Skin Involvement in Paediatric Patients with Type 1 Diabetes

Abstract

Skin involvement is an overlooked aspect in the management of paediatric patients with type 1 diabetes. A comprehensive search of published literature using the PubMed database was carried out using the following key terms: “children”, “pediatric/paediatric patients”, “skin”, “skin disorders”, “type 1 diabetes”. Dermatological side effects are frequently observed among diabetic children and adolescents. Insulin-induced lipodystrophies and allergic contact dermatitis caused by insulin pumps or glycaemic sensors are the most common skin reactions in these patients. Furthermore, several diabetes-associated skin diseases such as necrobiosis lipoidica, granuloma annulare, vitiligo, and bullosis diabeticorum may already be present in paediatric age. Paediatric diabetes specialists should pay attention to their patients’ skin so as to recognize these disorders, identify the potential causes, and choose the most suitable treatment. Finally, the evaluation of skin concentrations of advanced glycation end-products using non-invasive diagnostic techniques may be used to assess the risk of chronic complications of diabetes as early as adolescence.

Skin Problems due to Treatment with Diabetes Technology: A Narrative Review

“…Itching is a commonly reported symptom in many users of both insulin pumps and glucose sensors 11,15,16 . It can be found without further visual symptoms or in relation to contact dermatitis, scars, wounds or lipodystrophies 18 . Dry skin and itching symptoms are also in general more commonly observed in children with T1D compared to their healthy peers 19 , even though the skin barrier is not found to be impaired neither in children and adolescents nor in adults with T1D 20 .…”

“…Lipodystrophies is a well-known complication to the treatment with insulin which affect insulin absorption and are seen in the subcutaneous layer of the skin where most other skin problems do at least initiate in the epidermis of dermis layer of the skin 18 . It can be sub-divided in lipohypertrophy and lipoatrophy, where lipohypertrophy is characterized as a soft swelling with hypertrophy of the adipose tissue of subcutis, lipoatrophy is a depression with loss of adipose tissue of subcutis 9 .…”

“…Lipohypertrophy is thought to result from the anabolic effects of insulin. However, over time, the skin in lipohypertrophic areas becomes hyposensitized making infusion set insertion in those areas more comfortable and less painful 18 . Most studies show that proper injection technique with rotation of infusion set position is crucial for prevention of lipohypertrophy and that the insulin absorption is impaired when injected in lipohypertrophic areas 36 .…”

“…When it comes to the infections, part of the skin microbiome on the buttocks were different in the above mentioned skin barrier study 20 , which suggest this as a reason for infections. The insulin is the suspected cause for both lipoatrophy and lipohypertrophy and both reactions are subsequently also seen with insulin injections 18 , no direct comparative studies have been found comparing frequencies of these reactions with use of pen versus insulin pump.…”