Cromolyn sodium for insulin-induced lipoatrophy: old drug, new use.

Local insulin-induced lipoatrophy, an immune-mediated loss of subcutaneous adipose tissue at insulin administration sites, is now a rare complication of insulin therapy in patients with diabetes. Lipoatrophy incidence, previously noted in 10–55% of patients using animal-derived insulins (1), declined considerably with the advent of and improved purity of modern insulins. Yet, it continues to be reported with insulin analogs (2,3) and poses a clinical challenge owing to erratic insulin absorption at affected areas and distressing cosmetic issues. We previously demonstrated increased degranulating tryptase/chymase-positive mast cells in biopsies from insulin-induced lipoatrophic sites and reported that topical cromolyn sodium (prepared with 4% cromolyn sodium in petrolatum solvent for topical administration twice daily to affected areas) was efficacious therapy in a small series (4). Since this report, we were contacted by 34 health care providers, caregivers, and patients worldwide, to whom we administered surveys to …