E-cigarette burns: a new age

Dr Thomas Whitton1, Dr Rory Middleton1, Dr Jennifer Martins1

1Department of Plastic and Reconstructive Surgery, Royal Hobart Hospital, Hobart, Australia


Background: E-cigarettes (commonly known as vapes) are an emerging technology worldwide used to deliver a vaporised nicotine solution to be inhaled by the user.  Although their sale is illegal in Australia, their use is rapidly increasing.  A survey in 2016 revealed that 9% of Australian adults have used an e-cigarette, a doubling in use since 2013.  Overseas centres are observing increasing frequency of burns caused by e-cigarettes.  Faulty e-cigarettes cause flame, thermal, blast and alkali burns, usually due to exploding lithium-ion batteries, and also have the potential to cause inhalation injuries, deep-dermal and full-thickness burns.

Method: A literature review was performed through PubMed to identify articles that contained data regarding acute burn injuries caused by the use of e-cigarettes.

Results:  Burns from e-cigarettes most frequently occur in young males.  The upper and lower limbs were most commonly affected, followed by groin, genitalia and face.  The average surface area recorded was 4%, with most burns being mid-deep dermal or full-thickness, and on average, one third of cases required surgical management.  There are no agreed guidelines for the management of e-cigarettes, however following an initial systematic trauma assessment, a thorough assessment of the burn injury should be undertaken, including investigating for a chemical component with pH testing.  Appropriate initial management involves thorough irrigation with water, unless an alkali component is identified, then mineral oil should be used.  Surgical debridement and grafting may be required depending on the burn severity.

Conclusion:  There have only been a small number of burns caused by e-cigarettes reported in Australian burns centres, it is likely that we will see more presentations with burns secondary to their increased usage.  Further understanding of the mechanisms of these burns will facilitate better management.  Furthermore, increased education about the dangers of e-cigarettes is required to aid in prevention of these injuries.

References: 1) Serror K et al. 2018. ‘Burns caused by electronic vaping devices (e-cigarettes): A new classification proposal based on mechanisms.  Burns 44(3): 544-548.


Tom Whitton is a RMO at the Royal Hobart Hospital with an interest in surgery, including plastic and burns surgery.

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