Allergic contact dermatitis and irritant contact dermatitis from medical devices used by patients with insulin‐dependent diabetes mellitus

Reactions to diabetic monitors remain a common problem in adult and paediatric patients, especially as the use of continuous glucose monitors and insulin pumps become more widespread due to their convenience and integration with devices such as smartphones. The gold standard in the diagnosis of allergic contact dermatitis (ACD) is patch testing.1 When ACD is suspected to be connected to diabetes medical devices, baseline series, plastics, glues and acrylate-series patch tests, including isobornyl acrylate (IBOA), should be considered. ACD to adhesive chemicals in diabetic devices, including colophonium, modified colophonium, epoxy and acrylates, has recently garnered the attention of contact dermatitis groups around the world. IBOA was named the American Contact Dermatitis Society Contact Allergen of the year in 2020.2, 3 It is important to remember that irritant contact dermatitis (ICD) is also a common cause of dermatitis reactions from these medical devices. Repetitive trauma to the skin from removal and placement of adhesives, maceration of the skin and occlusion can potentially induce ICD. Differentiating between ICD and ACD may be difficult, and patch testing is required.4 It is often challenging to obtain information about the composition of these devices. Manufacturers usually do not provide a list of exact chemicals contained in the devices or generally state that 'polyacrylates' are present without specification.1 von Kobyletzki et al. highlighted that there is a significant research gap in this topic. The authors emphasized the need for improved knowledge about the chemical substances contained in these devices, better regulation on full labelling and improvement of the commercially available allergens for testing. The authors also mentioned the importance of diagnostic procedures and creating guidelines regarding referral routes for the affected patients.5 Treatment of ACD related to diabetic devices includes switching to a device without a known allergen. Unfortunately, the 'trial-error' scheme is, in some cases, the only solution for patients facing challenges with their devices due to discomfort, itching, pain or sleep deprivation. In acute contact dermatitis, topical corticosteroids are the first-line treatment, and steroids such as fluticasone propionate spray, clobetasol spray or other steroid sprays that are mostly water/alcohol based and not greasy are preferable as they often do not interfere with the device adhesion. As topical corticosteroids should not be a long-term solution due to the side effects, other alternatives include topical calcineurin inhibitors such as tacrolimus or pimecrolimus to control the sub-inflammatory process. Barrier protectants and wound dressings such as bordered polyurethane (Tegaderm®), hydrocolloid dressing (DuoDERM® Extra Thin dressing) or Hansaplast sensitive® can also be helpful for some patients to prevent direct contact of the adhesive with the skin. However, it is important to remember that hydrocolloid dressings may equally contain modified colophonium that might elicit reactions in sensitized patients.1, 3 Katlein França, Medical Reviewer Verywell and Health.com websites; Receive book royalties from Springer and Willey Blackwell. None related to this manuscript. Jiade Yu, Advisory board for Arcutis, Incyte, Sanofi, Leo, Astria Therapeutics, and O'Glacee; Consulting for Dermavant, iRhythm, National Eczema Association; Contributor to UpToDate. None related to this manuscript. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.