Electronic cigarette use (also known as vaping) is on the rise, according to the Centers for Disease Control (CDC). Data from the CDC’s National Health Interview Survey shows vaping increased from 4.5% in 2019 to 6.5% in 2023. While vaping is generally considered less harmful than traditional cigarette smoking, vaping is associated with acute lung injury and inflammation. Vapes contain cancer-causing chemicals, volatile organic compounds, and heavy metals. With only 20 years of use in the U.S., the full health impact of vaping is unknown.
A poster presented at the 2026 ODAC Dermatology conference titled “Vaping and Dermatologic Manifestations: A Scoping Review”
evaluated the dermatologic effects of vaping, including the impact to the oral mucosa. I interviewed poster author Julianna Gregory, BSN, of the Florida State University College of Medicine.
What led you to study the dermatologic effects of vaping?
This study was initiated in response to observations made during medical training, where there appeared to be a noticeable increase in the prevalence of vaping among students and young adults. While traditional cigarette smoking has become relatively uncommon within this population, the widespread use of electronic cigarettes and vaping products has emerged as a new and socially accepted behavior. This contrast was particularly striking and raised questions regarding the potential health implications of vaping, especially in comparison to the well-documented effects of conventional tobacco use.
Traditional cigarette smoking has long been associated with a range of dermatologic conditions, including impaired wound healing, premature skin aging, inflammatory dermatoses, and exacerbation of autoimmune skin diseases. Given these established associations, it was of interest to determine whether similar cutaneous effects had been reported in relation to vaping. Dermatologic findings often serve as early indicators of systemic or environmental exposures; however, existing reports of vaping-related skin manifestations appeared fragmented and largely limited to isolated case reports. The absence of a comprehensive synthesis of these findings motivated the development of a scoping review to systematically characterize the dermatologic effects of vaping and to assess the current scope of available evidence.
You conducted a broad review of research. What did you discover about the facial and oral impacts of vaping?
Facial and oral involvement emerged as the most commonly reported dermatologic manifestations associated with vaping. Oral findings included painful, persistent mucosal ulcerations that developed within months of initiating vaping, suggesting a direct irritant or cytotoxic effect of inhaled aerosols on the oral epithelium. These lesions were often refractory to standard symptomatic management and improved only after cessation of vaping, supporting a causal association.
Facial manifestations were most frequently characterized by irritant or allergic contact dermatitis affecting the lips, perioral skin, cheeks, and eyelids. In several cases, patch testing identified hypersensitivity reactions to metals such as nickel, which is known to be present in heating coils and other vaping device components. These findings suggest that repeated exposure to device-derived allergens and aerosolized particulates may contribute to cutaneous inflammation in exposed facial regions. Additionally, the review identified cases in which vaping appeared to exacerbate underlying inflammatory or autoimmune dermatologic conditions, including discoid lupus erythematosus involving the face. This raises concern that vaping-related oxidative stress or immune modulation may act as a trigger for disease flares in susceptible individuals.
Your research also uncovered the effects of vaping on other parts of the body, including the trunk and hands. What did you discover?
In addition to facial and oral involvement, the review identified dermatologic manifestations affecting the trunk, chest, neck, and extremities. Reported findings included urticarial eruptions characterized by transient, migratory erythematous plaques accompanied by pruritus. The diffuse distribution and episodic nature of these lesions suggest a systemic inflammatory or immunologic response to vaping-related exposures, rather than a purely localized irritant effect. These presentations raise the possibility that inhaled aerosolized substances may provoke generalized cutaneous hypersensitivity or immune activation.
Cutaneous involvement of the hands was also observed, particularly among individuals with frequent or prolonged contact with vaping devices. These cases most commonly presented as irritant or allergic contact dermatitis localized to areas of device handling. Repeated exposure to device components, heat generated during use, and residual e-liquid on device surfaces likely contributed to epidermal barrier disruption and subsequent sensitization. Together, these findings indicate that vaping may give rise to both localized contact-related dermatoses and more widespread cutaneous reactions mediated by systemic exposure, underscoring the multifaceted ways in which vaping can affect the skin.
In addition, your research found a case of skin effects after post-surgical use. What does that tell us?
One notable case described acute compromise of a surgical free flap occurring shortly after post-operative vaping, accompanied by a measurable decline in tissue oxygen saturation. This temporal association suggests that vaping may induce clinically significant vasoconstrictive effects, likely mediated by nicotine or other vasoactive substances present in vaping aerosols. Although the adverse impact of conventional cigarette smoking on wound healing and tissue perfusion is well established, this case demonstrates that vaping may pose comparable perioperative risks, despite being widely perceived as a safer alternative.
Importantly, this case also highlights a unique risk associated with vaping: its relative ease of concealment compared with traditional cigarette smoking. Vaping devices are smaller, produce less odor, and are more easily used discreetly, which may facilitate continued use even within hospital settings, as occurred in this case. This characteristic increases the risk of unintended perioperative exposure and may undermine standard smoking cessation protocols.
One of the studies in your research found dermatologic effects from a product that did not include nicotine. What does that tell us about the substances involved in vaping and their impacts?
The identification of dermatologic disease associated with a nicotine-free vaping product indicates that nicotine alone does not account for the cutaneous effects observed in individuals who vape. This finding suggests that other constituents of vaping products play an independent and clinically meaningful role in the development of skin pathology. These constituents include flavoring agents, carrier solvents such as propylene glycol and glycerin, thermal degradation byproducts generated during aerosolization, and materials derived from device components, including metals and silica-based wicks.
Many of these substances have the potential to function as cutaneous irritants, contact allergens, or immune-modulating agents. Through repeated exposure, they may disrupt the skin barrier, induce inflammatory cascades, or promote aberrant immune responses, leading to inflammatory or fibrotic dermatologic conditions. Importantly, these finding challenges the common perception that nicotine-free vaping products are inherently benign and underscores the complexity of vaping aerosols as mixtures of multiple bioactive compounds. It also highlights the need for further investigation into the dermatologic effects of non-nicotine constituents and device-related exposures, as well as greater clinical awareness that the absence of nicotine does not eliminate dermatologic risk.
What should dermatology clinicians take away from your research, and how should this affect patient care?
Dermatology clinicians should recognize vaping as a potential contributing factor in a wide spectrum of cutaneous and mucocutaneous conditions, including contact dermatitis, oral ulcerations, urticaria, exacerbations of autoimmune skin disease, and impaired wound healing. Accordingly, a comprehensive dermatologic history should routinely include detailed inquiry into vaping behaviors, including duration of use, frequency, device type, and e-liquid composition, in a manner analogous to traditional smoking histories.
Importantly, clinicians should be aware that adverse dermatologic effects may occur with both nicotine-containing and nicotine-free vaping products. In cases of unexplained, recurrent, or treatment-resistant dermatologic conditions—particularly those involving the face, hands, or oral mucosa—vaping-related exposure should be considered as a potential contributing factor, and cessation or modification of use may be warranted. These findings also underscore the importance of explicit perioperative counseling that includes vaping cessation, heightened inpatient monitoring, and consideration of vaping status when evaluating unexplained post-surgical complications. Collectively, the evidence supports approaching vaping with the same level of caution as conventional cigarette use in perioperative risk assessment and patient education.
Beyond individual patient encounters, this review highlights broader systemic and public health considerations. There is a clear need for standardized documentation of vaping behaviors within electronic medical record systems, as inconsistent or absent recording limits both clinical assessment and research efforts. Additionally, the literature revealed substantial international variability in regulations governing electronic nicotine delivery systems, including restrictions on device types and e-liquid constituents. This heterogeneity complicates both patient counseling and comparative research, and supports the need for more uniform regulatory frameworks.
This work was recently published and can be viewed here for those interested in reading more.
Additional authors of the poster include:
Abigail Watson, BS, Florida State University College of Medicine
Jessica Houpe, MD, Department of Dermatology, University of Central Florida/HCA Healthcare Dermatology Residency Program
Monica Constantinescu, MD, Florida State University College of Medicine and Florida State University Division of Micrographic Surgery and Dermatologic Oncology
Armand Cogentta, MD, Florida State University College of Medicine and Florida State University Division of Micrographic Surgery and Dermatologic Oncology