Tips for Tackling Adhesive Irritation and Allergies
Dealing with irritation from infusion set and CGM sensor adhesives
Kerri Sparling goes through the same routine every seven days: First, she removes her continuous glucose monitor (CGM) sensor and cleans a new insertion site with an alcohol pad to get the moisture, oil, and dirt off her skin. Then, she sticks a barrier pad onto her clean skin (remember to cut a small hole in the pad; sticking the sensor through the pad can lead to inaccurate readings) before inserting her CGM sensor. The paper-thin pad serves as a barrier, protecting her skin from the sensor’s adhesive. Without the pad, her skin would erupt into a blistering rash.
She’s willing to take the extra steps in her routine because going without a CGM or pump is not an option she’s willing to consider. “I’ve come to really rely on [my CGM] data, especially as I’ve developed hypoglycemia unawareness,” says Sparling, 37, who was diagnosed with type 1 when she was 7. “The data provides me with peace of mind that I never had with finger sticks alone.” Trial and error helped her find skin-friendly solutions for the skin reactions.
Figuring out the main components that cause allergy or irritation is difficult, says Rajani Katta, MD, a skin irritation specialist and clinical assistant professor of medicine at Baylor College of Medicine in Houston, Texas. “Each individual varies in terms of the particular cause of their reaction,” she says.
Most people who experience an adhesive reaction have an irritation—only a few people out of a hundred will have a true allergy to adhesive chemicals, says Joseph Fowler, MD, clinical professor of dermatology at the University of Louisville in Kentucky. It’s hard to pinpoint an exact number of people who have adhesive irritation because most cases go unreported.
Irritation or Allergy?
Bruce Brod, MD, president of the American Contact Dermatitis Society and clinical professor of dermatology at the University of Pennsylvania, says allergic reactions often spread beyond the skin directly underneath the adhesive patch. “It’s more of an intense reaction,” he says.
Irritation, on the other hand, tends to look chafed, scaly, or dry exactly where the adhesive sits on the skin. Both types of reactions can be red, flaky, itchy, and painful, though usually swelling and blisters indicate an allergic reaction, which will likely get worse with each exposure. If an allergy is suspected, your provider can recommend a skin-care regimen and products for relief, or a specialist for patch testing.
Several adhesives are known to cause allergy symptoms. Those include:
Acrylate is a simple chemical that creates stickiness in many adhesives, says Fowler. Different types of acrylates are used in patch adhesives, infusion sets, and glue in pumps and CGMs. Depending on how they’re processed for use, some acrylate chemicals, particularly those used for sticky liquids, powders, and pastes, can cause allergic reactions.
Colophony is a natural adhesive that comes from rosin, which is derived from the sap of pine and spruce trees. It is used as the sticky ingredient in some adhesive wipes, such as Skin Tac, says Katta. Some people swipe one of these wipes over their insertion site (but not where the sensor needle pierces the skin) before sticking on a sensor or infusion set. Using such adhesive wipes may help the sensor or set stay in place, but because colophony can cause allergic reactions, skin wipes must be used with caution.
This liquid adhesive is also used to help keep infusion sets and CGM sensors in place: Spray it on the skin (avoiding the spot where the sensor will insert), let it dry, then affix the set or sensor. If you have sensitive skin, it may be best to avoid this adhesive. Katta says mastisol is a common cause of allergic reactions.
Whether your skin reaction is from irritation or allergy, check out these expert recommendations to help treat your rash so you can continue to wear your device.
One way to prevent irritation from adhesives is to adopt a good skin care routine. This can help you protect and strengthen your skin barrier so it’s not as prone to irritation, says Katta.
Try this: Once you step out of the shower, pat your skin with a towel (you want skin a little damp) and apply moisturizer. “That locks in the moisture and helps provide strengthening to the skin barrier so it’s not as prone to dryness and irritation,” says Katta.
A good skin care regimen is as much about what you don’t do as what you do. Skip harsh soaps and long, hot showers, which can damage the skin barrier. Instead, take a 10- to 15-minute shower in lukewarm water.
When something stays in contact with the skin for long enough, it can cause irritation—whether you have sensitive skin or not. “I’ve seen a similar reaction just from [medical] tape being left on the skin for two days straight,” says Katta. The combination of sweat and a long-wear adhesive is enough to cause irritation in some people, so it’s no wonder that sensor adhesives and infusion sets, which stay on for multiple days, can trigger a reaction. “Just the stickiness, the pressure [of the device], and the friction on the skin of pulling the pad of [your device off] can irritate the skin,” says Fowler.
The first thing he recommends for people with irritation is to alternate from one side of the body to the other with each insertion. That’ll give the skin beneath the adhesive on a just-used site some time to recover. Sometimes skin care products can get stuck under the adhesive, causing irritation or allergy, says Katta. Steer clear of products with fragrance additives, formaldehyde preservatives (such as quaternium 15 and bronopol), and methylisothiazolinone, all of which can be extra irritating for people with sensitive skin.
When you’re dealing with contact dermatitis—a rash that occurs when certain substances come into contact with your skin—you want some kind of barrier between your skin and the adhesive, says Rachel Head, RD, CDE, a spokeswoman for the American Association of Diabetes Educators. That can take the form of a barrier wipe or physical barrier, such as an adhesive pad. But you have to be careful not to get the spray or wipe on the area where your CGM sensor needle pierces the skin—the sensor may be sensitive to the chemicals, which can affect your reading. Some people use a spray barrier on the sensor’s adhesive tape before inserting it, says Head. If you do that, you’ll need to cover the sensor temporarily to prevent spray from landing on it.
You shouldn’t have an issue with inserting infusion sets over skin sprayed or wiped with a barrier, says Head, but check with your pump manufacturer or health care provider to be sure.
Do ensure your CGM sensor or infusion set needle or cannula is clear of any physical barrier. One way to ensure this is to cut a small hole in the dressing for the sensor, cannula, or needle to fit through. Figuring out where the needle will pierce the skin is “probably the most difficult part about this,” says Head.
While barriers give many people relief, someone with a severe allergy may not be able to go this route. “Sometimes the allergens are very permeable, especially [with] acrylate allergies, and so even if a little bit penetrates through, they still could potentially react,” Brod says.
Corticosteroid creams and sprays are useful to clear up a rash, but they will only treat the symptoms. “It will calm the inflammation,” says Katta, who warns against using corticosteroids on the skin regularly. “With prolonged use, they can cause thinning of the skin and fragile skin in the areas they are used,” she says.
You’ll also want to be careful about using these anti-itch creams under adhesives. Trapped beneath an adhesive, a steroid cream may penetrate more deeply, increasing the risk for thinning of the skin, she says.
While people rarely stop using a device due to a rash, Head says she has seen it happen. “More often than not, we’ve been able to find workarounds,” she says. The trick? Ask your diabetes educator for a list of all the possible product and treatment options, then try each one until you find something that holds your device in place—without a skin reaction. “If that doesn’t work,” Head says, “we bring the patient in and make sure the technique is done correctly.”
If you’re allergic to or irritated by the adhesive on your CGM sensor or infusion set, there are several types of barrier products you can try to give your skin a little breathing room. Such products themselves can cause allergic reactions and irritation, however, so avoid them if your skin is sensitive, says Rajani Katta, MD, a skin irritation specialist and clinical assistant professor of medicine at Baylor College of Medicine in Houston, Texas. Among them:
Wipes and dressings: Barrier wipes add a layer of clear film to your skin that can stop irritating adhesives from causing a reaction. Some examples are Bard Protective Barrier Film, Skin Tac Barrier Wipe, and Bioclusive Transparent Film Dressing.
Pads: A physical bandage that contains a less-irritating adhesive is a good option, too. A popular pick is Johnson & Johnson’s Tough Pad.
Sprays: Anti-allergy products, such as Benadryl antihistamine spray, can be useful as a barrier that also calms the skin.
It’s a Mystery
Often diabetes device companies will respond to problems, such as adhesive irritation, by updating their formulas, says Bruce Brod, MD, president of the American Contact Dermatitis Society and clinical professor of dermatology at the University of Pennsylvania. But how can you know before you purchase a device whether you’ll be allergic to the adhesive? “There is not a lot of transparency in terms of listing specific chemical ingredients that are used in the adhesives in these devices, so it’s very hard to determine what’s causing an irritation or an allergic reaction,” he says.
He suggests calling the manufacturer’s toll-free number to speak with a representative. “It depends on the goodwill of the company as to whether they’re willing to disclose what’s in the device,” he says. Another option: Check with your diabetes educator, who may be able to provide a sample set or sensor for you to try out. Or see what the online diabetes community has to say—try community.diabetes.org.