Contact dermatitis in guitar players.

Abstract

Conflict of interest: none declared. Musicians are susceptible to an unusual variety of dermatoses specific to their occupation. Violin and viola players may develop ‘fiddler's neck', a lichenified plaque below the angle of the mandible on the left, corresponding to the site where the chin rests on the instrument while playing.1 Cello playing has similar hazards. Cases of ‘cello knee’, caused by the pressure applied to the instrument by the medial aspects of the knee, resulting in skin calluses, hyperpigmentation or lesions similar to fiddler's neck have been reported.2‘Cellist's chest'2 is a tender, hyperpigmented plaque with erythema, oedema, and inflammatory papules and cysts on the presternal skin, caused by the back of the instrument pressing on the chest when the bow is drawn across the strings. Harp enthusiasts can develop paronychia, onycholysis, subungual haemorrhages or calluses on the fingers as a result of playing their instrument.2 Musicians who develop an irritant contact dermatitis are thought to be relatively rare;2 however, it has been reported in horn players who use cleansers or silver polish containing solvents on their instruments.3 It is well known that colophony is present in the resin used by players of stringed instruments to wax the strings to increase the attrition between the bow and strings.4 The constituent of the instrument (especially hardwoods) may also produce a contact allergic reaction.5 We report a new ‘musician's dermatitis' affecting the hand, which was the result of nickel contact from guitar strings.