Endocrine Abstracts

Devices such as continuous glucose monitoring systems and insulin pumps are being increasingly used, improving quality of life and diabetic control for those with Type 1 diabetes mellitus. Skin reactions can occur at the local site which could be allergic, irritant or infective in nature. The history is key in differentiating between these. Typically infective or irritant dermatitis tend to cause intermittent problems and may start within days of a new device being applied to the skin. Allergic contact dermatitis (ACD) tends to present after months of device use and the problem persists, often meaning patients will have to stop use or use an alternative device. Accurate diagnosis allows individuals to successfully continue using these life changing technologies. We report on two cases in which ACD was considered, however not felt to be entirely typical. After thorough assessment they were found to have carriage of Staphylococcus aureus (S. aureus). Risk factors for S. aureus include diabetes and cannula sites, making these patients high risk. A 14 year old started using Omnipod insulin pump in October 2020, four months later a red itchy rash was noted at the local site, nasal swab was positive for S. aureus, treatment with decolonisation and oral Flucloxacillin was started. The rash persisted until nasal swabs were clear. A second patient started using the Omnipod insulin pump in Aug 2022, three months later an itchy red rash developed, both skin and nasal swabs were positive for S. aureus. Treatment with topical Fucibet and decolonisation cleared the rash, subsequent swabs were negative. Both cases have been able to continue using the devices without further issues. These cases demonstrate that accurate diagnosis can allow effective and timely management of device related rashes and highlight the importance of performing nasal swabs. In our service we routinely perform nasal and skin swabs if there are features that are not typical of ACD and are frequently finding positive nasal carriage and resolution of the problem with decolonisation.