Cigarette burns

What are cigarette burns?

Deliberate cigarette burns occur when a lighted cigarette is held against an individual’s skin resulting in first-, second- or third-degree burns (1). For a cigarette to create a burn, firm contact with the skin should last at least 2-3 seconds (2). The degree of damage depends on contact temperature, duration of exposure and affected skin region (3). Burns from cigarettes fall under the ‘contact burns’ category and leave particular traces compared to, for example, scald burn (caused by a hot liquid such as water or oil).

Cigarette burning is often employed in conjunction with a variety of torture methods (4). The Special Rapporteur on Torture has referred to cigarette burning as a method of torture (5) (6) (7).

In practice

The frequency of this torture method varies around the world. A Sri Lankan study from 2016 found that 57% of Sri Lankan torture victims were burned with cigarettes (1). In a 1984 Canadian study of mainly Chilean refugees, 23% of torture victims had been burned with cigarettes or cigars (8). One study of torture in six countries (Bangladesh, Iran, Peru, Syria, Turkey and Uganda) showed that burning with cigarettes was very common among Bangladeshi torture victims (71%), and less common or even absent (0-30%) in other populations of torture victims (9).

Scars resulting from cigarette burns may not always leave the same trace. In most cases, cigarette burns leave a distinctive 5-10 mm circular or oval shape scar. However, burns are sometimes placed one after another causing multiple scars that resemble a single long scar. Furthermore, if not pressed firmly to the skin, cigarettes may leave areas of hyperpigmentation that fade after a few months or years without scarring (10). The exact shape of the scar may also vary with some individuals producing raised scarring (hypertrophic) or lumpy scars that extend beyond the original wound (keloid). Some individuals may produce scars with a hyper or hypopigmented centre and a hyperpigmented relatively indistinct periphery (11).

Different types of cigarettes can lead to different burns. For example, the tip of a manufactured cigarette burns at around 400 degrees Celsius potentially resulting in serious injury compared to rolled cigarettes which are cooler and generally produce less significant damage (12).

Health consequences

Cigarette burns may lead to both physical and psychological adverse health outcomes. Perhaps the most salient physical outcome of burns is the pain they cause. Heat from the cigarette causes two kinds of burn sensation: a fast pricking pain and a slow burning pain (3). All burn wounds are susceptible to both bacterial and fungal infection which, if left untreated, may lead to complications. These infections can occur at the skin level where the wound may change colour, thickness or pain intensity (13) (14). The risk of infection is influenced by the amount of tissue burnt.

The traumatic nature of the burn and the pain may induce psychopathological responses potentially leading to psychological disorders such as depression, anxiety and post-traumatic stress disorder (PTSD) (3). Risk factors for developing these types of responses include whether the injury (or scar) is visible, whether an individual has prior anxiety and depressive mood disorders, and whether he or she has a resilient coping mechanism (4).

Conclusion

Although a few studies were conducted in certain Asian countries, literature is scant about cigarette burns and cigarette burning as a torture method. Available literature demonstrates that burns from cigarettes often result in distinctive oval-shaped scars rendering clear the employed torture method. Health consequences stemming from this method may be both physical – with infections being the greatest risk – and psychological – with the possibility of depression, anxiety and PTSD subsequently developing. Recognition of the fact that cigarette burning causes pain and may lead to adverse physical and psychological health effects is vital. Improved documentation of the practice will contribute to better learning about its prevalence and health consequences.

References
  1. Perera P. Physical methods of torture and their sequelae: a Sri Lankan perspective. J Forensic Leg Med. 2007 Apr;14(3):146–50.
  2. Das KK, Khondokar MS, Quamruzzaman M, Ahmed SS, Peck M. Assault by burning in Dhaka, Bangladesh. Burns. 2013 Feb 1;39(1):177–83.
  3. Van Loey NEE, Van Son MJM. Psychopathology and Psychological Problems in Patients with Burn Scars: Epidemiology and Management. Am J Clin Dermatol. 2003;4(4):245–72.
  4. Case of Saadi v. Italy [Internet]. 2008. Available from: file:///C:/Users/DOSO/Downloads/ECHR%20case%20law_Case%20of%20Saadi%20vs%20Italy_2008.pdf
  5. Manfred Nowak, UN Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment. Mission to Sri Lanka [Internet]. 2008 Feb. Available from: file:///C:/Users/DOSO/Downloads/A_HRC_7_3_Add-6-EN.pdf
  6. Manfred Nowak, UN Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment. Mission to Jordan [Internet]. 2007 May. Available from: file:///C:/Users/DOSO/Downloads/A_HRC_4_33_Add-3-EN.pdf
  7. Manfred Nowak, UN Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment. Mission to China [Internet]. 2006 Oct. Available from: file:///C:/Users/DOSO/Downloads/E_CN-4_2006_6_Add-6-EN.pdf
  8. Domovitch E, Berger PB, Wawer MJ, Etlin DD, Marshall JC. Human Torture: Description and Sequelae of 104 Cases. Can Fam Physician. 1984 Apr;30:827–30.
  9. Moisander PA, Edston E. Torture and its sequel--a comparison between victims from six countries. Forensic Sci Int. 2003 Nov 26;137(2–3):133–40.
  10. Hargreaves S. Book: The Medical Documentation of Torture. BMJ. 2002 Nov 2;325(7371):1044a–1044.
  11. Berman B, Viera MH, Amini S, Huo R, Jones IS. Prevention and Management of Hypertrophic Scars and Keloids After Burns in Children. J Craniofac Surg. 2008 Jul;19(4):989.
  12. Greenbaum AR, Donne J, Wilson D, Dunn KW. Intentional burn injury: an evidence-based, clinical and forensic review. Burns. 2004 Nov 1;30(7):628–42.
  13. United Nations, editor. Istanbul Protocol: manual on the effective investigation and documentation of torture and other cruel, inhuman, or degrading treatment or punishment. Rev. 1. New York: United Nations; 2004. 76 p. (Professional training series).
  14. Rafla K, Tredget EE. Infection control in the burn unit. Burns. 2011 Feb 1;37(1):5–15.

Researched and written by:
Dominique Leth-Sørensen and Laura Vestergaard Kelstrup with contribution by
Maha Aon, Lisa Michaelsen, Marie Brasholt, Brenda Van Den Bergh, Jens Modvig and Ergun Cakal.

April 2019
For questions and comments, please contact: factsheets@dignity.dk