E-cigarette Dermatitis

Objective To review and synthesise the global evidence regarding the health effects of electronic cigarettes (e‐cigarettes, vapes). Study design Umbrella review (based on major independent reviews, including the 2018 United States National Academies of Sciences, Engineering, and Medicine [NASEM] report) and top‐up systematic review of published, peer‐reviewed studies in humans examining the relationship of e‐cigarette use to health outcomes published since the NASEM report. Data sources Umbrella review: eight major independent reviews published 2017–2021. Systematic review: PubMed, MEDLINE, Scopus, Web of Science, the Cochrane Library, and PsycINFO (articles published July 2017 – July 2020 and not included in NASEM review). Data synthesis Four hundred eligible publications were included in our synthesis: 112 from the NASEM review, 189 from our top‐up review search, and 99 further publications cited by other reviews. There is conclusive evidence linking e‐cigarette use with poisoning, immediate inhalation toxicity (including seizures), and e‐cigarette or vaping product use‐associated lung injury (EVALI; largely but not exclusively for e‐liquids containing tetrahydrocannabinol and vitamin E acetate), as well as for malfunctioning devices causing injuries and burns. Environmental effects include waste, fires, and generation of indoor airborne particulate matter (substantial to conclusive evidence). There is substantial evidence that nicotine e‐cigarettes can cause dependence or addiction in non‐smokers, and strong evidence that young non‐smokers who use e‐cigarettes are more likely than non‐users to initiate smoking and to become regular smokers. There is limited evidence that freebase nicotine e‐cigarettes used with clinical support are efficacious aids for smoking cessation. Evidence regarding effects on other clinical outcomes, including cardiovascular disease, cancer, development, and mental and reproductive health, is insufficient or unavailable. Conclusion E‐cigarettes can be harmful to health, particularly for non‐smokers and children, adolescents, and young adults. Their effects on many important health outcomes are uncertain. E‐cigarettes may be beneficial for smokers who use them to completely and promptly quit smoking, but they are not currently approved smoking cessation aids. Better quality evidence is needed regarding the health impact of e‐cigarette use, their safety and efficacy for smoking cessation, and effective regulation. Registration Systematic review: PROSPERO, CRD42020200673 (prospective).

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“…Three otherwise eligible studies were excluded because of low quality scores. [20][21][22] Integrated data analysis…”

Section: Risk Of Bias Assessmentmentioning

confidence: 99%

Electronic cigarettes and health outcomes: umbrella and systematic review of the global evidence

Banks

Yazidjoglou

Brown

et al. 2023

Medical Journal of Australia

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“…Four publications presenting 5 cases of allergic contact dermatitis to nickel were identified [170][171][172][173]. Majority of patients were female (3/5), in their late 30s or early 50s.…”

Section: Allergymentioning

confidence: 99%

A Systematic Literature Review of E-Cigarette-Related Illness and Injury: Not Just for the Respirologist

Tzortzi

Kapetanstrataki

Evangelopoulou

et al. 2020

IJERPH

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Following the recent electronic cigarette (e-cigarette) illness outbreak, the current review aimed to collect all related clinical cases for study and analysis and provide a critical synopsis of the proposed injury mechanism. Adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines, e-cigarette-related clinical cases were identified via Google Scholar and PubMed databases. Additionally, references of published case reports and previous review papers were manually searched, revealing 159 publications presenting e-cigarette-related case reports and 19 reports by the Centers for Disease Control and Prevention. 238 individual cases were identified; 53% traumatic injuries due to e-cigarette explosion or self-combustion, 24% respiratory cases, and 12% poisonings. Additional cases pertained to oral, cardiovascular, immunologic, hematologic, allergic reactions, infant complications, and altered medication levels. Case reports were mainly published between 2016–2019 (78%). The oldest case, a lipoid pneumonia, was published in 2012. The current review showed that e-cigarette-related health effects extend beyond the acute lung injury syndrome, including traumatic, thermal injuries and acute intoxications. Physicians should be aware of the distinct clinical presentations and be trained to respond and treat effectively. Regulators and public health authorities should address the regulatory gap regarding electronic nicotine delivery systems (ENDS) and novel tobacco products.

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“…Reports of contact dermatitis to e-cigarette or e-liquid products have been documented, but almost all were to nickel present in the devices themselves (Table 2). [21][22][23][24][25] Without full ingredient lists on product labels, finding formaldehyde-free e-liquid products can be challenging. We found 12 e-liquid products that did not contain formaldehyde (Table 1).…”

Section: Discussionmentioning

confidence: 99%

Formaldehyde in Electronic Cigarette Liquid (Aerosolized Liquid)

et al. 2022

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Background: Aerosolized liquid (e-liquid) of electronic cigarettes can be toxic. Beyond the solvent (propylene glycol, vegetable glycerin) and nicotine, little is known about the liquid composition. Formaldehyde, a carcinogen and source of contact dermatitis, has been reported in the vaporized e-liquid, but no studies have assessed the actual e-liquid.Objective: The aim of the study was to evaluate e-liquid products for the presence of formaldehyde.Methods: Sixteen e-liquid products were purchased and analyzed for the release of formaldehyde using the chromotropic acid method of detection.Results: Of the 16 e-liquids purchased, 4 (25%) were positive for the presence of formaldehyde; 2 were flavored and 2 were nonflavored. All positive e-liquids were in pods or disposable electronic cigarette devices, and 2 were purchased from local vape shops. The average nicotine content in the positive e-liquids was 3.85% versus 4.03% in the negative e-liquids.Conclusions: The e-liquid products contain toxic chemicals not declared on product labels, as shown in this study with 25.0% of e-liquids containing formaldehyde. All positive e-liquids were within pods or disposable devices. Continued analysis of e-liquids and increased product regulation are needed.E lectronic cigarettes, or e-cigarettes, are battery-powered nicotine delivery systems. Aerosolized liquid (e-liquid) contains nicotine, solvents (propylene glycol, vegetable glycerin), flavors, and other additives. 1 There are various types of e-liquid products. Prefilled cartridges, including tanks and pods, are heat-resistant devices inserted into rechargeable e-cigarette devices. Disposable devices are nonreusable e-cigarettes that are discarded once the e-liquid is consumed. Refillable bottles are e-liquid products that can be used to refill e-cigarette devices or pod cartridges (Fig. 1). 2,3 Besides the solvent and nicotine, little is known about the flavorings and other additives contained within e-liquid products. 1 Product labels rarely provide detailed ingredient lists, and this information is not declared on e-liquid manufacturers' websites. In addition, there are no standardized e-liquid manufacturing guidelines, and quality can vary considerably across vendors. 4 Although tobacco manufacturers are required to comply with the Federal Food Drug and Cosmetic Act and to submit a listing of their ingredients to the US Food and Drug Administration, this information is not publicly available; when contacted directly, e-liquid vendors state that the ingredients are "proprietary information."

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E-cigarette Dermatitis

Cited by 4 publications

References 4 publications

Electronic cigarettes and health outcomes: umbrella and systematic review of the global evidence

Electronic cigarettes and health outcomes: umbrella and systematic review of the global evidence

A Systematic Literature Review of E-Cigarette-Related Illness and Injury: Not Just for the Respirologist

Formaldehyde in Electronic Cigarette Liquid (Aerosolized Liquid)

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