At the time of writing, the family have returned from our annual summer holiday on the Continent. A lovely relaxing time was had by all. What was also a pleasant surprise was the lack of cigarette smokers and the lack of the often-found detritus of cigarette butts that litter the pavements of Continental Europe. However, we did remark upon the rise of the e-cigarette. And e-cigarettes or vapers were, quite literally, everywhere.
There is still debate about the safety of electronic cigarettes; the exponential rise in their use and the associated benefit of reduced smoking of traditional cigarettes versus the safety and addictiveness of inhaling nicotine plus all the other ingredients in vaping liquid.
What has this got to do with dermatology?
It was also then interesting to read a case report in the August edition of Clinical and Experimental Dermatology journal highlighting a case of contact allergy to electronic cigarettes.
[Ormerod E and Stone N. Contact allergy and electronic cigarettes (and eyelash curlers) Clin Exp Derm 2017; 42: 682-3.]
What did it show?
The patient had a mild hand dermatitis on her dominant (right) hand. She also had facial, lip and eyelid swelling, itching and redness. She reported using metal eyelash curlers every now and again and metal e-cigarettes around the time of onset of the rash. She also reported a history of reactions to costume jewellery and belt buckles.
So is this a reaction to all electronic cigarettes?
No, this case highlights that electronic cigarettes (and metal eyelash curlers) can be potential sources of nickel release. Nickel is also commonly found in costume jewellery, belt buckles, the reverse side of watch faces and the arms of certain metal-rimmed glasses as any nickel allergic person will tell you.
How can you find out if you are nickel allergic?
Cutaneous patch testing should reveal this easily enough. Indeed, in this case, the patient was confirmed to have a strong positive reaction to nickel on patch testing. She was also found to be allergic to two other chemicals.
She wasn’t allergic to the vaping fluid?
As the ingredients in vaping fluid are often not fully disclosed, it is always a possibility but no, these two other chemicals were not found to be contained within the vaping fluid nor the flavourings in the vaping fluid in the type of e-cigarette she used.
Is it common to get a reaction to electronic cigarettes?
Well, this case report is only the second reported case of nickel allergy to an e-cigarette. The first case was reported in 2015 and again presented with a contact dermatitis of the thumb and index finger of the right (dominant) hand. The authors of the 2015 paper tested 11 different types of e-cigarette and 3 of these 11 were found to contain nickel.
[Maridet C, Atge B, Amici JM et al. The electronic cigarette: the new source of nickel contact allergy of the 21st century? Contact Dermat 2015; 73: 49-50.]
However, as the use of e-cigarettes continues to rise, more cases are sure to be reported as the link becomes increasingly recognised.
How do you stop getting the reaction?
Irrespective of the wider argument, if you were found to be allergic to nickel and were using a metal e-cigarette, the advice would be to avoid using it. Indeed, the case mentioned above improved with 2 months avoidance of both her metal e-cigarette (and her eyelash curlers)! Obviously, the diagnosis doesn’t prevent you from using other e-cigarettes, just make sure they are not metal ones!
Dr Sandy Flann, Consultant Dermatologist.