Contact Dermatitis From Glucose Sensors In Spain: A Multicentric Approach

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

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.

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

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.

Deriving a point of departure for assessing the skin sensitization risk of wearable device constituents with in vitro methods

Wearable devices are in contact with the skin for extended periods. As such, the device constituents should be evaluated for their skin sensitization potential, and a Point of Departure (PoD) should be derived to conduct a proper risk assessment. Without historical in vivo data, the PoD must be derived with New Approach Methods (NAMs). To accomplish this, regression models trained on LLNA data that use data inputs from OECD-validated in vitro tests were used to derive a predicted EC3 value, the LLNA value used to classify skin sensitization potency, for three adhesive monomers (Isobornyl acrylate (IBOA), N, N- Dimethylacrylamide (NNDMA), and Acryloylmorpholine (ACMO) and one dye (Solvent Orange 60 (SO60)). These chemicals can be used as constituents of wearable devices and have been associated with causing allergic contact dermatitis (ACD). Using kinetic DPRA and KeratinoSens™ data, the PoDs obtained with the regression model were 180, 215, 1535, and 8325 μg/cm2 for IBOA, SO60, ACMO, and NNDMA, respectively. The PoDs derived with the regression model using NAMs data will enable a proper skin sensitization risk assessment without using animals.

[Translated article] Medical Devices in Patients With Diabetes and Contact Dermatitis

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.

Prognosis and sequelae of meth(acrylate) sensitization in beauticians and consumers of manicure materials

BACKGROUND

Allergic contact dermatitis from (meth)acrylic monomers (ACDMA) in manicure products is increasing.

OBJECTIVE

To evaluate the prognosis, work performance impairment and sequelae of a cohort of beauticians and manicure consumers with ACDMA sensitized from the exposure to manicure products.

METHODS

We conducted a telephone survey with patients diagnosed with ACDMA.

RESULTS

One hundred and six patients were evaluated, including 75 (70.8%) beauticians and 31 (29.2%) consumers. All were women with a mean age of 39 (19-62). Thirty-seven of 75 beauticians (49.3%) continued to work. Twenty-seven of 106 (25.5%) patients continued to use manicure products with (meth)acrylates regularly. Seventeen of 51 (33.3%) patients who discontinued the exposure described ongoing nail/periungual changes. Nine of 58 (15.5%) patients who required dental restoration, orthodontic or occlusal splint materials recalled reactions from them; and, 25 of 96 (26%) who used sanitary napkins recalled intolerance to them starting after the diagnosis of ACDMA. Fifteen of 25 (60%) discontinued the use of sanitary napkins.

CONCLUSION

49.3% beauticians continued to work; most patients stopped wearing acrylic manicure materials; reactions from dental materials were not uncommon, however, removal of dental materials was never required; and, reactions to sanitary napkins developing after the diagnosis of ACDMA were common most leading to discontinuation of use.

Medical Devices in Patients With Diabetes and Contact Dermatitis

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.