The realisation came to Charlotte Priest through a cloud of raspberry vape smoke. In spring 2021, the circumference of her mouth started to develop red lesions, which soon spread to her eyes, nose and cheeks. Before long her entire face was plagued with the scaly demarcations, which arrived out of the blue after years of clear skin. Her GP was bewildered. He prescribed her a course of antibiotics for a vague, suspected 'viral infection' but they only further dried out her skin.
"I went back to the doctor after taking the antibiotics and told him that nothing had changed. He said just to leave my skin alone," Priest tells Refinery29 from her home in Derbyshire. "Then I got COVID-19 and because I lived with my family, I didn’t leave my room to protect them. I didn’t vape for the days that I was testing positive and instantly my skin improved. When I started again, it sort of came back — and that’s when I realised that it must be to do with vaping."
For a while now it’s been hard to move without drowning in a cloud of fruit-scented nicotine. Vice dubbed 2022 "The Year Of The Vape" and, according to a recent report, an estimated 4.3 million adults in Britain now use e-cigarettes (vapes), up from about 800,000 a decade ago. The current market leader, Elf Bars, sells 2.5 million in the UK every week. Vapes, which have been touted as a 'healthier' alternative to cigarettes, work by heating nicotine, flavourings and other chemicals, including known carcinogens acetaldehyde and formaldehyde, to create an aerosol that you inhale. The e-cigarettes that we know today were invented in Beijing in 2003 by Chinese pharmacist Hon Lik, who developed the device as an alternative to conventional smoking after his father died of smoking-related illnesses.
But all is not as it seems. A report released by Harvard University last year, which centred on four patients with chronic lung disease, found that e-cigarette use was the most likely cause. Other studies have unearthed corroborating evidence of the damage vapes are doing to our lungs, hearts and even our immune systems.
Researchers found an increase in the number of contact dermatitis cases associated with vape use. A study concluded that there is 'early evidence [e-cigarettes] are harmful to human skin'.
Priest had been casually vaping for a few years; at the pub, on her way to work, after an evening meal to unwind. It was after she started to vape more regularly that the 23-year-old’s eczema-prone skin began to flare for "the first time in years". A deep dive on the internet reinforced her suspicions: in addition to the overall health risks, vaping, much like smoking cigarettes, is reported to damage the skin. A study published in the Journal of the American Academy of Dermatology in 2019 reviewed all relevant literature on dermatologic conditions associated with the use of e-cigarettes, namely contact dermatitis [a type of eczema, often the result of contact with a particular substance], burns and oral lesions. Researchers found an increase in the number of contact dermatitis cases associated with vape use. The study concluded that there is "early evidence [e-cigarettes] are harmful to human skin".
"Both cigarettes and e-cigarettes contain thousands of chemicals, which cause damage and inflammation when they’re inhaled and exhaled, particularly to the layers of the skin," says Dr Parisha Acharya, an aesthetic doctor at London’s Waterhouse Young Clinic. "This external smoke targets the prime receptor in the skin, which is involved in ageing. All kinds of pollutants will target the skin once the barrier is damaged, but we know that these chemicals are particularly harmful in terms of pigmentation, premature ageing, deep wrinkles and worsening existing skin conditions such as eczema." Many of the liquids used in vapes also contain propylene glycol, a synthetic food additive that’s a known (albeit uncommon) skin allergen.
Dr Emma Wedgeworth, consultant dermatologist and British Skin Foundation spokesperson, also notes that burns have been reported due to the heat of the lithium batteries in vapes. She adds: "Nickel, which is one of the most common causes of contact dermatitis, is present in the heating coils of vapes and has been reported to cause redness and itching on hands."
Priest is not alone in her dermatological reaction to vaping. Six months after starting to use disposable vapes regularly, London-based Rachel Aduya, 22, found that her face became increasingly itchy, irritated and sensitive. "My face was so sore, I found that I couldn’t use any of my usual skincare products on it without it burning up," Aduya says. "Thinking it was eczema, I tried everything to calm it down before finding videos on TikTok of people having experienced the same thing on their faces after vaping."
Because widespread use of e-cigarettes is relatively recent, our collective knowledge pertaining to their long-term health effects is limited.
Aduya took a short vape hiatus, easing her transition with nicotine gum, to see if kicking the habit would help her skin heal. Within a matter of months, her complexion was back to normal; red rashes on her face had disappeared. She has now encouraged friends, whose skin has similarly worsened since becoming regular vapers, to give up e-cigarettes, although immediate improvements aren’t guaranteed. "It takes a while for the skin to renew itself," says Dr Acharya. "I’d normally say that it will take several of those skin cycles for you to start seeing visible changes within the skin. A normal skin cycle can be anything between three to six months."
The most concerning part of the overall impact of vaping for both Dr Wedgeworth and Dr Acharya, the latter of whom has noticed a spike in oral lesions among her patients who vape, is that because widespread use of e-cigarettes is relatively recent, our collective knowledge pertaining to their long-term health effects is limited.
"Tobacco has been around for hundreds of years so research into its effects is extensive, but vapes are only 20 years old, which means we know far less about the impact they’re actually having on us," Dr Acharya says. "From a medical perspective, there is a belief that getting people off cigarettes by vaping is the best route because they still get some sort of nicotine fix. But actually, I would say both are equally bad for you and we shouldn't be choosing one over the other as a healthier alternative."
Priest still vapes socially but is selective about how often and where she does it (she says she finds that vaping outdoors causes her skin to react less). "It’s become such a social thing in my friendship group that it’s hard to properly give it up," she says, "but doing it far less has changed my skin completely."
For those who are struggling to wean themselves off vapes, Dr Acharya’s guidance is clear. "Smokers' general skin concern tends to be that they notice that their skin is dry, dehydrated and dull," she says. "If you can use a nicotine substitute like gum to kick the habit, then your skin’s barrier function will eventually begin to return to normal, which will help your skin cells to renew once again. Just give it time."