Allergic contact dermatitis caused by glucose sensors in type 1 diabetes patients.

BACKGROUND: Allergic contact dermatitis caused by glucose sensors has become an increasing problem. Contact allergies to isobornyl acrylate, colophonium, ethyl cyanoacrylate and N,N-dimethylacrylamide have been reported. However, there is a paucity of information regarding the prevalence of sensor-related dermatitis and detailed patient histories. OBJECTIVES: To evaluate diabetes patients who have developed allergic contact dermatitis caused by glucose sensors. PATIENTS AND METHODS: Seventy patients with suspected contact allergy to glucose sensors referred to university hospital dermatology clinics in southern Finland were patch tested with the baseline series, an isobornyl acrylate dilution series, and a number of other acrylates. Atopic constitution, contact allergies, the severity of the dermatitis and the ability to continue with the same or another type of sensor were recorded. RESULTS: Positive patch test reactions to isobornyl acrylate were seen in 51 of 63 (81%) Freestyle Libre users. Colophonium or its derivatives gave positive reactions in five of seven Medtronic Enlite users. The median duration of sensor use before dermatitis was 6 months. The estimated prevalences of contact allergy to sensor adhesives were 0.7% for Freestyle Libre and 0.8% for Enlite. CONCLUSIONS: We suggest that patients who have difficulties in finding a tolerable glucose sensor or an insulin pump should be patch tested.

A 10-year open follow-up of eczema and respiratory symptoms in patients with atopic dermatitis treated with topical tacrolimus for the first 4 years.

OBJECTIVES: To examine the 10-year outcome of affected body surface area (BSA), respiratory symptoms, and serum IgE in adult AD patients 6 years after a 4-year intervention with topical tacrolimus. METHODS: Patients who 10 years ago participated in a 4-year, open tacrolimus study (n = 65) were contacted for assessment of affected BSA, bronchial hyper-reactivity (BHR), respiratory symptoms, skin prick tests and serum IgE. RESULTS: Altogether, 50 (77%) patients attended the follow-up visit. The median affected BSA decreased from 19% to 1.6% during the 10-year follow-up (p < 0.0001). Patients with active asthma and rhinitis symptoms at baseline reported a significant decrease at the follow-up (p = 0.02 andp = 0.01). In patients with BHR at baseline, the provocative dose of inhaled histamine producing a 15% decrease in FEV(1) increased. Responders (>or= 60% improvement of affected BSA) to tacrolimus treatment at the 1-year visit had a significantly smaller affected BSA at the 4- and 10-year visits than non-responders (< 60% improvement). Responders also showed a significant decrease in serum IgE at the follow-up visit compared to baseline (p = 0.002). CONCLUSIONS: The long-term, effective treatment of patients with AD may have a beneficial effect on affected BSA, respiratory symptoms, and serum IgE.

Effect of 0.03% tacrolimus ointment on conjunctival cytology in patients with severe atopic blepharoconjunctivitis: a retrospective study.

PURPOSE: To evaluate the efficacy and effect of tacrolimus ointment on conjunctival cytology in patients with atopic blepharoconjunctivitis or keratoconjunctivitis. METHODS: Ten patients with severe atopic blepharoconjunctivitis treated with 0.03% tacrolimus ointment once daily as an intermittent treatment were analysed retrospectively. The main outcome measures were clinical response to topical tacrolimus, adverse events and changes in the inflammatory cells obtained from conjunctival brush samples. RESULTS: Marked clinical responses in blepharitis and conjunctivitis symptoms were seen after a mean follow-up time of 6 weeks. Clinical scores decreased by 67% in blepharitis and 74% in conjunctivitis symptoms. No severe adverse events or signs of immunosuppression such as herpes simplex infections occurred. No significant changes occurred in visual acuity, refraction, anterior chamber, retina or intraocular pressure. Median decreases were 85% (p =0.01) in conjunctival eosinophils, 50% (p = 0.01) in neutrophils and 58% (p = 0.02) in lymphocytes. CONCLUSIONS: Tacrolimus ointment is potentially a safe and effective treatment for atopic blepharoconjunctivitis. Regular treatment of the eyelids once daily may also lead to clinical and cytological improvement of the conjunctivitis.