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E-cigarettes harmful alternative to tobacco regarding dermatological issues

Researchers explored the skin-related conditions associated with electronic cigarette use in a literature review and concluded that e-cigarettes are not safe alternatives to traditional tobacco cigarettes in developing dermatological issues.

All studies involving the effects of e-cigarette use on the skin or mucosa were obtained and reviewed after a PubMed database search.

Increased reports of contact dermatitis secondary to e-cigarette use have been reported, which is secondary to the release of nickel from the heating coil in the devices, according to researchers.

The coil is used to vaporize the liquid into an aerosol for inhalation and the nickel is transmitted through the device, which may irritate the dominant hand used to hold the e-cigarette.

Researchers reported a positive reaction on dimethyl glyoxime (DMG) nickel spot test. The team then analyzed multiple e-cigarette devices and found four devices testing positive on DMG history of allergic reaction to nickel.

The patient developed an erythematous itching rash to her dominant hand as well as erythema and swelling of the lips.

Thermal injury can also result from the battery temperature rising to an extent that it results in a fire and/or explosion due to poor product design, manufacturing failures and the use of low-quality materials in the production of the batteries leading to a lack of internal thermal regulation, according to researchers.

The common burn locations were reported on the thighs, lower legs, head, hands and genitalia.

Between 2015 and 2017, it was estimated that 2,035 cases of explosions and burns from e-cigarettes presented to U.S. EDs, which represents more than 40 times the number reported by the FDA from 2009 to 2015, they wrote.

Out of 30 cases of cutaneous burns, almost all patients required hospital administration and nine patients required surgery as a result of their injuries.

The devices were primarily being carried idle on personal attire at the time of explosion, according to researchers.

Additionally, a significantly increased prevalence of nicotine stomatitis was reported in e-cigarette users compared with former smokers.

Researchers also found a statistically significant increased prevalence of hyperplastic candidiasis — caused by an overgrowth of Candida species in the oral cavity — in e-cigarette consumers.

“Black hairy tongue, or lingua villosa nigra, is a benign, asymptomatic condition involving two pathological components: elongation of filiform papillae secondary to lack of desquamation on the dorsal aspect of the tongue, and discoloration of the tongue as a result of an altered oral environment leading to the growth of porphyrin-producing chromogenic bacteria or yeast,” researchers wrote.

Multiple findings demonstrate a statistically significant greater prevalence of black hairy tongue (BHT) in e-cigarette consumers compared with former smokers.

They propose the increased prevalence may be due to smoking-associated pH changes, mucosal drying effects, high intraoral temperatures, local alteration of membrane barriers and immune responses, or altered resistance to fungal and viral infections.

Researchers suggest conducting a thorough social history when encountering BHT.

In previous research, “exposure to e-cigarette smoke has shown to reduce cell viability, change ultrastructure and induce the release of proinflammatory cytokines in human keratinocytes,” they wrote.

Additional studies should investigate the dermatological manifestations in e-cigarette use. – by Abigail Sutton

Disclosures: The authors report no relevant financial disclosures.