JEADV
DOI: 10.1111/jdv.12984
REVIEW ARTICLE
Water pipe smoking and dermatologic consequences U. Wollina* Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany *Correspondence: U. Wollina. E-mail: [email protected]
Abstract Water pipe smoking is a recently growing addiction worldwide. It has become popular in Africa and the Western World and enfaces a renaissance in Middle East and Asia. The smoking technique leads to a different exposure to potential hazardous compounds compared to cigarette or classical pipe smoking. The common assumption that water pipe smoking is less dangerous to health is not substantiated by scientific data. Non-tobacco-based preparations reduce the exposure to nicotine but may contain equal or even higher concentrations of other toxic compounds. The medical literature on adverse effect of water pipe smoking on skin and oral mucosa is reviewed but future research is a demand. Received: 21 November 2014; Accepted: 24 December 2014
Conflicts of interests None declared.
Funding sources None declared.
Introduction Water pipe smoking after a decline in the 80’s of the last century has seen a renaissance in Arab countries and has become a fashion in Western World and Africa with a tremendous increase in users among young adults. The majority of them are males.1–4 In Germany, the lifetime prevalence of water pipe smoking among young adults has reached almost 70%.5 The prevalence of water pipe smoking in the USA is about 40%.6
The instrument and the basic technique Although the water pipe (nargil, narghile, arghila, argil, sheesha, shisha, hooka, huqqa, goza, guza, qalyan, hubble-bubble, lula, cachimba, chillum) may be present in different types and sizes, the basic construct is comprised of a bowl at the top (head) often with a windshield, a body, a hose with a mouthpiece and a water bowl at the base of the instrument filled half with water (and sometimes other fluids) (Fig. 1). Tobacco (mixture – mu’assel, pure tobacco paste – tumbak or ajami, tobacco with fruits and oils - jumbak) is burnt on the top bowl by coal embers. Suction through the mouthpiece draws the smoke through the water in the water bowl and then into the mouth and lungs of the smoker.7 Water pipe smoking is usually practised in groups sharing the pipe in a session of about an hour or more. In some countries smoking is performed in cafes, while in others shisha lounges have spread.1,7
JEADV 2015, 29, 1481–1484
Water pipe smoking is not less harmful than cigarette smoking Although there is a common belief among water pipe users that water pipes are less harmful than cigarette smoking, this has not been substantiated by any scientific data.8 Exposure to nicotine, heavy metals, cancerous nitrosamines, polycyclic aromatic hydrocarbons, mercapturic acid metabolites and radioactive isotopes is significiant.9,10 The exposure to nicotine is comparable to cigarette smoking but the exposure time is significantly longer leading to an 1.7 fold increase in the nicotine dose. Humectants lice glycerine and 1,2-propanediol increase the formation of smoke.11 The burning temperature of tobacco in water pipes is usually around 200 to 450 degree Celsius or less compared to 900 degree Celsius in cigarette smoking. The exposure to water pipe smoke on average is about ten times higher.12,13 The water pipe produces less smoke than the cigarette but it is not smokeless. The particle size after bubbling is about the same as of cigarette smoking, but the inhaled amount is higher.14 The chemical characterization of water pipe smoke versus cigarette smoking is summarized in Table 1. Therefore, diseases usually associated with cigarette smoking can also be seen with water pipe smoking, including chronic obstructive pulmonary disease, cardiovascular diseases and cancer.4,15,16 Maternal water pipe smoking increases infant mortality with an odds ratio of 3.09 compared to 2.54 for cigarette smoking. Another risk is low birthweight of the newborn.17
© 2015 European Academy of Dermatology and Venereology
Wollina
1482
(a)
(b)
Figure 1 Modern water pipe (hooka).
Table 1 Chemical characterization of water pipe smoke (WPS) compared to cigarette smoke (CS) Chemical compounds
WPS
CS 155 49
CO (mg)
2269 108 1.04 0.3
Nicotine (tobacco based preparation) (mg) Heavy metals (As, Cr, Ni, Pb)*
65.5 5.5 0.73
Higher or equal to CS 1193 226
Polycyclic aromatic hydrocarbons (mg) Tar (mg)* Volatile aldehydes (lg)
12
446–513 12 000 1610
Figure 2 Transmission of infections. (a) Aspergillus niger infection of the upper lip. (b) Herpes labialis.
References 33 34 33
35 305 49
34
9.4
33
2954 416
34
*Non-tobacco-based preparations may contain higher concentrations than tobacco-based preparations.
Acute toxicity Depending on the size of the water pipe carbon monoxide (CO) levels may vary considerably. Smaller pipes bear a greater risk of CO intoxication because they may produce about ten times the CO concentration of cigarette smoking. Another important variable is the time of consumption.18–20 Inhaled CO leads to CO– haemoglobin formation. Unconsciousness is a consequence of CO–Hb when the level is equal to or higher than 20% and may
JEADV 2015, 29, 1481–1484
Figure 3 Erosive leukoplakia of the lower lip.
lead to syncope. The treatment consists of high concentration of oxygen.5,19,21,22 Secondary polycythemia has been observed as a consequence of chronic prolonged water pipe smoking.23
© 2015 European Academy of Dermatology and Venereology
Water pipe smoking
1483
In Australia five cases of open pulmonary tuberculosis have been identified amongst young Caucasians sharing a water pipe. Of 45 contact persons who shared the water pipe with the identified cases, 64% had a significant positive tuberculosis skin test reaction.24 Other potential risks of sharing the mouthpiece are hepatitis, aspergillus pneumonia, helicobacter and herpes infection and transfer of human papilloma virus (HPV) (Fig. 2).25,26
Oral diseases
Figure 4 Koebnerization of psoriasis, lower lip.
Water pipe smoking has deleterious effects on oral health. Possible symptoms include staining of teeth, reduced ability to smell and taste and halitosis. Periodontal bone loss, negative effects on dental restoration, gingival recession, post-extraction alveolitis, implant loss, leukoplakia and the development of oral squamous cell carcinoma (SCC) have been reported, psoriasis can become koebnerized on the lips (Figs 3, 4) .27,28
(a)
Skin cancer Both SCC and keratoacanthoma of the lower lip have been observed in water pipe smokers (Fig. 5).29 Lip cancer is the most frequent neoplasia in the oro-maxillary region with a predominance of males. Solar exposure smoking in general and alcohol consumption are considered as the major exogenous factors.30 Other risk factors are age > 50 years of life and fair skin type.31 Comparing the wide-spread behaviour of water pipe smoking the rareness of reports on lip cancer (in particular SCC), there is at least no strong association of both.
Hand eczema (b)
Hand eczema in frequent users of water pipe has been coined ’hubble-bubble dermatitis’. It is of the hyperkeratotic fissuring type with predelection of palms and palmar area of fingers including finger tips. Since patch tests were negative it seems to be an irritant contact dermatitis.32 Epidemiologic studies in this field are missing.
Conclusions
Figure 5 Tumours: (a) Keratoacanthoma of the lower lip. (b)Squamous cell carcinoma of the lower lip.
The dermatological societies are faced to a new epidemic in smoking not identical to cigarette smoking but with potential hazards. Despite the fact that water pipe smoking has become popular in many parts of the world and particularly among adolescents and young adults, there is a scarcity of systematic studies on the consequences for healthy skin, skin ageing and skin cancer prevention.
References Infectious risks Water pipe smoking bears a significant risk of transmission of infectious diseases. Even if the mouthpiece is changed for different smokers, the hose and the water are not. Here, bacteria and other germs survive and get spread.7
JEADV 2015, 29, 1481–1484
1 Maziak W. The global epidemic of waterpipe smoking. Addict Behav 2011; 36: 1–5. 2 Bou FH, Kanj AN, Kanj NA. The growing epidemic of water pipe smoking: health effects and future needs. Respir Med 2014; 108: 1241–1253. 3 Nyongesa H, Adegu J. Water pipe smoking: an emerging trend with detrimental consequences. Pan Afr Med J 2014; 17: 200.
© 2015 European Academy of Dermatology and Venereology
1484
4 Aslam HM, Saleem S, German S, Qureshi WA. Harmful effects of shisha: literature review. Int Arch Med 2014; 7: 16. 5 von Rappard J, Sch€ onenberger M, B€arlocher L. Carbon monoxide poisoning following use of a water pipe/hookah. Dtsch Arztebl Int 2014; 111: 674–679. 6 Smith JR, Edland SD, Novotny TE et al. Increasing hookah use in California. Am J Public Health 2011; 101: 1876–1879. 7 Hammond SK. Global patterns of nicotine and tobacco consumption. Handb Exp Pharmacol 2009; 192: 3–28. 8 Alvur MT, Cinar N, Akduran F, Dede C. Fallacies about water pipe use in Turkish university students - what might be the consequences? Asian Pac J Cancer Prev 2014; 15: 1977–1980. 9 Khater AE, Abd E-AN, Al-Sewaidan HA, Chaouachi K. Radiological hazards of Narghile (hookah, shisha, goza) smoking: activity concentrations and dose assessment. J Environ Radioact 2008; 99: 1808–1814. 10 St Helen G, Benowitz NL, Dains KM, Havel C, Peng M, Jacob P 3rd. Nicotine and carcinogen exposure after water pipe smoking in hookah bars. Cancer Epidemiol Biomarkers Prev 2014; 23: 1055–1066. 11 Eissenberg T, Shihadeh A. Waterpipe tobacco and cigarette smoking: direct comparison of toxicant exposure. Am J Prev Med 2009; 37: 518–523. 12 Shihadeh A. Investigation of mainstream smoke aerosol of the argileh water pipe. Food Chem Toxicol 2003; 41: 143–152. 13 Aljarrah K, Ababneh ZQ, Al-Delaimy WK. Perceptions of hookah smoking harmfulness: Predictors and characteristics among current hookah users. Tob Induc Dis 2009; 5: 16. 14 Becquemin MH, Bertholon JF, Attoui M, Roy F, Roy M, Dautzenberg B. Particle size in water pipe smoke [French]. Rev Mal Respir 2008; 25: 839– 846. 15 Wali SO, Idrees MM, Alamoudi OS et al. Prevalence of chronic obstructive pulmonary disease in Saudi Arabia. Saudi Med J 2014; 35: 684–690. 16 Bentur L, Hellou E, Goldbart A et al. Laboratory and clinical acute effects of active and passive indoor group water-pipe (narghile) smoking. Chest 2014; 145: 803–809. 17 Singh PN, Eng C, Yel D, Kheam T, Job JS, Kanal K. Maternal use of cigarettes, pipes, and smokeless tobacco associated with higher infant mortality rates in Cambodia. Asia Pac J Public Health 2013; 25(5 Suppl): 64S–74S. 18 Clarke SF, Stephens C, Farhan M et al. Multiple patients with carbon monoxide toxicity from water-pipe smoking. Prehosp Disaster Med 2012; 27: 612–624. 19 La Fauci G, Weiser G, Steiner IP, Shavit I. Carbon monoxide poisoning in narghile (water pipe) tobacco smokers. CJEM 2012; 14: 57–59. 20 Akhter S, Ali WU, Rizvi N, Idrees N, Zaina F. Comparison of end tidal carbon monoxide (eCO) levels in shisha (water pipe) and cigarette smokers. Tob Induc Dis 2014; 12: 10.
JEADV 2015, 29, 1481–1484
Wollina
21 Bens BW, ter Maaten JC, Ligtenberg JJ. Carbon monoxide poisoning after smoking from a water pipe [Dutch]. Ned Tijdschr Geneeskd 2013; 157: A6201. 22 Karaca Y, Eryigit U, Aksut N, Turkmen S. Syncope associated with water pipe smoking. BMJ Case Rep 2013; 2013. pii: bcr2013009526. 23 Bonadies N, Tichelli A, Rov o A. When water does not clear the smut from the smoke. BMJ Case Rep 2013; 2013. pii: bcr2013200665. 24 Munckhof WJ, Konstantinos A, Wamsley M, Mortlock M, Gilpin C. A cluster of tuberculosis associated with use of a marijuana water pipe. Int J Tuberc Lung Dis 2003; 7: 860–865. 25 Urkin J, Ochaion R, Peleg A. Hubble bubble equals trouble: the hazards of water pipe smoking. ScientificWorldJournal 2006; 6: 1990–1997. 26 Chandir S, Hussain H, Salahuddin N et al. Extrapulmonary tuberculosis: a retrospective review of 194 cases at a tertiary care hospital in Karachi, Pakistan. J Pak Med Assoc 2010; 60: 105. 27 Zhang X, Li C, Song Y, Reichart PA. Oral leukoplakia in China: a review. Oral Maxillofac Surg 2010; 14: 195–202. 28 Dangi J, Kinnunen TH, Zavras AI. Challenges in global improvement of oral cancer outcomes: findings from rural Northern India. Tob Induc Dis 2012; 10: 5. 29 El-Hakim IE, Uthman MA. Squamous cell carcinoma and keratoacanthoma of the lower lip associated with “Goza” and “Shisha” smoking. Int J Dermatol 1999; 38: 108–110. 30 Maruccia M, Onesti MG, Parisi P, Cigna E, Troccola A, Scuderi N. Lip cancer: a 10-year retrospective epidemiological study. Anticancer Res 2012; 32: 1543–1546. 31 Czerninski R, Zini A, Sgan-Cohen HD. Lip cancer: incidence, trends, histology and survival: 1970-2006. Br J Dermatol 2010; 162: 1103–1109. 32 Onder M, Oztas M, Arnavut O. Nargile (Hubble-Bubble) smokinginduced hand eczema. Int J Dermatol 2002; 41: 771–772. 33 Shihadeh A, Salman R, Jaroudi E et al. Does switching to a tobacco-free waterpipe product reduce toxicant intake? A crossover study comparing CO, NO, PAH, volatile aldehydes, “tar” and nicotine yields. Food Chem Toxicol 2012; 50: 1494–1498. 34 Daher N, Saleh R, Jaroudi E et al. Comparison of carcinogen, carbon monoxide, and ultrafine particle emissions from narghile waterpipe and cigarette smoking: Sidestream smoke measurements and assessment of second-hand smoke emission factors. Atmos Environ (1994) 2010; 44: 8–14. 35 Hammal F, Chappell A, Wild TC et al. ‘Herbal’ but potentially hazardous: an analysis of the constituents and smoke emissions of tobacco-free waterpipe products and the air quality in the cafes where they are served. Tob Control 2013. doi: 10.1136/tobaccocontrol-2013-051169. [Epub ahead of print]
© 2015 European Academy of Dermatology and Venereology
DOI: 10.1111/jdv.12984
REVIEW ARTICLE
Water pipe smoking and dermatologic consequences U. Wollina* Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany *Correspondence: U. Wollina. E-mail: [email protected]
Abstract Water pipe smoking is a recently growing addiction worldwide. It has become popular in Africa and the Western World and enfaces a renaissance in Middle East and Asia. The smoking technique leads to a different exposure to potential hazardous compounds compared to cigarette or classical pipe smoking. The common assumption that water pipe smoking is less dangerous to health is not substantiated by scientific data. Non-tobacco-based preparations reduce the exposure to nicotine but may contain equal or even higher concentrations of other toxic compounds. The medical literature on adverse effect of water pipe smoking on skin and oral mucosa is reviewed but future research is a demand. Received: 21 November 2014; Accepted: 24 December 2014
Conflicts of interests None declared.
Funding sources None declared.
Introduction Water pipe smoking after a decline in the 80’s of the last century has seen a renaissance in Arab countries and has become a fashion in Western World and Africa with a tremendous increase in users among young adults. The majority of them are males.1–4 In Germany, the lifetime prevalence of water pipe smoking among young adults has reached almost 70%.5 The prevalence of water pipe smoking in the USA is about 40%.6
The instrument and the basic technique Although the water pipe (nargil, narghile, arghila, argil, sheesha, shisha, hooka, huqqa, goza, guza, qalyan, hubble-bubble, lula, cachimba, chillum) may be present in different types and sizes, the basic construct is comprised of a bowl at the top (head) often with a windshield, a body, a hose with a mouthpiece and a water bowl at the base of the instrument filled half with water (and sometimes other fluids) (Fig. 1). Tobacco (mixture – mu’assel, pure tobacco paste – tumbak or ajami, tobacco with fruits and oils - jumbak) is burnt on the top bowl by coal embers. Suction through the mouthpiece draws the smoke through the water in the water bowl and then into the mouth and lungs of the smoker.7 Water pipe smoking is usually practised in groups sharing the pipe in a session of about an hour or more. In some countries smoking is performed in cafes, while in others shisha lounges have spread.1,7
JEADV 2015, 29, 1481–1484
Water pipe smoking is not less harmful than cigarette smoking Although there is a common belief among water pipe users that water pipes are less harmful than cigarette smoking, this has not been substantiated by any scientific data.8 Exposure to nicotine, heavy metals, cancerous nitrosamines, polycyclic aromatic hydrocarbons, mercapturic acid metabolites and radioactive isotopes is significiant.9,10 The exposure to nicotine is comparable to cigarette smoking but the exposure time is significantly longer leading to an 1.7 fold increase in the nicotine dose. Humectants lice glycerine and 1,2-propanediol increase the formation of smoke.11 The burning temperature of tobacco in water pipes is usually around 200 to 450 degree Celsius or less compared to 900 degree Celsius in cigarette smoking. The exposure to water pipe smoke on average is about ten times higher.12,13 The water pipe produces less smoke than the cigarette but it is not smokeless. The particle size after bubbling is about the same as of cigarette smoking, but the inhaled amount is higher.14 The chemical characterization of water pipe smoke versus cigarette smoking is summarized in Table 1. Therefore, diseases usually associated with cigarette smoking can also be seen with water pipe smoking, including chronic obstructive pulmonary disease, cardiovascular diseases and cancer.4,15,16 Maternal water pipe smoking increases infant mortality with an odds ratio of 3.09 compared to 2.54 for cigarette smoking. Another risk is low birthweight of the newborn.17
© 2015 European Academy of Dermatology and Venereology
Wollina
1482
(a)
(b)
Figure 1 Modern water pipe (hooka).
Table 1 Chemical characterization of water pipe smoke (WPS) compared to cigarette smoke (CS) Chemical compounds
WPS
CS 155 49
CO (mg)
2269 108 1.04 0.3
Nicotine (tobacco based preparation) (mg) Heavy metals (As, Cr, Ni, Pb)*
65.5 5.5 0.73
Higher or equal to CS 1193 226
Polycyclic aromatic hydrocarbons (mg) Tar (mg)* Volatile aldehydes (lg)
12
446–513 12 000 1610
Figure 2 Transmission of infections. (a) Aspergillus niger infection of the upper lip. (b) Herpes labialis.
References 33 34 33
35 305 49
34
9.4
33
2954 416
34
*Non-tobacco-based preparations may contain higher concentrations than tobacco-based preparations.
Acute toxicity Depending on the size of the water pipe carbon monoxide (CO) levels may vary considerably. Smaller pipes bear a greater risk of CO intoxication because they may produce about ten times the CO concentration of cigarette smoking. Another important variable is the time of consumption.18–20 Inhaled CO leads to CO– haemoglobin formation. Unconsciousness is a consequence of CO–Hb when the level is equal to or higher than 20% and may
JEADV 2015, 29, 1481–1484
Figure 3 Erosive leukoplakia of the lower lip.
lead to syncope. The treatment consists of high concentration of oxygen.5,19,21,22 Secondary polycythemia has been observed as a consequence of chronic prolonged water pipe smoking.23
© 2015 European Academy of Dermatology and Venereology
Water pipe smoking
1483
In Australia five cases of open pulmonary tuberculosis have been identified amongst young Caucasians sharing a water pipe. Of 45 contact persons who shared the water pipe with the identified cases, 64% had a significant positive tuberculosis skin test reaction.24 Other potential risks of sharing the mouthpiece are hepatitis, aspergillus pneumonia, helicobacter and herpes infection and transfer of human papilloma virus (HPV) (Fig. 2).25,26
Oral diseases
Figure 4 Koebnerization of psoriasis, lower lip.
Water pipe smoking has deleterious effects on oral health. Possible symptoms include staining of teeth, reduced ability to smell and taste and halitosis. Periodontal bone loss, negative effects on dental restoration, gingival recession, post-extraction alveolitis, implant loss, leukoplakia and the development of oral squamous cell carcinoma (SCC) have been reported, psoriasis can become koebnerized on the lips (Figs 3, 4) .27,28
(a)
Skin cancer Both SCC and keratoacanthoma of the lower lip have been observed in water pipe smokers (Fig. 5).29 Lip cancer is the most frequent neoplasia in the oro-maxillary region with a predominance of males. Solar exposure smoking in general and alcohol consumption are considered as the major exogenous factors.30 Other risk factors are age > 50 years of life and fair skin type.31 Comparing the wide-spread behaviour of water pipe smoking the rareness of reports on lip cancer (in particular SCC), there is at least no strong association of both.
Hand eczema (b)
Hand eczema in frequent users of water pipe has been coined ’hubble-bubble dermatitis’. It is of the hyperkeratotic fissuring type with predelection of palms and palmar area of fingers including finger tips. Since patch tests were negative it seems to be an irritant contact dermatitis.32 Epidemiologic studies in this field are missing.
Conclusions
Figure 5 Tumours: (a) Keratoacanthoma of the lower lip. (b)Squamous cell carcinoma of the lower lip.
The dermatological societies are faced to a new epidemic in smoking not identical to cigarette smoking but with potential hazards. Despite the fact that water pipe smoking has become popular in many parts of the world and particularly among adolescents and young adults, there is a scarcity of systematic studies on the consequences for healthy skin, skin ageing and skin cancer prevention.
References Infectious risks Water pipe smoking bears a significant risk of transmission of infectious diseases. Even if the mouthpiece is changed for different smokers, the hose and the water are not. Here, bacteria and other germs survive and get spread.7
JEADV 2015, 29, 1481–1484
1 Maziak W. The global epidemic of waterpipe smoking. Addict Behav 2011; 36: 1–5. 2 Bou FH, Kanj AN, Kanj NA. The growing epidemic of water pipe smoking: health effects and future needs. Respir Med 2014; 108: 1241–1253. 3 Nyongesa H, Adegu J. Water pipe smoking: an emerging trend with detrimental consequences. Pan Afr Med J 2014; 17: 200.
© 2015 European Academy of Dermatology and Venereology
1484
4 Aslam HM, Saleem S, German S, Qureshi WA. Harmful effects of shisha: literature review. Int Arch Med 2014; 7: 16. 5 von Rappard J, Sch€ onenberger M, B€arlocher L. Carbon monoxide poisoning following use of a water pipe/hookah. Dtsch Arztebl Int 2014; 111: 674–679. 6 Smith JR, Edland SD, Novotny TE et al. Increasing hookah use in California. Am J Public Health 2011; 101: 1876–1879. 7 Hammond SK. Global patterns of nicotine and tobacco consumption. Handb Exp Pharmacol 2009; 192: 3–28. 8 Alvur MT, Cinar N, Akduran F, Dede C. Fallacies about water pipe use in Turkish university students - what might be the consequences? Asian Pac J Cancer Prev 2014; 15: 1977–1980. 9 Khater AE, Abd E-AN, Al-Sewaidan HA, Chaouachi K. Radiological hazards of Narghile (hookah, shisha, goza) smoking: activity concentrations and dose assessment. J Environ Radioact 2008; 99: 1808–1814. 10 St Helen G, Benowitz NL, Dains KM, Havel C, Peng M, Jacob P 3rd. Nicotine and carcinogen exposure after water pipe smoking in hookah bars. Cancer Epidemiol Biomarkers Prev 2014; 23: 1055–1066. 11 Eissenberg T, Shihadeh A. Waterpipe tobacco and cigarette smoking: direct comparison of toxicant exposure. Am J Prev Med 2009; 37: 518–523. 12 Shihadeh A. Investigation of mainstream smoke aerosol of the argileh water pipe. Food Chem Toxicol 2003; 41: 143–152. 13 Aljarrah K, Ababneh ZQ, Al-Delaimy WK. Perceptions of hookah smoking harmfulness: Predictors and characteristics among current hookah users. Tob Induc Dis 2009; 5: 16. 14 Becquemin MH, Bertholon JF, Attoui M, Roy F, Roy M, Dautzenberg B. Particle size in water pipe smoke [French]. Rev Mal Respir 2008; 25: 839– 846. 15 Wali SO, Idrees MM, Alamoudi OS et al. Prevalence of chronic obstructive pulmonary disease in Saudi Arabia. Saudi Med J 2014; 35: 684–690. 16 Bentur L, Hellou E, Goldbart A et al. Laboratory and clinical acute effects of active and passive indoor group water-pipe (narghile) smoking. Chest 2014; 145: 803–809. 17 Singh PN, Eng C, Yel D, Kheam T, Job JS, Kanal K. Maternal use of cigarettes, pipes, and smokeless tobacco associated with higher infant mortality rates in Cambodia. Asia Pac J Public Health 2013; 25(5 Suppl): 64S–74S. 18 Clarke SF, Stephens C, Farhan M et al. Multiple patients with carbon monoxide toxicity from water-pipe smoking. Prehosp Disaster Med 2012; 27: 612–624. 19 La Fauci G, Weiser G, Steiner IP, Shavit I. Carbon monoxide poisoning in narghile (water pipe) tobacco smokers. CJEM 2012; 14: 57–59. 20 Akhter S, Ali WU, Rizvi N, Idrees N, Zaina F. Comparison of end tidal carbon monoxide (eCO) levels in shisha (water pipe) and cigarette smokers. Tob Induc Dis 2014; 12: 10.
JEADV 2015, 29, 1481–1484
Wollina
21 Bens BW, ter Maaten JC, Ligtenberg JJ. Carbon monoxide poisoning after smoking from a water pipe [Dutch]. Ned Tijdschr Geneeskd 2013; 157: A6201. 22 Karaca Y, Eryigit U, Aksut N, Turkmen S. Syncope associated with water pipe smoking. BMJ Case Rep 2013; 2013. pii: bcr2013009526. 23 Bonadies N, Tichelli A, Rov o A. When water does not clear the smut from the smoke. BMJ Case Rep 2013; 2013. pii: bcr2013200665. 24 Munckhof WJ, Konstantinos A, Wamsley M, Mortlock M, Gilpin C. A cluster of tuberculosis associated with use of a marijuana water pipe. Int J Tuberc Lung Dis 2003; 7: 860–865. 25 Urkin J, Ochaion R, Peleg A. Hubble bubble equals trouble: the hazards of water pipe smoking. ScientificWorldJournal 2006; 6: 1990–1997. 26 Chandir S, Hussain H, Salahuddin N et al. Extrapulmonary tuberculosis: a retrospective review of 194 cases at a tertiary care hospital in Karachi, Pakistan. J Pak Med Assoc 2010; 60: 105. 27 Zhang X, Li C, Song Y, Reichart PA. Oral leukoplakia in China: a review. Oral Maxillofac Surg 2010; 14: 195–202. 28 Dangi J, Kinnunen TH, Zavras AI. Challenges in global improvement of oral cancer outcomes: findings from rural Northern India. Tob Induc Dis 2012; 10: 5. 29 El-Hakim IE, Uthman MA. Squamous cell carcinoma and keratoacanthoma of the lower lip associated with “Goza” and “Shisha” smoking. Int J Dermatol 1999; 38: 108–110. 30 Maruccia M, Onesti MG, Parisi P, Cigna E, Troccola A, Scuderi N. Lip cancer: a 10-year retrospective epidemiological study. Anticancer Res 2012; 32: 1543–1546. 31 Czerninski R, Zini A, Sgan-Cohen HD. Lip cancer: incidence, trends, histology and survival: 1970-2006. Br J Dermatol 2010; 162: 1103–1109. 32 Onder M, Oztas M, Arnavut O. Nargile (Hubble-Bubble) smokinginduced hand eczema. Int J Dermatol 2002; 41: 771–772. 33 Shihadeh A, Salman R, Jaroudi E et al. Does switching to a tobacco-free waterpipe product reduce toxicant intake? A crossover study comparing CO, NO, PAH, volatile aldehydes, “tar” and nicotine yields. Food Chem Toxicol 2012; 50: 1494–1498. 34 Daher N, Saleh R, Jaroudi E et al. Comparison of carcinogen, carbon monoxide, and ultrafine particle emissions from narghile waterpipe and cigarette smoking: Sidestream smoke measurements and assessment of second-hand smoke emission factors. Atmos Environ (1994) 2010; 44: 8–14. 35 Hammal F, Chappell A, Wild TC et al. ‘Herbal’ but potentially hazardous: an analysis of the constituents and smoke emissions of tobacco-free waterpipe products and the air quality in the cafes where they are served. Tob Control 2013. doi: 10.1136/tobaccocontrol-2013-051169. [Epub ahead of print]
© 2015 European Academy of Dermatology and Venereology
