持続皮下インスリン注入療法（CSII）を行う糖尿病をもつ小児の皮膚トラブルの実態

Investigation of skin trouble in children with diabetes using continuous subcutaneous insulin infusion (CSII)

　持続皮下インスリン注入療法（CSII）は小児においてもその有効性が認められ，導入する者が増えてきているが，小児のCSIIトラブルの実態は明らかになっていない．そこで，CSII実施中の小児の皮膚症状を観察し皮膚トラブルの実態を明らかにすることを目的とした．ケア方法や症状について，本人及び保護者より聴取し，穿刺部周囲の角質水分量と，サーモグラフィで皮膚温度，エコーで表皮から皮下組織までの厚さを計測した．所属施設の倫理審査委員会の承認を得て実施した．CSII実施中の小児8名を対象に10−11月（平均気温14.4℃，平均湿度74.5％であった時期）に調査を行った．テープかぶれやかゆみが多く観察され，かぶれがある群では角質水分量が有意に低いことが明らかになった（p=0.002）．また，高温多湿の時期には硬結や発赤，膿みがあったことが聴取から明らかになった．以上のことより，季節により皮膚トラブルの種類が異なり，ケア方法も変える必要がある可能性が示唆された．

　Continuous subcutaneous insulin infusion (CSII) has shown its effectiveness in children, and the number of users are increasing. However, the actual situation of CSII troubles in children has not been clarified. Therefore, we aimed to clarify the actual condition of the skin troubles observing the skin manifestation of the child undergoing CSII in this study. Interviews were conducted with individuals and guardians regarding care methods and symptoms. The stratum corneum hydration around the puncture site, the thickness of the subcutaneous tissue by ultrasound and skin temperature on thermography were measured. When wounds were present, photographs were taken, and the size was measured by image analysis. This survey was approved by the Ethical Review Board of the affiliated institution. Eight children undergoing CSII were participated in this study. This survey was conducted in October to November (the average temperature was 14.4℃ and the average humidity was 74.5%); it was revealed that tape-rash and itch were observed. The stratum corneum hydration was significantly lower in the group with rash (p=0.002). In addition, it was clarified from the interview that there was induration, redness and pus in hot and humid season. Therefore, it was indicated that the type of skin trouble depends on the season, and that the care method needs to be changed.