In the first half of 2016, 10 patients with bad burns and facial fractures were admitted to North Carolina Jaycee Burn Center at UNC Hospitals. They almost all needed surgery — and one patient lost his eye after an e-cigarette he was smoking exploded.

These cases represent a nationwide phenomenon of severe thermal burns caused by e-cigarettes. Thermal burn injuries happen when somebody is exposed to a contact with steam, flames, or hot surfaces and liquids with temperatures of at least 115 degrees.

“We know that this is a big problem at burn centers across the United States,” said Clare Meernik, MPH, research specialist in the UNC Tobacco Prevention and Evaluation Program. “We think these explosions are happening to a greater extent than the current medical literature suggests.”

Meernik is also the author of an editorial for the British Medical Journal, in which she calls for better surveillance and documentation of e-cigarette related injuries, regulation in their manufacture, and more information for consumers.

“There’s a flame component to the burn injury, but there’s also a chemical component,” said Felicia Williams, MD, who is an assistant professor of surgery at the UNC School of Medicine and co-author of the editorial. “We fear that trauma centers may not be aware of the severe nature of these burns. Patients need optimal long-term management to ensure wound healing occurs from both components.”

One of the main problems with the management of these wounds is that there is no national system used to code injuries related to e-cigarettes, and yet more than nine million people in the United States use them.

“We need a better surveillance system so we can begin to grasp the gravity of burn injuries in the United States and around the world,” Williams said. “We need to better document the scope of burn injuries in the medical literature and help physicians to be better prepared to treat patients with these particular kinds of burns and facial fractures.”