Continuous glucose monitoring (CGM) and flash glucose monitoring (FGM) devices have been available for several years now. The Abbott Freestyle Libre system of all these devices has become the most popular. It’s ability to revolutionize the glucose management regime of diabetics by providing more common readings of glucose levels while eliminating or reducing the need for finger sticks has proved extremely beneficial and driven it growth worldwide.
As the number of users increase it is becoming clear from user surveys and groups that the frequency of skin problems experienced by users is shown to be as high as 50% .
Many skin problems are mild to moderate although a high number are shown to be severe. Severe skin injury and blistering has been demonstrated in Freestyle Libre users. There are even Facebook groups purely dedicated to the subject of Freestyle Libre and Dexcom rashes.
Skin damage due to the adhesive on Freestyle Libre (general medical adhesives and other glucose monitoring devices) is collectively known as MARSI (medial adhesive related skin injury).
A few mechanisms of damage that contribute to MARSI are:
Contact Dermatitis: Is inflamation of the skin. It results from either exposure to allergens (allergic contact dermatitis) or irritants (irritant contact dermatitis). Inflammation can be demonstrated as a warm, itchy area or even redness (erythema due to increased blood flow to an area).
A major contributor to contact dermatitis is Freestlye libre users is Acrylate. Acrylates present in many medical adhesives and some skin protection barriers such as Cavilon and Marathon have been shown to have reactions in over 30% of users.
Physical skin damage: Removing a harsh adhesive from the skin can cause the skin to tear or damage from the physical action of removal. It can result in a red, sore area where the adhesive was attached, but in some cases it can be more severe lifting several layers of skin with it and bleeding.
Folliculitis: is an inflammatory reaction in the hair follicles due to the presence of bacteria or fungal infection. This can happen when hair follicles are occluded or covered for a prolonged period.
Prevention of MARSI is therefore a major challenge for Freestlye Libre users and can be addressed in several ways.
Avoiding MARSI with CGM and FGM devices such as Freestyle Libre
- Change the adhesive on the Freestyle Libre with another adhesive that causes less or no reactions on your skin, but provides the performance and weartimes you require (up to 14 days). This method is not recommended as Medical device companies put a lot of time, money and effort into researching suitable medical grade adhesives that are backed by clinical safety data and have full tractability characteristics.
- Use a skin protection barrier. These can come in the form of thin films or barrier protection sprays/ liquids. It is advisable to use an ACRYLATE FREE skin protection barrier which will physically separate the skin from the medical adhesive.
- Use an adhesive remover when removing your device. Adhesive removers are specially formulated to remove medical adhesives from skin gently eliminating physical skin damage. While some people choose to use oils such as baby oil, these can be less effective and leave oily residues, which may affect application of the next device..
MD’s problems with Freestyle Libre MARSI
MD has been using the Freestyle Libre FGM for some time and during that period has experienced many MARSI related issues. MD has chosen to continue using Freestyle Libre despite the problems experienced due tot he benefits it offers to frequently monitor and more easily manage glucose levels.
Fig 1 is a milder MARSI problem that MD has experienced. Historically “Freestyle Libre rashes” for MD have been very severe.
MD has been searching for a sustainable solution that can limit the MARSI problems while still allowing continued use.
Fig 1- Left arm post sensor removal no skin barrier
MD’s Solution to Freestyle Libre erythema (MARSI)
Due to the on going and severe MARSI through with use of the Freestyle Libre sensor MD decided to use 2 methods to improve skin condition.
- Replace the sensor adhesive with a “double sided fashion tape” (again not recommended as such an adhesive is not tested or validated for use directly on skin). This did result in slightly less skin damage on sensor removal, however it was far from ideal as significant erythema was still present (see fig 1).
- Use a skin barrier film for protection of the skin under the sensor adhesive. Initially MD used a competitor skin barrier film, however the level of protection was not sufficient and still resulted in significant MARSI (see fig 2). MD then sampled and tried Trio Elisse skin Barrier film. This resulted in a significant improvement in skin condition upon sensor removal and the best quality of skin MD had since starting to use Freestyle Libre.
Fig 2 - Skin condition using a competitor skin barrier film following Freestyle Libre removal
Fig 3- Skin condition using Trio Elisse Barrier Film following Freestyle Libre removal
The best outcome for MD was to use Trio Elisse Barrier Film to prep and protect skin before application of the Freestyle Libre sensor. A significant reduction in MARSI can be clearly seen and it has allowed MD to continue using Freestyle Libre sensors which have made such a positive difference to MD’s diabetes management and quality of life (QOL).
Not all Skin Barrier Films are created equal
There are many skin barrier films available, with differing technologies and skin protection methods. What this dos result in is very differing levels of protection. Not obvious from product descriptions, but demonstrable from clinical use and evaluation in direct comparison.
Trio Elisse Barrier film is a unique blend of silicones that offer a unique level of skin protection and is the only barrier film to contain Zanthalene (an organic agent for soothing sore, red and damaged skin).