How safe is the habitual use of incense sticks?

Incense burning (agarbatti/dhoop) is deeply rooted in Indian cultural, spiritual, and Ayurvedic traditions, where it symbolizes purification, devotion, and tranquillity. However, increasing scientific evidence suggests that habitual use may pose significant health hazards. This correspondence highlights the overlooked toxicological burden of incense smoke. A clinical case of allergic contact dermatitis with depigmentation, induced by prolonged incense exposure, exemplifies its dermatological risks. Beyond fragrance, burning incense generates a complex mixture of gases and particulate matter, including carbon monoxide, nitrogen oxides, volatile organic compounds, aldehydes, and polycyclic aromatic hydrocarbons—many with known irritant, mutagenic, or carcinogenic potential. Fine particulates (PM₂.₅, PM₁₀) contribute to oxidative stress, airway inflammation, and systemic absorption. Epidemiological studies from Asian and Middle Eastern populations link long-term incense use to asthma, chronic bronchitis, cardiovascular dysfunction, and elevated risks of respiratory and nasopharyngeal cancers. Vulnerable groups such as children, elderly individuals, and pregnant women are particularly at risk due to prolonged indoor exposure. While Ayurveda prescribes dhoopana karma using natural resins, modern incense products often incorporate synthetic binders and perfumes, magnifying hazards. Mitigation strategies include improved ventilation, reduced frequency, safer formulations, and regulatory oversight. Balancing cultural continuity with scientific caution is essential for safeguarding public health.