D2.246 - Occupational contact dermatitis to chromium in guitarist

Introduction

Nickel, wood, and acrylates are allergens known to cause allergic contact dermatitis (ACD) in guitarists. In bass or electric guitars, chromium is a cause of ACD due to prolonged contact, particularly in humid conditions, with the chromium coating (body, strings, and frets). 

Case-report

A 55-year-old right-handed patient, professional guitarist for 20 years, presented with hand eczema for 4 years, which worsened shortly after changing the guitar strings. Apremilast, introduced 3 months earlier, did not improve the eczema, partially relieved with topical corticosteroids and finger cots use, and completely relieved when not playing at all. Ten days after stopping playing the guitar, there was partial resolution of the fissure pulpitis and thenar eminence eczema. He was patch tested with the European baseline series, with several supplemental series including cosmetics, rubber and gloves, metals, textile dyes, and personal care products. Semi-open tests were performed for 4 personal strings with a reading on day 4 (D4). The presence of nickel and cobalt was tested in the patient’s strings. Cobalt was detected in one of the two types of strings labelled containing it, also containing bronze. Nickel was detected in the only one identified so by the company.  

At D4, patch-tests were positive for chromium (+) and negative for strings. The eczema had improved with changing strings, eviction of leather (phone case, leather steering wheel, leather jacket he wore at every concert) and cotton gloves when playing. The patient’s guitar company confirmed chromium parts in the guitar and fabrication process.

Cobalt wasn't found in one string tested, labelled containing. The manufacturer informed different cobalt concentrations of each string in the set. All strings of one set should be tested. Unfortunately, we haven’t tested the guitar with diphenylcarbazide spot (unavailable).

Discussion 

All the string companies confirmed no chromium, in accordance with negative tests. European and American chromium regulations differ. Chromium biomarkers are studied in exposed workers using chromium, but not for musicians with several instruments, made of or treated with chromium. Despite the European directives REACH on chromium-containing cements and leather articles, there is a lack of international consensus on chromium. Notably, indirect and not systematic exposure to chromium among guitar players (guitar and leather daily used) reinforces the need for exhaustive tests and international regulation.