Information presented at American Academy of Dermatology’s 70th Annual Meeting by Anthony F. Fransway, MD, FAAD, of Ft. Myers, FL.
Whether your clients play a musical instrument in your school band, as a weekend hobby, or as a professional, you may be at risk for a common skin condition. 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. While metals, skin care products and cosmetics are common culprits for allergic contact dermatitis, musical instruments pose a potential hazard due to some of the components of the instruments that come into contact with the skin.
Hazard by instrument
Brass instruments (flute, trombone, trumpet, tuba)
- Metals found in the 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.
Woodwind instruments (bassoon, clarinet, oboe, saxophone)
- A variety of specific allergens are responsible for irritant contact dermatitis in cane reeds, chromium, cobalt, exotic woods and nickel.
- Lip swelling, infections and the spread of viruses (as described above) also can occur from playing these instruments. String Instruments (cellos, violas, violins)
- The composition of these instruments and products used with these instruments may contain allergens that can cause contact dermatitis in musicians: chromium, exotic woods, nickel, paraphenylenediamine (staining agent for woods), propolis (bee glue), a component of Italian varnishes used in all Stradivarius violins and rosin.
Treating contact dermatitis
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.
Whether the dermatitis is caused by an irritant or an allergy, Fransway recommends refraining from playing the instrument while the skin heals. 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.
Topical corticosteroids or calcineurin inhibitors, such as tacrolimus or pimecrolimus, can allow the dermatitis to heal.
Change is good
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 the component of the instrument causing an allergic reaction with another material is recommended. For example, mouthpieces and guitar strings are available in different compositions.
Fransway cautioned that if a change is not made, the dermatitis will recur more rapidly with each exposure.