Harpist's Finger: Case Report of a Trauma-Induced Blister in a Beginner Harpist and Review of String Instrument–Associated Skin Problems in Musicians
Musicians may develop skin problems resulting from playing their instruments. Dermatologic conditions in string players usually are secondary to allergic contact dermatitis (allergens include chromium, nickel, colophony, paraphenylenediamine, propolis, and exotic woods) and physical trauma (between either the fingers and the strings or the body and the instrument). A beginner harpist who developed harpist's finger—blister and subsequent callus of her left index finger from repeated trauma between the digit and the harp strings—is described, and string instrument–associated skin problems in musicians are reviewed.
The 2 metallic substances, chromium and nickel, have been observed as allergens in musicians who play cello, guitar, harp, sitar, and violin. Allergic contact dermatitis to chromium has been described in electric guitarists, caused by contact with chromated steel components of their instruments, such as the strings, bridge, and frets, as well as the chromated leather accessories such as the guitar strap; a harpist for whom the allergen was used as a tanning agent for the harp strings; and a violinist whose E string was gold plated surrounding a chromated steel core.2,6,16 Nickel-related contact dermatitis has been described in a cellist whose wooden bow handle contained nickel, guitarists whose guitar strings contained the allergen, sitarists from the nickel mizrab covering the right index finger, and a violinist from the metal clamp of the violin's chin rest.1,3,6,8,20 Colophony (rosin) is a naturally occurring complex mixture of resin acids and neutral substances obtained from different species of coniferous trees (family Pinaceae). The principal sensitizer of colophony is abietic acid and its derivatives. Allergic contact dermatitis to colophony has been observed in cellists, violinists, and viola players who apply rosin to wax the strings on the bows of their instruments.1-8,15 Paraphenylenediamine is not only a skin sensitizer but also a skin irritant. Its principal use is in cosmetics as a black hair dye ingredient. Patch testing with a positive reaction to paraphenylenediamine was observed in an 11-year-old girl who had a cello with a black-string bow. She presented with scaling on her right thumb, index finger, and middle finger. A positive patch test result for paraphenylenediamine also was noted in a violinist who developed cutaneous eruptions located on his neck where it came into contact with the instrument's black chin rest.5-7 Propolis, also known as bee glue, has been reported to cause allergic contact dermatitis not only in musicians, such as cellists and violinists, but also in instrument makers. It can be found in many products of everyday use, such as chewing gum, facial creams, mouthwash preparations, and toothpastes. In addition, propolis is used as an ingredient in violin varnish.6,7 Exotic woods occasionally are used in the construction of the fingerboards of guitars and the body and/or chin rests of violas and violins. In string instruments, allergic contact dermatitis has been attributed to Brazilian rosewood (Dalbergia nigra), Indian rosewood (Dalbergiones species), East Indian rosewood (Dalbergia latifolia Roxb.), and ebony (Diospyros species) in chin rests and Makassar ebony in a violin. Because boxwood (Buxus sempervirens) does not contain any known allergens, it has been suggested as an alternative chin rest wood for musicians with allergic contact dermatitis to the wooden chin rest of their instrument.1,5-8 Physical trauma in musicians who play string instruments can result from the instrument or its strings. Dermatologic problems can be the sequelae of string instrument–induced physical trauma caused by the interaction of the fingers with the strings, which results in acro-osteolysis; callosities, such as harpist's fingers; Garrod pads; and nail dystrophies. Alternatively, mechanical trauma–associated skin conditions can occur secondary to pressure of the instrument against either the neck, chest, groin, knee, nipple, proximal arm, or scrotum.1,3-7,9,11-14,17-20
Conclusion
Musicians who play string instruments, such as the cello, guitar, harp, sarod, sitar, viola, and violin, can develop skin problems that usually result from either allergic contact dermatitis or physical trauma. The most common allergens are chromium, nickel, colophony, paraphenylenediamine, propolis, and exotic woods. Trauma-associated skin conditions are caused by either the interaction of the musician's fingers with the strings or pressure of the instrument against the musician's body. Harpist's finger is an example of a trauma-induced dermatologic problem, presenting as a callus on the affected finger, which may be preceded by soreness and blister formation that can be observed in beginner harpists.
