Musicians at risk for common skin condition

Hazards 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 these musicians.
  • Cane reeds
  • Chromium
  • Cobalt
  • Exotic woods
  • 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
  • Rosin

Treating Contact Dermatitis:

See a dermatologist

• 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.

Take a break

• Whether the dermatitis is caused by an irritant or an allergy, Dr. 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 a component of the instrument causing an allergic reaction with another material is recommended.
  • For example, mouthpieces and guitar strings are available in different compositions.
  • Dr. Fransway cautioned that if a change is not made, the dermatitis will recur more rapidly with each exposure.

Tips for Sharing Instruments:

• 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.
• Practice good hygiene.