E-Cigarette Exposure May Increase Risk of Atopic Dermatitis in Children

Parental e-cigarette use may be associated with increased risk of pediatric atopic dermatitis (AD) due to secondhand smoke exposure, according to findings published in JAMA Dermatology. The potential connection offers additional lifestyle modifications that can be made by parents to help mitigate the symptoms associated with pediatric AD and inform those who are unknowingly increasing their children’s risk of developing AD.

As e-cigarette usage becomes more prevalent, it is crucial for parents to be aware of the potential hazards that secondhand smoke poses to their children's skin health. Image Credit: © Piman Khrutmuang - stock.adobe.com

AD, a form of eczema, is a chronic skin condition that often begins in infancy and is characterized by constant itchy, inflamed, and dry skin. Children with AD typically have very sensitive skin and may be irritated more easily by sweating, heat, rough clothing, and some detergents, soaps, or cleansers with harsh chemicals or fragrances. In some cases, children may develop allergies to specific ingredients typically found in moisturizers or topical medications. It is also common for children with AD to have allergies to foods, animals, dust mites, and environmental allergens like pollen, although the association between AD and allergies is unclear.¹

Pediatric AD is typically controlled through good skin care practices, which may involve topical medications, moisturizers, baths, and antihistamines, as well as lifestyle modifications to mitigate flares or discomfort. When left untreated, children with AD are at higher risk of skin infections due to frequent scratching. Environmental factors, such as exposure to pet dander, dust mites, cigarette smoke, and potentially secondhand e-cigarette smoke, can increase the risk of worsening symptoms, as well as the possibility of developing AD in childhood.¹

The researchers conducted a retrospective, cross-sectional analysis of the 2014 to 2018 National Health Interview Survey (NHIS) to determine a possible association between e-cigarettes and risk of AD as use of e-cigarettes becomes more prevalent. The study builds on previous investigations of household secondhand tobacco smoke (SHS) and AD in adolescence, which have found positive associations between household, as well as environmental, SHS exposure and cases of AD in children.^2-4

The study utilized information collected from the NHIS, a face-to-face, nationally representative survey of approximately 35,000 households, which is conducted annually by the CDC. For the survey, the CDC chooses a child younger than 18 from each included household, as well as the adult caregiver for additional questions. To ascertain cases of pediatric AD, the survey included questions such as: “During the past 12 months, has [name] had … eczema or any kind of skin allergy?” Parental e-cigarette use was defined with the question, “Have you ever used an e-cigarette even 1 time?” and history of use was determined by matching children to the adult respondent from their household.²

The results showed that of 48,637,111 individuals (mean age, 8.4 years [95% CI, 8.3-8.4] years), 6,54,515 (mean age, 8.0 years [95% CI, 7.8-8.1 years]) indicated a history of AD (13.1% [95% CI, 12.6%-14.0%). The prevalence of parental e-cigarette use was 14.4% (95% CI, 13.9%-15.0%) in the non-AD population and 18.0% (95% CI, 16.5%-19.0%) in the AD population. On multivariable analysis adjusted for asthma, allergic rhinitis, respiratory allergies, parental smoking history, and sociodemographic factors, children with parental e-cigarette use had higher odds of AD (adjusted odds ratio [aOR], 1.24 [95% CI, 1.08-1.42]).²

The findings suggest a positive correlation between parental use of e-cigarettes, exposure to secondhand smoke, and increased risk of developing pediatric AD. The researchers speculate that the association is due to inflammatory states caused by e-cigarettes, which is evidenced by in vitro studies that demonstrate increased oxidative stress in human keratinocytes and 3-dimensional skin models exposed to e-cigarette fluids and aerosol residues.²

As e-cigarette usage becomes more prevalent, it is crucial for parents to be aware of the potential hazards that secondhand smoke poses to their children's skin health. By making informed lifestyle changes, parents can significantly reduce their children's risk of developing or exacerbating pediatric AD, thereby fostering better overall health outcomes.

References

1. Eczema. Cincinnati Children’s Hospital. September 2021. Accessed June 17, 2024. https://www.cincinnatichildrens.org/health/e/eczema#:~:text=Children%20with%20atopic%20dermatitis%20may%20have%20allergies%20to%20foods%2C%20pets,the%20eczema%20in%20most%20children

2. Youn GM, Sarin KY, Chiou AS, et al. Parental e-cigarette use and pediatric atopic dermatitis. JAMA Dermatol. May 22, 2024. doi:10.1001/jamadermatol.2024.1283

3. Akhtar S, Al-Shanfari S, Booalayan H, et al. Exposure to household secondhand tobacco smoke and the odds of developing atopic dermatitis among adolescents: A causal mediation analysis. Tob Induc Dis. February 1, 2024. doi:10.18332/tid/176967

4. Kim J, Lee E, Lee K, et al. Relationships between secondhand smoke incursion and wheeze, rhinitis, and eczema symptoms in children living in homes without smokers in multi-unit housing, Nicotine & Tobacco Research. March 6, 2018. doi: 10.1093/ntr/nty027