Burns on the face, arms and hands that require skin grafts. Acne boils and ugly rashes. Black hairy tongue and other oral lesions.

These are some of the ways that vaping can do serious damage to someone’s skin, a new evidence review shows.

For example, an estimated 2,035 people with electronic cigarette burn injuries were treated in U.S. emergency rooms between 2015 and 2017, more than 40 times the number of vaping burns reported between 2009 and 2015, researchers found.

Faulty or malfunctioning e-cigarettes can overheat and either explode or burn to the touch, said senior study author Dr. Kurt Ashack, a dermatology resident with the University of Illinois at Chicago.

“It could cause a pretty significant burn, where you lose at least the top layer of skin, if not more,” he said. Device explosions also have caused people to lose teeth, the findings showed.

The chemicals contained in vaping devices have also been shown to cause skin problems in some users, Ashack added.

Some people are allergic to the propylene glycol that is used as the base for most e-liquids, Ashack said. Those folks could develop a rash from exposure.

The nickel contained in the device’s heating element also can cause a rash, the researchers said. Cases include a woman with nickel allergy who developed a rash on her dominant hand and swelling of the lips. Others developed scaly rashes on their hands and face from nickel exposure.

The nicotine contained in e-cigarettes also isn’t doing the skin any favors either, said Dr. Jill Waibel, a dermatologist in Miami.

“We know nicotine and all the other chemicals break down collagen and elastin,” two important components of healthy skin, Waibel said. “We’ve known for almost a decade that people who smoke have premature wrinkles and aging.”

Nicotine also has been known to increase the risk of skin cancer and slow your skin’s ability to heal wounds, she added.

“Every surgeon will tell you if you have a major surgery, if you smoke your skin won’t heal,” Waibel said.

The vapor being inhaled also can predispose the mouth to an array of oral lesions, the researchers reported.

“That’s usually due to e-cigarettes decreasing the immune response in the mouth, which can lead to an overgrowth of bacteria and yeast,” Ashack explained.

These include a condition called black hairy tongue, in which the tongue takes on a dark and furry appearance because dead cells discolored by germs have built up. One study found that e-cigarette users suffer from black hairy tongue more often than cigarette smokers, the researchers noted.

E-cigarette users also have been known to develop lacy white patches on the gums, tongue or insides of the cheeks, a condition called an oral lichenoid reaction, according to the report. Oral thrush also can develop in vapers, caused by an overgrowth of Candida yeast in the mouth.

Research is continuing on these effects, but those efforts have been hampered by the lack of U.S. Food and Drug Administration regulation on e-cigarettes, Ashack said.

“We don’t even know what the chemicals of certain flavors are,” Ashack said. “We don’t really know what’s in there.”

Until more is known, people should avoid vaping, Waibel said. People who are quitting traditional smoking should try other nicotine replacements that have been proven safe, she advised.

“Initially, the thought was that e-cigarettes are going to help people quit. I think the data now show that people who use e-cigarettes are still smoking regular cigarettes,” Waibel said. “If that was the goal, I don’t think it’s actually happened.”

The review was published recently in the Journal of the American Academy of Dermatology.

More information

The U.S. Centers for Disease Control and Prevention has more about e-cigarettes.