Further Evidence of Allergic Contact Dermatitis Caused by 2,2'-Methylenebis(6-tert-Butyl-4-Methylphenol) Monoacrylate, a New Sensitizer in the Dexcom G6 Glucose Sensor

Insulin Pump Therapy and Adverse Skin Reactions With Focus on Allergic Contact Dermatitis in Individuals Living With Diabetes Mellitus: A Systematic Review and Clinical-Based Update

BACKGROUND

The use of insulin pumps (continuous subcutaneous insulin infusion [CSII]) in individuals living with type 1 diabetes (T1D) improves disease control. However, adverse skin reactions may hamper compliance. We aimed to assess the relationship of insulin pumps, particularly that of infusion set therapy, used in children and adults with T1D and dermatitis including allergic contact dermatitis (ACD).

METHODS

A systematic search of PubMed, and EMBASE, of full-text studies reporting dermatitis in persons with diabetes using a CSII was conducted from 2020 to 2023. The Newcastle-Ottawa Scale was used to assess study quality. The inventory performed at the Department of Occupational and Environmental Dermatology, Malmö, Sweden (YMDA) was also performed highlighting the diagnostic process.

RESULTS

Among the 391 screened abstracts, 21 studies fulfilled the inclusion criteria. Seven studies included data on children only, four studies were on adults, and nine studies reported data on both children and adults. Participants were exposed to a broad range of pumps. Dermatitis was rarely specified. Up to 60% of those referred to a university hospital due to skin reactions possibly related to insulin pumps had an ACD.

CONCLUSIONS

The review and our findings indicate that there is not sufficient focus on contact allergy in the primary toxicological evaluations of substances used also for insulin pump therapy products and that possible adverse skin reactions are not correctly followed up in the clinical setting.

[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.

A toddler with systemic contact dermatitis caused by diabetes devices

Continuous glucose monitors (CGM) and insulin pumps have become the preferred treatment option for most young children and adolescents with type 1 diabetes (T1D), by avoiding fingerstick testing and providing real-time glucose measurements. These medical devices and their adhesives contain substances which have been identified as being responsible for allergic contact dermatitis. We describe the case of a toddler who developed severe contact dermatitis from her diabetes devices, leading to secondary infections and hospital admissions. This was followed by the development of a symmetrical exanthema with retroauricular and glutaeal distribution. Patch tests were positive for isobornyl acrylate (IBOA) and 4-tert-butylcatechol (PTBC). Her symmetrical exanthema was interpreted as systemic contact dermatitis due to IBOA and PTBC in her diabetes devices. We suspect that systemic contact dermatitis is an underreported complication in diabetic patients.

Contact allergy to the Dexcom G6 glucose monitoring system -role of 2,2'-methylenebis(6-tert-butyl-4-methylphenol) monoacrylate in the new adhesive

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.