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. 2004 Apr 16:4:3.
doi: 10.1186/1471-5945-4-3.

Contact dermatitis and other skin conditions in instrumental musicians

Thilo Gambichler  1 , Stefanie Boms, Marcus Freitag
Affiliations

Contact dermatitis and other skin conditions in instrumental musicians

Thilo Gambichler et al. BMC Dermatol. .

Abstract

Background: The skin is important in the positioning and playing of a musical instrument. During practicing and performing there is a permanent more or less intense contact between the instrument and the musician's skin. Apart from aggravation of predisposed skin diseases (e.g., atopic eczema or psoriasis) due to music-making, specific dermatologic conditions may develop that are directly caused by playing a musical instrument.

Methods: To perform a systematic review on instrument-related skin diseases in musicians we searched the PubMed database without time limits. Furthermore we studied the online bibliography "Occupational diseases of performing artist. A performing arts medicine bibliography. October, 2003" and checked references of all selected articles for relevant papers.

Results: The most prevalent skin disorders of instrumental musicians, in particular string instrumentalists (e.g., violinists, cellists, guitarists), woodwind players (e.g., flautists, clarinetists), and brass instrumentalists (e.g., trumpeters), include a variety of allergic contact sensitizations (e.g., colophony, nickel, and exotic woods) and irritant (physical-chemical noxae) skin conditions whose clinical presentation and localization are usually specific for the instrument used (e.g., "fiddler's neck", "cellist's chest", "guitar nipple", "flautist's chin"). Apart from common callosities and "occupational marks" (e.g., "Garrod's pads") more or less severe skin injuries may occur in musical instrumentalists, in particular acute and chronic wounds including their complications. Skin infections such as herpes labialis seem to be a more common skin problem in woodwind and brass instrumentalists.

Conclusions: Skin conditions may be a significant problem not only in professional instrumentalists, but also in musicians of all ages and ability. Although not life threatening they may lead to impaired performance and occupational hazard. Unfortunately, epidemiological investigations have exclusively been performed on orchestra musicians, though the prevalence of instrument-related skin conditions in other musician groups (e.g., jazz and rock musicians) is also of interest. The practicing clinician should be aware of the special dermatologic problems unique to the musical instrumentalist. Moreover awareness among musicians needs to be raised, as proper technique and conditioning may help to prevent affection of performance and occupational impairment.

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Figures

Figure 1
Figure 1
Intense skin contact with potentially chromium as well as nickel-sensitizing components on the frets and strings (arrow head) of an electric guitar's neck.
Figure 2
Figure 2
Intense skin contact with potentially chromium as well as nickel-sensitizing components on the strings and bridge (arrow head) of an electric guitar's body.
Figure 3
Figure 3
Video images (magnification, × 30) of the ring fingers of an electric guitar player who uses for picking the plectrum technique as shown in Fig. 1B. Images have been performed on the skin of the centre of the fingertips [A = left ring finger (picking hand); B = right ring finger (fretboard hand). Image of the ring finger of the fretboard hand (B) clearly demonstrates a clumsy and faded fingerprint structure as compared to the left ringer that is not used for playing.
Figure 4
Figure 4
Two-dimensional imaging with optical coherence tomography in vivo (SkinDex 300, ISIS optronics GmbH, Mannheim, Germany) of the same sites as shown in Figure 2. The border between the cornified and living epidermis is clearly seen [75]. Hence the extent of the stratum corneum from skin surface (SS) to the border of the viable layer (VL) could easily be assessed. A significantly thicker stratum corneum has been observed on the right ring finger (B) as compared to the left ring finger (A) [mean values of 3 assessments on different sites: 274 μm (A) vs 513 μm (B)].
See this image and copyright information in PMC

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