Radiation Effects of Mobile Phones and Tablets on the Skin: A Systematic Review.
Mobile phones and tablets have become the most effective communication tools especially in metropolitan cities . Exposure of the general population to radiofrequency (RF) fields from mobile phones and other communication tools has become universal and continuous in recent years . The number of mobile phone users has gone up to 5 billion in a world of 7.4 billion . Development of using mobile phones has increased concerns about the safety of health, in recent years. The studies reflected public concerns about childhood and adult cancers. The possibility that some individuals experience hypersensitivity or other symptoms in response to mobile exposure was a high priority for research .
The emitted radiation in mobile phone and tablet is electromagnetic ray in the microwave range (850-1800) . Collected evidence indicates that the frequency produced by mobile phones or base stations may affect the health of the people [4, 5].
The skin receives much radiation in contact with mobile phone and tablet although many studies have been carried out on the effect of electromagnetic radiation on biologic system and intracranial tumors [1, 6], Diseases of the skin, especially skin cancers and contact dermatitis, are very important because of their high prevalence, chronic nature of the disease, and high impact on the quality of life  (skin diseases cause pain and discomfort in 21% to 87% of the affected people) . Skin diseases allocated high burden of disease (rank eighteenth) in all age groups .
Among the factors that are related to skin diseases, less attention has been paid to environmental factors. Most studies have been done on these factors, in animals. The results indicate that exposure to radiation emitted by mobile phones caused skin changes in rats, as, increased thickness of surface layer, atrophy of epidermis, deep layer proliferation, vascular proliferation, impairment in collagen tissue and protein expression in human skin in proteomics approach.
The lack of studies on the association between mobile phone use and risk of skin diseases prompted us to examine these associations in this systematic review.
2.1. Search Strategy. We reviewed PubMed, Scopus, Cochrane library, Google Scholar, and Springer 1995 to 2017. A range of mesh, key words, and their combinations were used, including skin disease, cell phone, smart phone, mobile phone, electrochemical magnetic field, skin cancer, skin carcinoma, and health effects. We also did not consider articles that merely assessed the physiologic effects and reviewed the bibliographies for additional publications. The language of publication was English and Persian.
2.2. Selection Criteria. We included studies that had the following criteria: cross-sectional, cohort, and crossover studies to refer to the impact of mobile phone radiation on skin diseases. If the data were duplicated, the first published study was entered in the analysis. Studies retrieved from the databases that had the predetermined selection criteria were assessed by two of the authors independently. If the authors had disagreed, they resolved by discussion or in consultation with a third author.
The exclusion criteria were included: nonrelevant articles on the type of study and subject of research, low-quality studies based on the CASP checklist, and studies that did not contain enough information. In the larger studies included in this survey were any conducted solely by telephone.
2.3. Quality Evaluation of Articles. The quality of the articles was evaluated based on the CASP scale by two researchers. This checklist contains 11 sections for cross-sectional studies and 12 sections for cohort studies.
2.4. Data Extraction. The information consisted of the name of the first author, where (country) the study was conducted, and the date of publication, sample size, and the method of data collection (Table 1).
Figure 1 shows a flow chart that we searched and selected appropriate articles. In the first step, a total of 150 articles were found by searching databases and bibliographies. 75 articles were excluded because those had not inclusion criteria. We reviewed the full text of selected articles, as shown in Figure 1, 6 articles were included in the systematic review.
The sample size in the 6 studies (one cohort study and five cross-sectional studies) was 392119, and the details of the articles are presented in Table 1. All studies were done on both sexes and the mean age was 35 years. The diseases that were assessed in these studies included skin cancer, dermatitis, itching, warmth and burning feeling, and rash (Table 2).
(1) In a nationwide cohort study, 355,701 mobile phone users in Denmark from 1987 to 2007 were followed up. After a period of at least 20 years, little evidence of skin cancer risk was observed among the mobile phone users .
(2) In a cross-sectional study that was conducted in 2008 on 2000 Swedish adolescence aged 15-19 years, the most participants assessed, they had skin complaints as rash and dermatitis .
(3) A cross-sectional study was initiated in 1995 including 11982 GSM and NMT users in Sweden and 2500 in Norway, the authors observed a low-risk warmth on the behind and around the ear .
(4) A cross-sectional study on 17,000 people in Norway and Sweden showed 31% mobile phone users in Norway, and 13% of those in Sweden had experienced at least one symptom that included the sensations of warmth on the ear and behind/around the ear, burning sensations in the facial skin. Most skin symptoms usually began during or after the call and lasted for up to 2 h but these results suggest an awareness of the symptoms, but not necessarily a serious health problem .
(5) A survey was conducted among a total of 330 medical students at the King Saud University. This study presents an overview about the impact of radiofrequency waves on the health of medical students in Saudi Arabia. The most of skin symptoms were reported including facial dermatitis .
In this systematic review, we searched articles in databases. Abstracts and text of the articles were examined from various aspects. Eight articles were evaluated for quality, and then, six papers entered a systematic review.
In the present study, the studied population was of both sexes with an average age of 35 years; therefore, this shows the importance of the issue. These persons have high performance in communities, so their illness increases the burden of the disease.
All studies were cross-sectional or cohort, and there were different morbidity indexes between mobile radiation and skin diseases. The duration of exposure to mobile radiation was very different for skin signs; therefore, we did not have the possibility of meta-analyzing studies. Oftedal et al. in 1999, with a sample size of 17,000, reported the prevalence of skin problems caused by mobile use  However, in a cohort study, Poulsen et al. reported the incidence of skin cancer .
We found that the use of mobile phones was associated with a mildly increased risk of skin problems. This is the first systematic review on the effects of mobile phone radiation on skin diseases.
From 6 articles that enter to systematic review, two studies did not reveal a serious health problem [12, 13]. In two other studies, these pointed to warmth sensation after the use of mobile phones [6, 11]. Cell phones play an important role in people's lives since the last few decades, and people have been exposed for so long, so addressing their effects on health can prevent harmful effects among mobile phone users. IARC (International Agency for Research on Cancer) classified that the mobile-emitted radiation could be some risk of carcinogenicity, so further studies into heavy use of mobile phones needs to be conducted .
Previous studies have reported that collagen tissue increased in cells exposed to mobile radiation. Mobile phone radiation for one hour causes morphological changes and increased fibroblast activity of the skin. Another study also found that exposure to 900 MHz mobile phone radiation creates exocytosis in skin cells. Some studies have shown that the degree of destruction caused by mobile radiation is related to the duration of exposure to radiation . Epidemiological studies conducted on humans and animals indicate that electromagnetic waves produce a wide range of side effects in different systems of the body , but they have not achieved a definite result . Skin reactions in the ears and around it are the most common symptoms reported among mobile phone users during a telephone call [12, 17]. As worldwide rates of mobile phone users rise, Richardson showed that mobile phone-associated contact dermatitis is increasing. In order to control allergens in phones, many phones have metals such as nickel that are sufficient to induce contact dermatitis; Therefore, patients with dermatitis of the face, neck, hands, breasts, or anterior thighs, should be examined for exposure to mobile .
In patients with profuse sweating, it provides a predisposing condition, and the penetration of nickel to the skin increases the occurrence of contact dermatitis. Therefore, mobile phone dermatitis should be considered in the differential diagnosis of contact dermatitis. The patch test and dimethylglyoxime test may be helpful in establishing the diagnosis .
In the study of Hardel et al. in 2011, he concluded that there is no relationship between the use of mobile phones and skin cancer .
Overall evaluations showed that the effects of mobile phone radiation on skin diseases are weak and have no statistical significance. Some studies have shown weak impacts, and some studies have found that over ten years of mobile use have been effective, but mobile phones are still a new technology and little evidence about long-term side effects is available, as a result, prevention is the best approach. Epidemiological studies on this topic are limited, and its long-term effects have not been evaluated, and there is a gap in the assessment relationship between mobile phone radiation and skin diseases. People are worried about the health effects of mobile phones, especially since it is part of daily life. As a result, the implementation of standard policies and strategic planning for primary health care by government officials on this topic is necessary to reduce people's concerns in order to provide suitable solutions for high-risk people. These programs require extended studies on mobile phone technology and its impact on the safety of mobile users. Our study has limitations. First, only few studies on the study of mobile phone radiation and skin disease are available. Second, we did not have the ability to access the full text of some articles and low levels of evidence.
Conflicts of Interest
The authors declare that they have no conflicts of interest.
This study was supported by grants from the Sabzevar University of Medical Sciences. The authors thank the Sabzevar University's Clinical Research Center.
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A. Keykhosravi, (1) M. Neamatshahi, (2) R. Mahmoodi, (3) and E. Navipour (3)
(1) Department of Pediatrics, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Khorasan Razavi, Iran
(2) Department of Social Medicine, Faculty of Medicine, Research Center Social Determinants health, Sabzevar University of Medical Sciences, Khorasan Razavi, Iran
(3) Department of Social Medicine, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Khorasan Razavi, Iran
Correspondence should be addressed to E. Navipour; firstname.lastname@example.org
Received 12 February 2018; Accepted 21 March 2018; Published 12 April 2018
Academic Editor: Jacek Cezary Szepietowski
Caption: Figure 1: Flow chart of the process of study entering in a systematic review study.
Table 1: Studies on the effects of mobile on skin diseases. First author Date of Date of Country publication performance Sandstrom et al.  2000 1995 Sweden Norway Oftedal et al.  2000 1999 Sweden Fredrik Soderqvist 2008 2005-2006 Sweden Khan  2008 2007 Saudi Arabia Poulsen et al.  2012 1990-2007 Denmark Claudio Gomez-Perretta 2013 2003 Spain First author Age (range) Participants Sandstrom et al.  30-50 17000 Oftedal et al.  30-50 17000 Fredrik Soderqvist 15-19 2000 Khan  NA 330 Poulsen et al.  30 355701 Claudio Gomez-Perretta 15-81 88 First author Place and population Sandstrom et al.  Norway and Sweden Oftedal et al.  Norway and Sweden Fredrik Soderqvist Among Swedish adolescents Khan  Medical students in Saudi Arabia Poulsen et al.  CANULI ("cancer of social ulighed"; cancer and social inequality) Claudio Gomez-Perretta Known illness in 2003 was subsequently disregarded Table 2: Methodology of studies included in the systematic review. First Study design Statistical methods author Sandstrom Cross-sectional Multivariate logistic regression et al.  Oftedal Cross-sectional Chi-square test et al  Fredrik Cross-sectional Chi-square test and logistic regression Soderqvist Khan  Cross-sectional Chi-square test Poulsen Cohort Log-linear Poisson regression models et al.  Claudio Cross-sectional Analysis of variance test (ANOVA) Gomez- Perretta First Outcome Exposure author Sandstrom Warming and burning Cellular phone et al. ear skin  Oftedal Burning sensations in the Mobile phone et al facial skin and warming  sensation behind and around the ear Fredrik Health symptoms Wireless Soderqvist telephones Khan  Facial dermatitis Mobile phone Poulsen Skin cancer Mobile phone et al.  Claudio Health symptoms Mobile phone Gomez- Perretta First Measure of association author Sandstrom Prevalence of symptoms et al.  Oftedal Percentage of symptoms (%) et al  Fredrik Odds ratio Soderqvist Khan  Percentage of health complaints Poulsen Incidence rate ratios (IRRs) et al.  Claudio Odds ratio Gomez- Perretta First Conclusions author Sandstrom A statistically significant association between calling et al. time/number of calls per day and the prevalence of  warmth behind/around or on the ear, headaches, and fatigue Oftedal These findings, together with our results, may indicate et al a causal relation between the use of mobile phones and  warming sensations. These results suggest an awareness of the symptoms, but no serious skin health problem Fredrik The findings of the present study indicate that the use Soderqvist of mobile phones causes skin rash & burning sensation Khan  The findings of the present study indicate that mobile phones play a large part in the daily life of medical students, and therefore its impact on psychology and health should be discussed with the students to prevent the harmful effects Poulsen This nationwide study of mobile phone subscribers et al. provided no support for a relationship between mobile  phone use and skin cancer. Claudio The findings of this study indicate that no Gomez- relationship was found between the rays emitted from Perretta mobile phone and the skin changes
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|Author:||Keykhosravi, A.; Neamatshahi, M.; Mahmoodi, R.; Navipour, E.|
|Publication:||Advances in Medicine|
|Date:||Jan 1, 2018|
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