D1.305 - Management of Contact Dermatitis in Pediatric Type 1 Diabetes: A Therapeutic Protocol with Topical Pimecrolimus
Background
Contact dermatitis (CD) is a frequent dermatologic complication among children and adolescents with type 1 diabetes (T1D) using insulin pumps and continuous glucose monitoring (CGM) devices. CD negatively impacts quality of life, adherence to treatment, and glycemic control, representing a significant economic burden. CD may present as irritant contact dermatitis (ICD) or allergic contact dermatitis (ACD). ACD, a type IV hypersensitivity reaction, is often caused by allergens in adhesive tapes, with colophonium identified as a major culprit. Despite patch testing aiding diagnosis, false negatives are possible, limiting its sensitivity.
Method
We evaluated a therapeutic protocol using topical 1% pimecrolimus cream (Elidel®) in two pediatric patients with CD due to adhesives in diabetes devices. Pimecrolimus, a calcineurin inhibitor approved for atopic dermatitis, was applied over a 10-day period to both affected and preventive areas prior to device placement. This duration corresponded to the sensor lifespan (Dexcom G6/G7). Patients were instructed to avoid sunlight exposure to minimize side effects such as burning or itching.
Results
The first patient, N.T., exhibited localized lesions at device sites (Figure 1a and 1c), while the second, N.V., experienced severe lesions leading to diabetic ketoacidosis (DKA) due to device malfunction (Figure 1b and 1d). Following the protocol, both patients achieved complete healing of active lesions and prevention of new ones. No significant adverse effects were reported.
Conclusion
The use of topical pimecrolimus demonstrated efficacy in treating and preventing CD in children and adolescents with T1D. This approach improves skin integrity, enhances patient adherence to therapy, and reduces the risk of severe diabetes-related complications. The findings highlight the need for standardized protocols and further research to optimize the management of dermatologic issues in pediatric diabetes care.
