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Radiation Effects of Mobile Phones and Tablets on the Skin: A Systematic Review.

1. Introduction

Mobile phones and tablets have become the most effective communication tools especially in metropolitan cities [1]. Exposure of the general population to radiofrequency (RF) fields from mobile phones and other communication tools has become universal and continuous in recent years [2]. The number of mobile phone users has gone up to 5 billion in a world of 7.4 billion [1]. 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 [3].

The emitted radiation in mobile phone and tablet is electromagnetic ray in the microwave range (850-1800) [1]. 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 [7] (skin diseases cause pain and discomfort in 21% to 87% of the affected people) [8]. Skin diseases allocated high burden of disease (rank eighteenth) in all age groups [9].

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. Methods

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).

3. Results

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 [6].

(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 [10].

(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 [11].

(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 [12].

(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 [13].

4. Conclusions

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 [12] However, in a cohort study, Poulsen et al. reported the incidence of skin cancer [6].

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 [14].

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 [4]. Epidemiological studies conducted on humans and animals indicate that electromagnetic waves produce a wide range of side effects in different systems of the body [15], but they have not achieved a definite result [16]. 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 [18].

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 [19].

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 [20].

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.

https://doi.org/ 10.1155/2018/9242718

Conflicts of Interest

The authors declare that they have no conflicts of interest.

Acknowledgments

This study was supported by grants from the Sabzevar University of Medical Sciences. The authors thank the Sabzevar University's Clinical Research Center.

References

[1] K. Vishnu, B. Nithyaja, C. Pradeep, R. Sujith, P. Mohanan, and V. Nampoori, "Studies on the effect of mobile phone radiation on DNA using laser induced fluorescence technique," Laser Physics, vol. 21, no. 11, pp. 1945-1949, 2011.

[2] A. Lopez-Furelos, J. M. Leiro-Vidal, A. A. Salas-Sanchez, F. J. Ares-Pena, and M. E. Lopez-Martin, "Evidence of cellular stress and caspase-3 resulting from a combined two-frequency signal in the cerebrum and cerebellum of sprague-dawley rats," Oncotarget, vol. 7, no. 40, p. 64674, 2016.

[3] Z. Sienkiewicz, C. Calderon, K. A. Broom et al., "Are exposures to multiple frequencies the key to future radiofrequency research?," Frontiers in Public Health, vol. 5, p. 328, 2017.

[4] F. Ozguner, G. Aydin, H. Mollaoglu, O. Gokalp, A. Koyu, and G. Cesur, "Prevention of mobile phone induced skin tissue changes by melatonin in rat: an experimental study," Toxicology and Industrial Health, vol. 20, no. 6-10, pp. 133-139, 2004.

[5] J. Bianchi, B. Page, and S. Robertson, Your Dermatology Pocket Guide: Common Skin Conditions Explained, NHS Education for Scotland, Edinburgh, UK, 2012.

[6] A. H. Poulsen, S. Friis, C. Johansen et al., "Mobile phone use and the risk of skin cancer: a nationwide cohort study in Denmark," American Journal of Epidemiology, vol. 178, no. 2, pp. 190-197, 2013.

[7] L. M. Hollestein and T. Nijsten, "An insight into the global burden of skin diseases," Journal of Investigative Dermatology, vol. 134, no. 6, pp. 1499-1501, 2014.

[8] G. Sanclemente, C. Burgos, J. Nova et al., "The impact of skin diseases on quality of life: a multicenter study," Actas DermoSifiliograficas, vol. 108, no. 3, pp. 244-252, 2017.

[9] R. J. Hay, N. E. Johns, H. C. Williams et al., "The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions," Journal of Investigative Dermatology, vol. 134, no. 6, pp. 1527-1534, 2014.

[10] F. Soderqvist, M. Carlberg, and L. Hardell, "Use of wireless telephones and self-reported health symptoms: a population-based study among Swedish adolescents aged 15-19 years," Environmental Health, vol. 7, no. 1, p. 18, 2008.

[11] M. Sandstrom, J. Wilen, K. Hansson Mild, and G. Oftedal, "Mobile phone use and subjective symptoms. Comparison of symptoms experienced by users of analogue and digital mobile phones," Occupational Medicine, vol. 51, no. 1, pp. 25-35,2001.

[12] G. Oftedal, J. Wilen, M. Sandstrom, and K. H. Mild, "Symptoms experienced in connection with mobile phone use," Occupational Medicine, vol. 50, no. 4, pp. 237-245, 2000.

[13] M. Khan, "Adverse effects of excessive mobile phone use," International Journal of Occupational Medicine and Environmental Health, vol. 21, no. 4, pp. 289-293, 2008.

[14] Z. Naeem, "Health risks associated with mobile phones use," International Journal of Health Sciences, vol. 8, no. 4, p. 5, 2014.

[15] E. Derias, P. Stefanis, A. Drakeley, R. Gazvani, and D. Lewis-Jones, "Growing concern over the safety of using mobile phones and male fertility," Archives of Andrology, vol. 52, no. 1, pp. 9-14, 2006.

[16] A. Colonna, "Cellular phones and cancer: current status," Bulletin du Cancer, vol. 92, no. 7, pp. 637-643, 2005.

[17] K. H. Mild, G. Oftedal, M. Sandstroms, J. Wilen, T. Tynes, and B. Haugsdal, "Comparison of symptoms experienced by users of analogue and digital mobile phones," Arbetslisrapport, vol. 23, pp. 1-47, 1998.

[18] C. Richardson, C. R. Hamann, D. Hamann, and J. P. Thyssen, "Mobile phone dermatitis in children and adults: a review of the literature," Pediatric Allergy, Immunology, and Pulmonology, vol. 27, no. 2, pp. 60-69, 2014.

[19] O. Kwon, Y. Choi, H. Chung, and J. Park, "Cellular phone dermatitis at an unusual site," Our Dermatology Online, vol. 8, no. 4, pp. 487-488, 2017.

[20] L. Hardell, M. Carlberg, K. H. Mild, and M. Eriksson, "Case-control study on the use of mobile and cordless phones and the risk for malignant melanoma in the head and neck region," Pathophysiology, vol. 18, no. 4, pp. 325-333, 2011.

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; navipoure931@mums.ac.ir

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. [11]       2000          1995       Sweden Norway
Oftedal et al. [12]         2000          1999          Sweden
Fredrik Soderqvist          2008        2005-2006       Sweden
Khan [13]                   2008          2007       Saudi Arabia
Poulsen et al. [6]          2012        1990-2007       Denmark

Claudio Gomez-Perretta      2013          2003           Spain

First author             Age (range)   Participants

Sandstrom et al. [11]       30-50         17000
Oftedal et al. [12]         30-50         17000
Fredrik Soderqvist          15-19          2000
Khan [13]                    NA            330
Poulsen et al. [6]           30           355701

Claudio Gomez-Perretta      15-81           88

First author                     Place and population

Sandstrom et al. [11]              Norway and Sweden
Oftedal et al. [12]                Norway and Sweden
Fredrik Soderqvist             Among Swedish adolescents
Khan [13]                  Medical students in Saudi Arabia
Poulsen et al. [6]       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.
[11]

Oftedal      Cross-sectional               Chi-square test
et al
[12]

Fredrik      Cross-sectional   Chi-square test and logistic regression
Soderqvist

Khan [13]    Cross-sectional               Chi-square test

Poulsen          Cohort          Log-linear Poisson regression models
et al.
[6]

Claudio      Cross-sectional      Analysis of variance test (ANOVA)
Gomez-
Perretta

First                   Outcome                 Exposure
author

Sandstrom        Warming and burning         Cellular phone
et al.                 ear skin
[11]

Oftedal       Burning sensations in the       Mobile phone
et al          facial skin and warming
[12]             sensation behind and
                    around the ear

Fredrik             Health symptoms            Wireless
Soderqvist                                     telephones

Khan [13]          Facial dermatitis          Mobile phone

Poulsen               Skin cancer             Mobile phone
et al.
[6]

Claudio             Health symptoms           Mobile phone
Gomez-
Perretta

First             Measure of association
author

Sandstrom         Prevalence of symptoms
et al.
[11]

Oftedal         Percentage of symptoms (%)
et al
[12]

Fredrik                 Odds ratio
Soderqvist

Khan [13]    Percentage of health complaints

Poulsen        Incidence rate ratios (IRRs)
et al.
[6]

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
[11]           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
[12]         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 [13]          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
[6]                        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
Article Type:Report
Date:Jan 1, 2018
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