A few months ago, 2,2'-methylenebis(6-tert-butyl-4-methylphenol) monoacrylate (MBPA) was identified as a new component in the adhesive of the G6 model. Furthermore, it was suspected that isobornylacrylate (IBOA) was also a component of the exchanged adhesive. OBJECTIVES Our objective was to investigate if MBPA plays a major role in the increasing skin problems of patients without a history of IBOA-sensitization. Furthermore, our aim was to examine whether IBOA is contained in the newer model adhesive and may also contribute to allergic contact dermatitis (ACD). PATIENTS AND METHODS Five patients with a newly occurred ACD caused by the glucose monitoring system Dexcom G6 were investigated. Patch testing including MBPA in 3 different concentrations, as well as IBOA were performed. Gas chromatography-mass spectrometry of the newer system Dexcom G6 was carried out. RESULTS All patients were shown to be sensitized to MBPA, while MBPA 0,5% showed the strongest reaction. On the other hand, IBOA was tested negative. CONCLUSION In our study group MBPA was observed to be the triggering allergen of the recently changed adhesive.
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Affiliation(s)
- Eva Oppel
- Department of Dermatology and Allergology, University Hospital LMU, Munich, Germany
| | - Christof Högg
- Department of Conservative Dentistry and Periodontology, University Hospital LMU, Munich, Germany.,Walther Straub Institute of Pharmacology and Toxicology, Faculty of Medicine LMU, Munich, Germany
| | - Anna Oschmann
- Department of Dermatology and Allergology, University Hospital LMU, Munich, Germany
| | - Burkhard Summer
- Department of Dermatology and Allergology, University Hospital LMU, Munich, Germany
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10
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Allergic Contact Dermatitis, an Important Skin Reaction in Diabetes Device Users: A Systematic Review. Dermatitis 2022; 33:110-115. [PMID: 35245221 DOI: 10.1097/der.0000000000000861] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Diabetes management has undergone many advances over the years, including the introduction of devices that allow patients to monitor blood glucose and administer insulin. Although these devices have improved patients' quality of life, they are associated with adverse reactions.A systematic literature search was performed up to May 2020 in PubMed, Cochrane, and Embase databases, with no temporal restrictions. Articles were screened by title, abstract, and full text as needed. A manual search among the references of the included articles was also performed.Two hundred sixty-five articles were identified, and 50 studies met inclusion criteria. Several cases of allergic contact dermatitis due to the use of insulin infusion systems and blood glucose monitoring have been reported. Acrylates, methacrylates, and colophonium, as well as, in particular, isobornyl acrylate, represent the main allergens responsible.Skin reactions, in particular allergic contact dermatitis, are a very common adverse event caused by insulin pumps and glucose sensors, which may lead to discontinue the usage of these devices with serious consequences for the patients. Collaboration between specialists, specifically between dermatologists and diabetologists, with patients and manufacturers is essential for the correct management of diabetes devices and potential related skin reactions.
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11
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Passanisi S, Salzano G, Galletta F, Aramnejad S, Caminiti L, Pajno GB, Lombardo F. Technologies for Type 1 Diabetes and Contact Dermatitis: Therapeutic Tools and Clinical Outcomes in a Cohort of Pediatric Patients. Front Endocrinol (Lausanne) 2022; 13:846137. [PMID: 35370980 PMCID: PMC8965381 DOI: 10.3389/fendo.2022.846137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
The increasing use of technological devices for the management of diabetes is related to the prolonged exposure of patients' skin to chemical and mechanical agents and, consequently, to the increased risk of developing dermatological complications. Among these, contact dermatitis is the most insidious skin disorder. Despite the magnitude of the issue, no universally accepted recommendations on the management of this common complication are currently available. Our observational study aimed to describe all the solutions adopted by patients and their caregivers to treat and prevent the appearance of contact dermatitis and to describe the clinical impact of this cutaneous complication. Twenty-one pediatric patients (mean age 12.1 ± 3.7 years) with type 1 diabetes were recruited in the study. The most common treatment used to treat acute skin lesions was the application of topical corticosteroids, sometimes associated with topical antibiotics (9.5%). In order to prevent the further appearance of dermatitis, the most frequently adopted measure was the use of hydrocolloid and/or silicone-based adhesives, followed by the application of protective barrier films. One patient reported benefit from the off-label use of fluticasone propionate nasal spray. However, only 52.4% of the study participants achieved a definitive resolution of the skin issue, and 38.1% of patients were forced to discontinue insulin pump therapy and/or continuous glucose monitoring. No differences were observed in glycated hemoglobin values between the period before and after the onset of contact dermatitis. Our study confirms the severity of this dermatological complication that may hinder the spread of new technologies for the management of diabetes. Finally, our findings highlight the importance of establishing close collaboration both with pediatric allergy specialists to prescribe the most suitable treatment and with manufacturing companies to ensure that adhesives of technological devices are free of harmful well-known sensitizers.
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Affiliation(s)
- Stefano Passanisi
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Messina, Italy
- *Correspondence: Stefano Passanisi,
| | - Giuseppina Salzano
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Messina, Italy
| | - Francesca Galletta
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, Allergy Unit, University of Messina, Messina, Italy
| | - Sara Aramnejad
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Messina, Italy
| | - Lucia Caminiti
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, Allergy Unit, University of Messina, Messina, Italy
| | - Giovanni B. Pajno
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, Allergy Unit, University of Messina, Messina, Italy
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Messina, Italy
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Kamann S, Wagner N, Oppel E. Moderne Sensortechnik zur kontinuierlichen Glukosemessung: Anwendungseinschränkungen durch Kontaktallergien. J Dtsch Dermatol Ges 2021; 19:1715-1722. [PMID: 34894186 DOI: 10.1111/ddg.14621_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/30/2021] [Indexed: 11/29/2022]
Affiliation(s)
| | - Nicola Wagner
- Hautklinik, Universitätsklinik Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen
| | - Eva Oppel
- Klinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität, München
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13
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Kamann S, Wagner N, Oppel E. Modern diabetes devices for continuous blood sugar measuring: Limitations due to contact allergies. J Dtsch Dermatol Ges 2021; 19:1715-1721. [PMID: 34751512 DOI: 10.1111/ddg.14621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/30/2021] [Indexed: 12/29/2022]
Abstract
During the past years, diabetes diseases have increased significantly worldwide. However, new technologies such as continuous glucose measurement using a subcutaneous sensor are developing just as rapidly. A continuous improvement in insulin pump therapy is also contributing to an improved quality of life. A common feature of these modern devices for diabetes therapy is that they remain fixed in place on the skin for several days. In recent years, skin reactions, in particular pronounced contact dermatitis due to the devices and their adhesives have been increasingly reported. In particular, isobornyl acrylate, which used to be included in a glucose measurement sensor set, was identified as a main allergen. Development of contact allergy can result both in a necessity to quit the measuring system and in allergic cross-reactions to other systems.
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Affiliation(s)
- Stefanie Kamann
- Department of Dermatology and Allergology, Feldafing, Germany
| | - Nicola Wagner
- Department of Dermatology, University Medical Center Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Eva Oppel
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
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14
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Nivet E, Lo G, Nivot-Adamiak S, Guitteny MA, De Kerdanet M. Impact of OMNIPOD® on the quality of life of adolescents with type 1 diabetes. Arch Pediatr 2021; 29:21-26. [PMID: 34753634 DOI: 10.1016/j.arcped.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 07/28/2021] [Accepted: 10/03/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Several pediatric studies have demonstrated that therapy using a conventional insulin pump improves glycemic control and quality of life. At the beginning of this study, a new tubeless insulin pump, Omnipod®, had recently been marketed in France. OBJECTIVES Analyze the response of adolescents treated with multiple injections to the proposal to use this new medical device and compare both the quality of life and the glycemic control of adolescents according to their choice. MATERIAL AND METHODS This was a prospective, observational study of adolescents aged 10-17 years who had type 1 diabetes for more than 1 year, all treated with multi-injection insulin delivery according to a basal-bolus regimen. They were separated into three groups: group A choosing to use the Omnipod® system, group B taking the time to think before making a decision, and group C choosing to keep their multi-injection therapy. The three groups were compared according to their quality of life with validated tools and glycemic control. RESULTS Groups were formed with 30 (25%) patients in group A, 55 patients (45%) in group B, and 36 patients (30%) in group C. As to the WHO Well-Being Index, no significant difference appeared in the study for the patients in the three groups. An increased treatment satisfaction score was found, evolving from 3.79 ± 0.68 to 4.36 ± 0.56, p = 0.002 (group A) and from 3.87 ± 0.7 to 4.16 ± 0.7, p = 0.032 (group B), with no significant change for group C (from 4.39 ± 0.6 to 4.31 ± 0.62, p = 0.582). The wish to change treatment score improved for group A (from 4.14 ± 0.88 to 1.68 ± 0.9; p < 0.001) and group B (from 3.51 ± 1.05 to 1.84 ± 1; p < 0.001), with no significant change for group C (from 1.81 ± 0 0.98 to 1.61 ± 0.8; p = 0.432). There was no significant difference regarding HbA1c rates in the three groups. CONCLUSION There was no significant difference in quality-of-life scores between adolescents who chose to switch from multiple injection to the tubeless patch pump and those who retained multi-injection treatment, but increased satisfaction was observed in the former group.
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Affiliation(s)
- E Nivet
- Service endocrinologie pédiatrique, Assistante spécialiste, CHU Rennes, Hôpital Sud, 16 boulevard de Bulgarie, 35200 Rennes, France.
| | - G Lo
- PH endocrinologue et diabétologue pédiatrique, CH Libourne,70 Rue Réaux, 33500 Libourne, France
| | - S Nivot-Adamiak
- Service endocrinologie pédiatrique, PH endocrinologue et diabétologue pédiatrique, CHU Rennes, Hôpital Sud, 16 boulevard de Bulgarie, 35200 Rennes, France
| | - M-A Guitteny
- Service endocrinologie pédiatrique, PH endocrinologue et diabétologue pédiatrique, CHU Rennes, Hôpital Sud, 16 boulevard de Bulgarie, 35200 Rennes, France
| | - M De Kerdanet
- Service endocrinologie pédiatrique, PH endocrinologue et diabétologue pédiatrique, CHU Rennes, Hôpital Sud, 16 boulevard de Bulgarie, 35200 Rennes, France
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15
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Lombardo F, Passanisi S, Tinti D, Messina MF, Salzano G, Rabbone I. High Frequency of Dermatological Complications in Children and Adolescents with Type 1 Diabetes: A Web-Based Survey. J Diabetes Sci Technol 2021; 15:1377-1381. [PMID: 32757778 PMCID: PMC8655296 DOI: 10.1177/1932296820947072] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Despite advances in the management of type 1 diabetes (T1D), there is an increasing incidence of skin reactions related to diabetes devices such as patch pumps and glucose sensors. Aim of the present study was to assess the prevalence of dermatological complications in pediatric patients with T1D using technological devices. METHODS Online survey regarding skin reactions related to the use of patch pumps and/or glucose sensors was administered to families of children and adolescents (0-17 years) with T1D. Data were collected on demographic characteristics, duration of diabetes, and clinical features of dermatological complications if present. RESULTS Our study population consisted of 139 patients (female 51.8%) aged 11.1 ± 3.3 years. More than half (51.1%) experienced skin reactions due to patch pumps or glucose sensors. Dermatological complications were mainly caused by continuous glucose monitoring (56.3% of total). Timing of appearance of dermatological reactions varied from a few days to several months after the introduction of the device. The application of hypoallergenic barrier bandages was the most frequently adopted measure to solve the issue. CONCLUSIONS Our study confirmed high frequency of dermatological complications among pediatric patients with type 1 diabetes. Well-designed studies are awaited to provide clear recommendations to minimize the burden of skin issues related to technological devices.
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Affiliation(s)
- Fortunato Lombardo
- Department of Human Pathology in Adult
and Developmental Age, University of Messina, Messina, Italy
| | - Stefano Passanisi
- Department of Human Pathology in Adult
and Developmental Age, University of Messina, Messina, Italy
- Stefano Passanisi, Department of Human
Pathology in Adult and Developmental Age, University of Messina, Via Consolare
Valeria 1, Messina, 98124, Italy.
| | - Davide Tinti
- Department of Pediatrics, University of
Turin, Torino, Italy
| | - Maria Francesca Messina
- Department of Human Pathology in Adult
and Developmental Age, University of Messina, Messina, Italy
| | - Giuseppina Salzano
- Department of Human Pathology in Adult
and Developmental Age, University of Messina, Messina, Italy
| | - Ivana Rabbone
- Department of Pediatrics, University of
Turin, Torino, Italy
- Department of Science of Health, Hub
Regional Center of Pediatric Diabetology, University of Oriental Piemonte, Novara,
Italy
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16
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Ulriksdotter J, Svedman C, Bruze M, Mowitz M. Allergic contact dermatitis caused by dipropylene glycol diacrylate in the Omnipod® insulin pump. Br J Dermatol 2021; 186:334-340. [PMID: 34510410 DOI: 10.1111/bjd.20751] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cases of allergic contact dermatitis (ACD) caused by isobornyl acrylate (IBOA) in the Omnipod® insulin pump have previously been reported. OBJECTIVES To present three cases of patients with ACD caused by a new allergen in the pump, and results from chemical analyses. METHODS Omnipod pumps from different batches were analysed by gas chromatography-mass spectrometry. Aimed testing, with the department's medical device (MD) series and substances identified in the pump including dipropylene glycol diacrylate (DPGDA) at 0·01% and 0·1% in petrolatum (pet.), was performed. Patch testing also included extracts from the device, the adhesive patch as is, and allergens from baseline series. RESULTS All patients tested positive to 0·1% DPGDA in pet., and two patients additionally to a 0·01% concentration. DPGDA was found in extracts of the Omnipod pumps brought by the patients. An Omnipod pump from an earlier batch contained tripropylene glycol diacrylate, IBOA, N,N-dimethylacrylamide, di(ethylene glycol)ethyl ether acrylate (DEGEA) but no DPGDA. One of the patients reacted positively to all of these allergens except DEGEA, which was not tested. CONCLUSIONS When suspecting ACD to MDs, DPGDA at 0·1% in pet. should be tested. The contents of Omnipod have changed over time. Patch testing with updated test series and relevance assessment of positive reactions is a delicate task. Children, with lifelong use of MDs, risk contracting many allergies with potential cross-allergies. A question should be raised as to whether these low molecular weight acrylates should be used at all in devices constantly worn on the skin.
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Affiliation(s)
- J Ulriksdotter
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden.,Department of Dermatology, Helsingborg Hospital, Bergaliden 14, 251 87, Helsingborg, Sweden
| | - C Svedman
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - M Bruze
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - M Mowitz
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
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17
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Rigo RS, Levin LE, Belsito DV, Garzon MC, Gandica R, Williams KM. Cutaneous Reactions to Continuous Glucose Monitoring and Continuous Subcutaneous Insulin Infusion Devices in Type 1 Diabetes Mellitus. J Diabetes Sci Technol 2021; 15:786-791. [PMID: 32389062 PMCID: PMC8258506 DOI: 10.1177/1932296820918894] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII) are the standard of care for type 1 diabetes in children. There is little reported on device-related skin complications and treatment options. This study documents cutaneous reactions to CGM and CSII devices in children and young adults with type 1 diabetes. METHODS One hundred and twenty-one subjects (3-25 years) with type 1 diabetes and CGM and/or CSII use were recruited over a three-month period from the Naomi Berrie Diabetes Center at Columbia University Irving Medical Center. A five-question survey was completed for each subject detailing demographic data, diabetes management, and device-related skin complications. RESULTS Sixty percent of subjects reported skin complications related to CGM and/or CSII use. Terms most frequently used to describe cutaneous reactions were "red," "itchy," "painful," and "rash." Subjects who used both CGM and CSII were more likely to report skin problems than those who used only CSII (odds ratio 2.9, [95% confidence interval: 1.2-6.7]; P = .015). There were no associations between skin complications and sex or race/ethnicity. Twenty-two percent of subjects with adverse skin event(s) discontinued use of a device due to their skin problem. Seven percent were evaluated by a dermatologist. Eighty-one percent used a range of products to treat their symptoms, with variable perceived clinical outcomes. CONCLUSIONS Skin complications related to CSII or CGM devices are commonly reported in pediatric patients with type 1 diabetes and may lead to interruption or discontinuation of device use. Future studies are needed to elucidate the causes of these reactions and determine the best methods for prevention.
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Affiliation(s)
- Rachel S. Rigo
- Columbia University Irving Medical Center, New York, NY, USA
| | - Laura E. Levin
- Columbia University Irving Medical Center, New York, NY, USA
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA
| | - Donald V. Belsito
- Columbia University Irving Medical Center, New York, NY, USA
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA
| | - Maria C. Garzon
- Columbia University Irving Medical Center, New York, NY, USA
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA
| | - Rachelle Gandica
- Columbia University Irving Medical Center, New York, NY, USA
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Kristen M. Williams
- Columbia University Irving Medical Center, New York, NY, USA
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
- Kristen M. Williams, MD, Naomi Berrie Diabetes Center, Columbia University Irving Medical Center, 1150 Saint Nicholas Avenue, 2nd Floor, New York, NY 10032, USA.
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18
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Gatica-Ortega ME, Mowitz M, Pastor-Nieto MA, Navarro-Triviño FJ, Fernández-Redondo V, Hernández-Cano N, Borrego L, Gómez-de-la-Fuente E, Torralba M, Svedman C, Giménez-Arnau A. Contact Dermatitis From Glucose Sensors In Spain: A Multicentric Approach. Contact Dermatitis 2021; 85:554-562. [PMID: 34185891 DOI: 10.1111/cod.13924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/06/2021] [Accepted: 06/27/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Allergic contact dermatitis from glucose sensors may interfere with their ongoing application. OBJECTIVE To evaluate a series of Spanish patients with contact dermatitis to glucose sensors regarding former sources of contact allergens, patch test results and outcomes from the ongoing use of the device. METHODS A series of patients with contact dermatitis from glucose sensors was investigated in eight dermatology departments across Spain epidemiologic features, brands, latency time to develop dermatitis, the ability to continue using the devices as well as the patch test results. RESULTS Thirty patients were evaluated mean age: 20 .93 years. 66 .7 % were children and 66 .7 % female. 90 .0 % used Freestyle Libre FSL. 8 /26 30 .8 % reacted to isobornyl acrylate IBOA and 2 /20 10 .0 % to N,N dimethylacrylamide DMAA. The mean latency time to develop dermatitis was 9 months. 16 /29 55 .2 % patients continued using the same sensor causing the reaction. 13 /29 44 .8 % were unable to continue using the sensor due to severe reactions. Of them, 5 were positive to IBOA, one to IBOA and DMAA; one to DMAA; one to colophony and 1 to isopropyl alcohol wipes. In one patient the outcome was unknown. CONCLUSION The frequency of sensitization to IBOA and DMAA, was lower than in other European series, but similar to a previously published Spanish article. Legislation requiring manufacturers to provide information regarding medical devices composition and cooperate with the investigation of contact dermatitis is urgently needed. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Martin Mowitz
- Dept. of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - María A Pastor-Nieto
- Dermatology Dept. Hospital Universitario de Guadalajara Guadalajara, Spain.,Dept. of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, Faculty of Medicine, Alcalá University Alcalá de Henares, Madrid, Spain
| | | | | | | | - Leopoldo Borrego
- Universidad de Las Palmas de Gran Canaria. Dermatology Dept. Hospital Universitario Insular Dermatology Dept. Hospital Universitario Insular
| | | | - Miguel Torralba
- Dept. of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, Faculty of Medicine, Alcalá University Alcalá de Henares, Madrid, Spain.,Internal Medicine Dept., University Hospital of Guadalajara, Spain
| | - Cecilia Svedman
- Dept. of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Ana Giménez-Arnau
- Dermatology Dept. Hospital del Mar, IMIM, Universitat Autònoma de Barcelona
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19
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Gatica-Ortega ME, Pastor-Nieto MA. Dermatitis alérgica de contacto y otras dermatosis asociadas al uso de bombas de insulina y sensores de glucosa. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.piel.2019.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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20
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Ahrensbøll-Friis U, Simonsen AB, Zachariae C, Thyssen JP, Johansen JD. Contact dermatitis caused by glucose sensors, insulin pumps, and tapes: Results from a 5-year period. Contact Dermatitis 2020; 84:75-81. [PMID: 32677709 DOI: 10.1111/cod.13664] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/10/2020] [Accepted: 07/15/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND The number of patients with contact dermatitis from glucose sensors and insulin infusion sets is increasing. Patch testing is challenging because of a lack of information concerning the constituent materials of medical devices. OBJECTIVES To report on products and causes of allergic reactions to glucose sensors or insulin infusion sets over a 5-year period and suggest a short screening series. METHODS Analysis of patch test data from consecutive patients suspected of allergic contact dermatitis (ACD) to glucose sensors and/or insulin infusion sets from 2015-2019. RESULTS Patient numbers increased from 4 to 15 per year; 30/38 (78.9%) were children. In 29 (76.3%), a diagnosis of allergic/probable ACD was established, mostly due to the tapes of the device or allergens in these tapes (n = 23) followed by allergens in the device housing (n = 10). Isobornyl acrylate, abitol, and colophonium were the most common allergens. Information from manufacturers was often difficult to obtain and, if accessible, inadequate. For this reason, the diagnosis was delayed for more than 1.5 years in 12 (31%) patients. CONCLUSIONS The increasing number of patients, mostly children, with ACD from devices used in treatment of type 1 diabetes demonstrates the importance of this problem. Allergies can easily be overlooked, due to the lack of mandatory labeling of the constituent materials of the devices.
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Affiliation(s)
- Ulrik Ahrensbøll-Friis
- National Allergy Research Centre, Department of Dermatology and Allergy, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Anne Birgitte Simonsen
- Department of Dermatology and Allergy, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Claus Zachariae
- Department of Dermatology and Allergy, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Jacob P Thyssen
- Department of Dermatology and Allergy, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Jeanne D Johansen
- National Allergy Research Centre, Department of Dermatology and Allergy, Copenhagen University Hospital Gentofte, Hellerup, Denmark
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21
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Kontaktallergie auf kontinuierliche Glukosemesssysteme und Insulin-Patch-Pumpen. Hautarzt 2020; 71:41-43. [DOI: 10.1007/s00105-020-04623-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Oppel E, Kamann S, Heinemann L, Klein A, Reichl FX, Högg C. Freestyle libre 2: The new isobornyl acrylate free generation. Contact Dermatitis 2020; 83:429-431. [PMID: 32542740 DOI: 10.1111/cod.13638] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/11/2020] [Accepted: 06/13/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Eva Oppel
- Department of Dermatology and Allergology, University Hospital, LMU Munich, Munich, Germany
| | - Stefanie Kamann
- Department of Allergy, Dermatology Feldafing, Feldafing, Germany
| | | | - Anna Klein
- Department of Dermatology and Allergology, University Hospital, LMU Munich, Munich, Germany
| | - Franz-Xaver Reichl
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Munich, Germany.,Walther Straub Institute of Pharmacology and Toxicology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Christof Högg
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Munich, Germany.,Walther Straub Institute of Pharmacology and Toxicology, Faculty of Medicine, LMU Munich, Munich, Germany
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23
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Kamann S, Heinemann L, Oppel E. Usage of Hydrocolloid-Based Plasters in Patients Who Have Developed Allergic Contact Dermatitis to Isobornyl Acrylate While Using Continuous Glucose Monitoring Systems. J Diabetes Sci Technol 2020; 14:582-585. [PMID: 31538817 PMCID: PMC7576941 DOI: 10.1177/1932296819876964] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Continuous glucose monitoring (CGM) systems replace more and more capillary self-monitoring of blood glucose by patients with diabetes. However, at least a subset of patients experience adverse skin reactions such as severe allergic contact dermatitis (ACD) after prolonged usage of CGM systems. A major allergen isobornyl acrylate (IBOA) has been identified recently. OBJECTIVES After developing an ACD, patients have difficulties in continuing the usage of their CGM system (and also of, eg, certain patch pumps). Most of such patients look for possibilities to continue the usage of, eg, a CGM system that requires intermittent scanning (iscCGM, Freestyle Libre). PATIENTS AND METHODS Eight patients with a known ACD were supplied with different hydrocolloid-based plasters (n = 5 with Hansaplast blister plaster, n = 2 with Cutimed Hydro B from BSN, and n = 1 with Stomahesive baseplate from Convatec). They attached these plasters to their skin underneath their iscCGM system. RESULTS All patients were able to continue the usage of this iscCGM system when using such plasters. CONCLUSION Patients with ACD benefit from the usage of such plasters; however, some limitations have to be acknowledged.
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Affiliation(s)
- Stefanie Kamann
- Dermatology and Allergology, Feldafing, Germany
- Stefanie Kamann, MD, Dermatology and Allergology, Seewiesstraße 1, 82340 Feldafing, Germany.
| | | | - Eva Oppel
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
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24
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Contact Allergy-Emerging Allergens and Public Health Impact. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072404. [PMID: 32244763 PMCID: PMC7177224 DOI: 10.3390/ijerph17072404] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/17/2020] [Accepted: 03/30/2020] [Indexed: 02/07/2023]
Abstract
Contact allergy (sensitisation) and allergic contact dermatitis (ACD) resulting from it have a considerable public health impact. For the present review, all pertinent articles were systematically searched via Medline and Web of Science™; additionally, all available issues of the journals "Contact Dermatitis" and "Dermatitis" were manually searched, covering the years 2018-2019, thereby extending and re-focusing a previous similar review. New allergens, or previously described allergens found in a new exposure context or of other current importance, are described in sections according to substance classes, e.g., metals, preservatives, fragrances. As a common finding in many investigations, a lack of information on product composition has been noted, for instance, regarding a newly described allergen in canvas shoes (dimethylthiocarbamylbenzothiazole sulfide) and, most notably, absence of co-operation from manufacturers of glucose-monitoring devices and insulin pumps, respectively. These latter devices have been shown to cause severe ACD in a considerable number of diabetic patients caused by the liberation of isobornyl acrylate and N,N'-dimethylacrylamide, respectively, as demonstrated by an international collaboration between dermatologists and chemists. Improved and complete ingredient labelling for all types of products, and not just cosmetics, must be put on the legislative agenda.
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25
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Abstract
The design and development of insulin pumps and various glucose sensor systems has an enormous impact on life quality of diabetic patients. Surveillance and therapy of diabetes has improved due to the new diabetic devices, which are affixed to the patients' skin for several days. Since their introduction, irritant and allergic contact dermatitis have been frequently reported. Patients often acquire contact sensitization to isobornyl acrylate, N,N-dimethylacrylamide or formerly to 2‑ethyl-cyanoacrylate. These contact allergens were found in the patch, in the glue to affix the box on the patch or in the casing of the system itself. Development of contact allergy to substances of these systems may result in the need to abandon modern diabetic devices.
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26
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27
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Lombardo F, Passanisi S, Caminiti L, Barbalace A, Marino A, Iannelli M, Messina MF, Pajno GB, Salzano G. High Prevalence of Skin Reactions Among Pediatric Patients with Type 1 Diabetes Using New Technologies: The Alarming Role of Colophonium. Diabetes Technol Ther 2020; 22:53-56. [PMID: 31464516 DOI: 10.1089/dia.2019.0236] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
In the past few years, the increasing use of devices for diabetes treatment, such as continuous subcutaneous insulin infusion pumps, flash glucose monitoring, continuous glucose monitoring systems, sensor-augmented pumps, and automated insulin delivery devices, has resulted in important improvements in disease management. Meanwhile, the longer a patient uses a device, the greater the likelihood of developing a skin reaction. Allergic contact dermatitis is the most frequently described skin side effect caused by adhesive tapes contained in the insulin infusion sets or glucose sensor sets and used to connect these devices to the body. We describe 18 patients, followed up at our Pediatric Diabetes Centre, who experienced dermatological complications due to diabetes device use from January 2018 to December 2018. All the patients were patch tested with allergens from a "standard" series and from a "plastics and glues" series. Patch tests resulted positive in 66.7% of patients. Colophonium was the most frequently isolated sensitizing allergen (41.1% of cases). It is a complex mixture of >100 compounds derived from pine trees. Colophonium is commonly used, in both unmodified and modified forms, as a fast-acting adhesive for industrial, medical, or other commercial uses. Its presence in the adhesive of the insulin sets and glucose sensors was confirmed by the manufacturer of some devices brand. On the basis of our results, we stress the importance of contacting manufacturers for product information. We also highlight that there should be stricter legal restrictions to label medical adhesives, even if only small amounts of colophonium are used.
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Affiliation(s)
- Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Stefano Passanisi
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Lucia Caminiti
- Allergy Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Andrea Barbalace
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Alessandra Marino
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Mauro Iannelli
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Maria Francesca Messina
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Giovanni Battista Pajno
- Allergy Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Giuseppina Salzano
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
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28
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Kamann S, Oppel E, Liu F, Reichl FX, Heinemann L, Högg C. Evaluation of Isobornyl Acrylate Content in Medical Devices for Diabetes Treatment. Diabetes Technol Ther 2019; 21:533-537. [PMID: 31287728 DOI: 10.1089/dia.2019.0163] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Along with increased usage of continuous glucose monitors, flash glucose monitors, and patch pumps by patients with diabetes, the frequency of skin reactions has also increased. Skin irritation and itching can be annoying to users. However, more serious contact allergies to one or more components of the adhesives or plastic material of the housing of the devices can become lifelong. Redness and itchiness are so strong that patients can no longer use a particular system. In August 2017, a major culprit allergen, isobornyl acrylate (IBOA), was identified for these more serious reactions. Objectives: Our objective was to evaluate IBOA content in different medical products. Methods: The plastic material used for the housing of the Freestyle Libre (n = 3), Dexcom G6 (n = 3), and Enlite (n = 4) was analyzed for IBOA content by gas chromatography-mass spectrometry. Adhesives of the different systems were also analyzed. Results: IBOA was found in the housings of Freestyle Libre and Enlite sensor, but not in the Dexcom G6. Conclusions: Patients with an IBOA allergy should consider switching to a medical product without IBOA. Furthermore, removal of IBOA from devices that contact the skin is encouraged.
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Affiliation(s)
| | - Eva Oppel
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
| | - Fangfang Liu
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilian University, Munich, Germany
- Walther-Straub-Institute of Pharmacology and Toxicology, Ludwig-Maximilian University, Munich, Germany
| | - Franz-Xaver Reichl
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilian University, Munich, Germany
- Walther-Straub-Institute of Pharmacology and Toxicology, Ludwig-Maximilian University, Munich, Germany
| | | | - Christof Högg
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilian University, Munich, Germany
- Walther-Straub-Institute of Pharmacology and Toxicology, Ludwig-Maximilian University, Munich, Germany
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29
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Oppel E, Kamann S, Heinemann L, Reichl F, Högg C. The implanted glucose monitoring system Eversense: An alternative for diabetes patients with isobornyl acrylate allergy. Contact Dermatitis 2019; 82:101-104. [DOI: 10.1111/cod.13392] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/22/2019] [Accepted: 08/27/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Eva Oppel
- Department of Dermatology and AllergologyLudwig‐Maximilian University Munich Germany
| | | | | | - Franz‐Xaver Reichl
- Department of Conservative Dentistry and PeriodontologyUniversity Hospital, Ludwig‐Maximilian University Munich Germany
- Walther‐Straub‐Institute of Pharmacology and Toxicology, Ludwig‐Maximilian University Munich Germany
| | - Christof Högg
- Department of Conservative Dentistry and PeriodontologyUniversity Hospital, Ludwig‐Maximilian University Munich Germany
- Walther‐Straub‐Institute of Pharmacology and Toxicology, Ludwig‐Maximilian University Munich Germany
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30
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Mine Y, Urakami T, Matsuura D. Allergic contact dermatitis caused by isobornyl acrylate when using the FreeStyle ® Libre. J Diabetes Investig 2019; 10:1382-1384. [PMID: 30758915 PMCID: PMC6717817 DOI: 10.1111/jdi.13023] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 01/25/2019] [Accepted: 01/31/2019] [Indexed: 12/04/2022] Open
Abstract
We present the case of an 8-year-old girl with type 1 diabetes who developed severe allergic contact dermatitis by using FreeStyle® Libre. A patch test was carried out using a piece of the adhesive part of the sensor of the FreeStyle® Libre, and subsequently by using the potential contact allergens in the sensor, isobornyl acrylate. She reacted positively to the adhesive part of the sensor, and also reacted positively to isobornyl acrylate with three different concentrations, 0.1%, 0.05% and 0.01%, over 48-h, 72-h and 7-day periods. The FreeStyle® Libre is a useful and less invasive device that can be used for continuous glucose monitoring in patients with diabetes. In contrast to the remarkable advantages, allergic contact dermatitis caused by isobornyl acrylate in the adhesive part of FreeStyle® Libre is one of the potential adverse events.
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Affiliation(s)
- Yusuke Mine
- Department of PediatricsNihon University HospitalTokyoJapan
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31
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Herman A, Baeck M, Montjoye L, Bruze M, Giertz E, Goossens A, Mowitz M. Allergic contact dermatitis caused by isobornyl acrylate in the Enlite glucose sensor and the Paradigm MiniMed Quick‐set insulin infusion set. Contact Dermatitis 2019; 81:432-437. [DOI: 10.1111/cod.13374] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/01/2019] [Accepted: 08/04/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Anne Herman
- Department of DermatologyCliniques universitaires Saint‐Luc Brussels Belgium
- IREC (Institut de Recherche Experimentale et Clinique) Pôle Pneumologie, ORL, DermatologieUniversité Catholique de Louvain Brussels Belgium
| | - Marie Baeck
- Department of DermatologyCliniques universitaires Saint‐Luc Brussels Belgium
- IREC (Institut de Recherche Experimentale et Clinique) Pôle Pneumologie, ORL, DermatologieUniversité Catholique de Louvain Brussels Belgium
| | - Laurence Montjoye
- Department of DermatologyCliniques universitaires Saint‐Luc Brussels Belgium
- IREC (Institut de Recherche Experimentale et Clinique) Pôle Pneumologie, ORL, DermatologieUniversité Catholique de Louvain Brussels Belgium
| | - Magnus Bruze
- Department of Occupational and Environmental DermatologyLund University, Skåne University Hospital Malmö Sweden
| | - Emil Giertz
- Department of DermatologyBlekinge Hospital Karlskrona Sweden
| | - An Goossens
- Department of DermatologyUniversity Hospitals KU Leuven Leuven Belgium
| | - Martin Mowitz
- Department of Occupational and Environmental DermatologyLund University, Skåne University Hospital Malmö Sweden
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32
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Herman A, Goossens A. The need to disclose the composition of medical devices at the European level. Contact Dermatitis 2019; 81:159-160. [DOI: 10.1111/cod.13354] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Anne Herman
- Department of DermatologyCliniques universitaires Saint‐Luc, Brussels, Belgium
- Institute of Experimental and Clinical ResearchPneumology, ENT and Dermatology Pole, Université catholique de Louvain Brussels Belgium
| | - An Goossens
- Department of DermatologyUniversity Hospitals, KU Leuven Leuven Belgium
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33
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34
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Herman A, Mowitz M, Aerts O, Pyl J, Montjoye L, Goossens A, Bruze M, Baeck M. Unexpected positive patch test reactions to sesquiterpene lactones in patients sensitized to the glucose sensor FreeStyle Libre. Contact Dermatitis 2019; 81:354-367. [DOI: 10.1111/cod.13330] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/28/2019] [Accepted: 06/03/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Anne Herman
- Department of Dermatology, Cliniques universitaires Saint‐Luc, Brussels, and IREC (Institut de Recherche Experimentale et Clinique) Pôle Pneumologie, ORL, DermatologieUniversité Catholique de Louvain Brussels Belgium
| | - Martin Mowitz
- Department of Occupational and Environmental Dermatology, Lund UniversitySkåne University Hospital Malmö Sweden
| | - Olivier Aerts
- Department of DermatologyUniversity Hospital Antwerp (UZA) and University of Antwerp (UA) Antwerp Belgium
| | - Jeroen Pyl
- Department of DermatologyUniversity Hospital Antwerp (UZA) and University of Antwerp (UA) Antwerp Belgium
| | - Laurence Montjoye
- Department of Dermatology, Cliniques universitaires Saint‐Luc, Brussels, and IREC (Institut de Recherche Experimentale et Clinique) Pôle Pneumologie, ORL, DermatologieUniversité Catholique de Louvain Brussels Belgium
| | - An Goossens
- Department of DermatologyUniversity Hospitals Leuven Belgium
| | - Magnus Bruze
- Department of Occupational and Environmental Dermatology, Lund UniversitySkåne University Hospital Malmö Sweden
| | - Marie Baeck
- Department of Dermatology, Cliniques universitaires Saint‐Luc, Brussels, and IREC (Institut de Recherche Experimentale et Clinique) Pôle Pneumologie, ORL, DermatologieUniversité Catholique de Louvain Brussels Belgium
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35
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Kamann S, Oppel E. Hydrocolloid blister plaster decreases allergic contact dermatitis caused by Freestyle Libre and isobornyl acrylate. Contact Dermatitis 2019; 81:380-381. [DOI: 10.1111/cod.13329] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/06/2019] [Accepted: 05/29/2019] [Indexed: 11/27/2022]
Affiliation(s)
| | - Eva Oppel
- Department of Dermatology and AllergologyLudwig‐Maximilian University Munich Germany
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36
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Oppel E, Kamann S, Reichl F, Högg C. The Dexcom glucose monitoring system—An isobornyl acrylate‐free alternative for diabetic patients. Contact Dermatitis 2019; 81:32-36. [DOI: 10.1111/cod.13248] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/13/2019] [Accepted: 02/17/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Eva Oppel
- Department of Dermatology and Allergy University Hospital, LMU Munich Munich Germany
| | - Stefanie Kamann
- Department of Allergy Dermatology Feldafing Feldafing Germany
| | - Franz‐Xaver Reichl
- Department of Conservative Dentistry and Periodontology University Hospital, LMU Munich Munich Germany
- Walther Straub Institute of Pharmacology and Toxicology Faculty of Medicine, LMU Munich Munich Germany
| | - Christof Högg
- Department of Conservative Dentistry and Periodontology University Hospital, LMU Munich Munich Germany
- Walther Straub Institute of Pharmacology and Toxicology Faculty of Medicine, LMU Munich Munich Germany
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37
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Shinkawa E, Washio K, Tatsuoka S, Fukunaga A, Sakaguchi K, Nishigori C. A case of contact dermatitis caused by isobornyl acrylate in FreeStyle Libre: The usefulness of film‐forming agents. Contact Dermatitis 2019; 81:56-57. [DOI: 10.1111/cod.13239] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 01/31/2019] [Accepted: 02/04/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Eriko Shinkawa
- Division of Dermatology, Department of Internal Related Kobe University Graduate School of Medicine Kobe Japan
| | - Ken Washio
- Division of Dermatology, Department of Internal Related Kobe University Graduate School of Medicine Kobe Japan
| | - Saori Tatsuoka
- Division of Dermatology, Department of Internal Related Kobe University Graduate School of Medicine Kobe Japan
| | - Atsushi Fukunaga
- Division of Dermatology, Department of Internal Related Kobe University Graduate School of Medicine Kobe Japan
| | - Kazuhiko Sakaguchi
- Division of Diabetes and Endocrinology, Department of Internal Medicine Kobe University Graduate School of Medicine Kobe Japan
| | - Chikako Nishigori
- Division of Dermatology, Department of Internal Related Kobe University Graduate School of Medicine Kobe Japan
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38
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Cutaneous Adverse Effects of Diabetes Mellitus Medications and Medical Devices: A Review. Am J Clin Dermatol 2019; 20:97-114. [PMID: 30361953 DOI: 10.1007/s40257-018-0400-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Diabetes mellitus is one of the most prevalent chronic diseases in the USA. If uncontrolled, diabetes can lead to devastating complications. Diabetes medications and medical devices largely contribute to the significant financial expense that the disease inflicts on affected individuals and society. Alongside significant economic burden, there are numerous cutaneous adverse effects associated with diabetes medications and medical devices. Despite the large and increasing number of individuals living with diabetes and the wide use of the related medications and medical devices, there is limited literature that comprehensively documents their cutaneous adverse effects. These cutaneous adverse effects are significant as they can worsen glycemic control, increase disease distress, and may increase risk of associated complications. Thus, it is important that providers can recognize these cutaneous adverse effects, identify the culprit agents, and can properly manage them. In this article, we provide a critical review of the cutaneous adverse effects of medications and devices used in the management of diabetes and provide insight into risk factors and prevention and an overview of therapeutic management. An emphasis is placed on clinical recognition and treatment for use of the medical providers who, regardless of practice setting, will treat patients with diabetes.
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39
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Herman A, de Montjoye L, Tromme I, Goossens A, Baeck M. Allergic contact dermatitis caused by medical devices for diabetes patients: A review. Contact Dermatitis 2018; 79:331-335. [DOI: 10.1111/cod.13120] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 08/13/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Anne Herman
- Department of Dermatology; Cliniques universitaires Saint-Luc; Brussels Belgium
| | | | - Isabelle Tromme
- Department of Dermatology; Cliniques universitaires Saint-Luc; Brussels Belgium
| | - An Goossens
- Department of Dermatology; University Hospitals, KU Leuven; Leuven Belgium
| | - Marie Baeck
- Department of Dermatology; Cliniques universitaires Saint-Luc; Brussels Belgium
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40
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Corazza M, Scuderi V, Musmeci D, Foti C, Romita P, Borghi A. Allergic contact dermatitis caused by isobornyl acrylate in a young diabetic patient using a continous glucose monitoring system (Freestyle Libre). Contact Dermatitis 2018; 79:320-321. [DOI: 10.1111/cod.13075] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 06/17/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Monica Corazza
- Section of Dermatology, Department of Medical Sciences; University of Ferrara; Emilia-Romagna Italy
| | - Valeria Scuderi
- Section of Dermatology, Department of Medical Sciences; University of Ferrara; Emilia-Romagna Italy
| | - Dario Musmeci
- Section of Dermatology, Department of Medical Sciences; University of Ferrara; Emilia-Romagna Italy
| | - Caterina Foti
- Department of Biomedical Science and Human Oncology, Dermatological Clinic; University of Bari; Bari Italy
| | - Paolo Romita
- Department of Biomedical Science and Human Oncology, Dermatological Clinic; University of Bari; Bari Italy
| | - Alessandro Borghi
- Section of Dermatology, Department of Medical Sciences; University of Ferrara; Emilia-Romagna Italy
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