Musicians at Risk for Contact Dermatitis

Overview

Whether you play a musical instrument in your school band, as a weekend hobby, or as a professional, you may be at risk for contact dermatitis.

Contact dermatitis is characterized by a rash that can occur anywhere on the body (typically the hands and face in musicians) and is caused by something that comes into contact with the skin, which makes the skin become red, scaly and inflamed.

Contact dermatitis can be caused by an irritant or an allergy. Metals, skin care products and cosmetics are common culprits for allergic contact dermatitis, but musical instruments pose a potential hazard due to some of the components of the instruments that come into contact with the skin.

Instrument hazards for contact dermatitis

Metals found in brass instruments, such as nickel, cobalt, palladium, silver and gold, can cause contact dermatitis.

Lip swelling can result from the pressure of forcing air through instrument mouthpieces.

Infections of Staphylococcus aureus (MRSA and non-MRSA) and herpes simplex virus can spread through the sharing of mouthpieces.

Human papillomavirus (HPV) and Hepatitis A, B and C also can be spread if instruments are not cleaned properly.

With woodwind instruments (bassoon, clarinet, oboe, saxophone), lip swelling, infections and the spread of viruses (as described above) can occur. Specific allergens responsible for irritant contact dermatitis in musicians include:

• Cane reeds
• Chromium
• Cobalt
• Exotic woods
• Nickel

The composition of string instruments such as cellos, violas, violins, and the products used with these instruments may contain allergens that can cause contact dermatitis in musicians including:

• Chromium
• Exotic woods
• Nickel
• Paraphenylenediamine (staining agent for woods)
• Propolis (bee glue), a component of Italian varnishes used in all Stradivarius violins
• Rosin

Treating contact dermatitis in musicians

To determine whether the contact dermatitis is due to an irritant or an allergy, it is important for musicians to see a dermatologist for proper evaluation and treatment. A dermatologist can perform patch testing to identify the cause of the dermatitis. Once the cause is known, the dermatologist can help the musician determine what changes should be made in order to return to playing the instrument. Refrain from playing the instrument while the skin heals. Topical corticosteroids or calcineurin inhibitors (TCIs) , such as tacrolimus or pimecrolimus, may be prescribed.

Tips for avoiding or improving a contact dermatitis flare

• If the musician has irritant contact dermatitis caused by friction or pressure, modifying the area of contact with the instrument — such as wearing protective gloves — may help improve the condition.
• If allergic contact dermatitis is the culprit, substituting a component of the instrument such as mouth pieces or guitar strings, with another material is recommended.
• If sharing is to occur, mouthpieces should be cleaned with soap and water or with alcohol to prevent the spread of infection.
• Keep instruments clean and replace worn or damaged parts in intimate contact with the body.

Musicians spend so much time seeking perfection in their chosen media that the musical instrument becomes an extension of their physical bodies. Occasionally, like the rest of one’s anatomy, those body parts have issues that can result in medical conditions — such as contact dermatitis — that require proper treatment. A dermatologist can identify the appropriate measures to rectify the problem and restore harmony.