Contact dermatitis and other skin conditions in instrumental musicians

Dermatologic conditions in dancers: a statewide survey

Performing artists, such as dancers, singers, actors and musicians, rely on their physical bodies to successfully execute their artforms. However, literature regarding dermatologic conditions that impact dancers is lacking. An anonymous REDCap® secure survey was distributed by email to Dance Majors, Dance Minors, and Dance Instructors/Professors at five Virginia undergraduate institutions. Responses regarding demographics, style of dance, and dermatological diseases were recorded over a 2 month period. When asked about developing skin disease, 57 (59%) of survey participants reported experiencing skin diseases, such as acne, eczema, hyperhidrosis, and plantar warts. When asked about skin diseases exacerbated or believed to be caused from dancing, 56 (59%) reported blisters, callouses, skin splitting, nail/foot infection, ingrown nails, and floor burns. This study demonstrates two main findings: dancing may exacerbate current skin disorders and some skin conditions may be caused by dancing. Additionally, the common practice of dancing barefoot likely contributes to the development of certain skin conditions. Limitations include sample size, response bias, and lack of validation of the survey.

Changes in Dento-Facial Morphology Induced by Wind Instruments, in Professional Musicians and Physical Exercises That Can Prevent or Improve Them-A Systematic Review

The aim of this study is to highlight the changes that occur regarding dento-facial morphology, facial, and masticatory muscles in musicians who play wind instruments. Anatomical and functional changes may occur after the long-term use of each type of wind instrument. We considered studies of the impact of playing the wind instrument on the masticatory muscle activity and the resulting modifications. Both children and adults can be affected by playing wind instruments in regard to tooth positioning and facial morphology. These changes relate to the type of wind instruments, the type of vowels and tones used by instrumentalists. There most valuable breathing techniques have been identified that improve the redistribution of pressure, with a minimizing effect on the morphological changes in the oral cavity and cephalic extremity, implicitly on the masticatory functional disorders. In addition to these beneficial effects on the stomatognathic system, these breathing techniques favorably increase lung capacity. Furthermore, a series of toning exercises for neck muscles-which are actively involved and overworked by wind instrument-playing artists-was identified. The study concludes that less experienced instrumentalists demonstrate increased facial muscle engagement, possibly leading to excessive strain, while experienced instrumentalists exhibit more optimized patterns of muscle activity. The novelty of this research lies in its interdisciplinary approach to understanding the influence of wind instruments on dento-facial morphology, addressing preventive and corrective measures to mitigate undesirable outcomes.

Prevalence and antibiotic resistance of Staphylococcus aureus associated with a college-aged cohort: life-style factors that contribute to nasal carriage

Staphylococcus aureus is an opportunistic human pathogen that can frequently be found at various body locations, such as the upper respiratory tract, nostrils, skin, and perineum. S. aureus is responsible for causing a variety of conditions, which range from minor skin infections and food poisoning to life-threatening sepsis and endocarditis. Furthermore, S. aureus has developed resistance to numerous antimicrobial agents, which has made treatment of S. aureus infections difficult. In the present study, we examined lifestyle factors that could increase the likelihood of S. aureus carriage, the overall prevalence of S. aureus, as well as assessed the antibiotic resistance profiles of the S. aureus isolates among a population of college students. Five hundred nasal samples were collected and analyzed via selective growth media, coagulase and protein A testing, as well as polymerase chain reaction and DNA sequencing. One hundred four out of the 500 samples collected (21%) were identified as containing S. aureus. The S. aureus isolates were resistant to penicillin (74%), azithromycin (34%), cefoxitin (5%), ciprofloxacin (5%), tetracycline (4%), and trimethoprim (1%), but sensitive to gentamicin and rifampin. Lastly, we identified several lifestyle factors (i.e., pet exposure, time spent at the university recreational facility, musical instrument usage, and tobacco usage) positively correlated with S. aureus nasal colonization.

Nipple eczema: A systematic review and practical recommendations

The nipple is the focal point of the human breast and serves important physiological, sexual, and aesthetic purposes. It can be affected by atopic, irritant, and allergic contact eczema, which often reduce the patient's quality of life. The objective of this article is to discuss the different types of nipple eczema and highlight relevant differential diagnoses and treatment options. A systematic search of PubMed was conducted to identify and critically appraise the existing literature on the topic. All articles on nipple eczema were considered eligible, regardless of publication date, language or study design. A final of 33 manuscripts on nipple eczema remained. The scarce literature and the limited number of high-quality manuscripts impedes provision of structured data on nipple eczema. To securely reach the educative value of this manuscript, the systematic review was combined with a manual databank search and selected manual search of textbooks. The differential diagnosis of nipple eczema encompasses among others nipple psoriasis, nipple candidiasis and Paget's disease. In case of diagnostic uncertainty, swabs or biopsies are indicated. Treatment of nipple eczema needs to rapidly control the signs and symptoms of the disease, since it can have a negative effect on quality of life and can lead to premature arrest of breastfeeding. The key treatment step is starting with topical corticosteroids or calcineurin inhibitors, both of which are considered safe during lactation. Avoidance of provoking factors, such as repetitive friction, chemical agents, or allergens, can help. The use of nipple protection devices can be proposed for nursing women and sometimes adjusting of latch/suck positioning during breastfeeding is needed. Furthermore, patients should be advised to moisturize the nipple intensively and to switch to emollient wash products. Warm water compresses, black tea compresses or commercially available tannin containing topicals can provide comfort.

Occupational Dermatoses

Occupational skin diseases (OSDs) are one of the major problems in working life. Among occupational diseases, 30-45% are skin diseases. Contact dermatitis accounts for the greatest part (95%) of OSDs. It adversely affects the quality of life of workers. Classification of OSD is too difficult as there are geographical variations in the occupational groups affected. However, commonly affected occupational groups are agricultural workers, healthcare workers, construction workers, metal workers, cleaners, housekeepers, food handlers, hairdressers, beauticians, and mechanics. Because of the unorganized workplace, lack of a proper notification system for occupational dermatoses, and under-reporting of cases, there is a paucity of information regarding the magnitude of the problem of OSD in India. Although in India many studies have been conducted on individual small occupational groups, data on the complete epidemiology of OSD is limited. In this article, we have tried to compile the common OSDs in various occupations.

Propolis Affects Pseudomonas aeruginosa Growth, Biofilm Formation, eDNA Release and Phenazine Production: Potential Involvement of Polyphenols

Pseudomonas aeruginosa (P. aeruginosa) is an opportunistic pathogen responsible for a wide range of clinical conditions, from mild infections to life-threatening nosocomial biofilm-associated diseases, which are particularly severe in susceptible individuals. The aim of this in vitro study was to assess the effects of an Albanian propolis on several virulence-related factors of P. aeruginosa, such as growth ability, biofilm formation, extracellular DNA (eDNA) release and phenazine production. To this end, propolis was processed using three different solvents and the extracted polyphenolic compounds were identified by means of high performance liquid chromatography coupled to electrospray ionization mass spectrometry (HPLC-ESI-MS) analysis. As assessed by a bioluminescence-based assay, among the three propolis extracts, the ethanol (EtOH) extract was the most effective in inhibiting both microbial growth and biofilm formation, followed by propylene glycol (PG) and polyethylene glycol 400 (PEG 400) propolis extracts. Furthermore, Pseudomonas exposure to propolis EtOH extract caused a decrease in eDNA release and phenazine production. Finally, caffeic acid phenethyl ester (CAPE) and quercetin decreased upon propolis EtOH extract exposure to bacteria. Overall, our data add new insights on the anti-microbial properties of a natural compound, such as propolis against P. aeruginosa. The potential implications of these findings will be discussed.

Low Level of Allergens in the Argentinean Plant Zuccagnia punctata Cav.: Screening and Quality Control of North-Western Propolis Using an LC-DAD-QTOF System

North-western Argentinean propolis (NAP), having promising bioactivity, was recently included into the National Food Code. Zuccagnia punctata Cav., a native shrub of north-western Argentina, is one of the prevalent botanical sources of NAPs, but no information on its allergenic constituents was available so far. A liquid chromatography-diode array detector -quadrupole-time of flight system (LC-DAD-QTOF) was used as a screening method for the reliable identification of sensitizing agents belonging to caffeic acid derivatives in Z. punctata and in two NAPs collected in the provinces of Catamarca and Tucumán. Caffeic acid phenethyl ester, one of the most active allergens in propolis, was never detected in either Z. punctata or NAP. Among 31 sensitizers, only geranyl caffeate was alleged in Z. punctata as <10% of its major constituent, whereas three caffeic acid derivatives with strong allergenic effect, i.e., geranyl, pentenyl, and benzyl caffeates, occurred in NAP samples (29%–36% of the Z. punctata major constituent), indicating other minor botanical sources. However, the high content of chalcones and flavonoids ascribed to Z. punctata significantly contributes to the antiallergenic and antioxidant character of these NAPs. This peculiar chemical profile depends on the extremophile condition in which this shrub grows and suggests other studies to characterize such raw materials for oral and topical formulations.

Occupational Health and the Performing Arts: An Introduction

OBJECTIVE

Workplace hazards in the performing arts cause injuries, disabilities, and deaths every year. Occupational health professionals are familiar with most of these hazards and are particularly qualified to contribute to efforts to reduce them. This article reviews current health issues in the performing arts and highlights opportunities for occupational health contributions.

METHODS

Recognized experts in performing arts medicine were consulted and articles illustrating performing arts health issues were reviewed. Literature sources included medical databases, unindexed art-health publications, and popular press articles.

RESULTS

Resources discussing hazards and health issues in theater, dance, voice, and instrumental musicians were located and reviewed.

CONCLUSIONS

Treatment providers have a history of involvement with segments of the performing arts. The occupational health approach to workplace health issues can effectively complement these efforts. Sources of further information on performing arts health concerns are available.

[Skin and mucosal diseases in musicians]

Whether they are professional or amateur, musicians are exposed to a various number of complications in relation to their practice, including cutaneous ones. The latter are often a simple musical stigma and a reason for pride for the musician. If they are symptomatic and disturb the musician, they have to be treated and prevented. We reviewed here those occupational and peculiar lesions that are often not that well known to the dermatologist.

Fiddler's Neck: A Review

Fiddler's neck is a common dermatologic condition associated with instrument use in violin and viola players. It typically manifests as a submandibular and/or supraclavicular lesion. It is a benign condition, but it may be mistaken for lymph-edema or a salivary gland malignancy. Otolaryngologists who treat patients with fiddler's neck should be aware of appropriate management protocols and the need to avoid surgical excision. We obtained informed consent from 3 violinists to present their cases as specific examples of fiddler's neck. In addition, we present a literature review based on our PubMed search for articles about this instrument-induced dermatitis. The literature suggests that submandibular fiddler's neck is caused by mechanical pressure and shear stress on the skin and that it can present as erythema, scarring, edema, and lichenification. Supraclavicular fiddler's neck, on the other hand, is caused by allergic contact dermatitis, and it can present as an eczematous, scaly, and/or vesicular lesion. In most cases, a good history (especially of string instrument use), physical examination, and a patch test are sufficient to diagnose this condition. Management of fiddler's neck includes a topical steroid, proper instrument handling, neck padding, changing the instrument's materials, and/or reducing the amount of playing time. Surgical excision is usually not advisable.

Involvement of blood mononuclear cells in the infertility, age-associated diseases and cancer treatment

Blood mononuclear cells consist of T cells and monocyte derived cells. Beside immunity, the blood mononuclear cells belong to the complex tissue control system (TCS), where they exhibit morphostatic function by stimulating proliferation of tissue stem cells followed by cellular differentiation, that is stopped after attaining the proper functional stage, which differs among various tissue types. Therefore, the term immune and morphostatic system (IMS) should be implied. The TCS-mediated morphostasis also consists of vascular pericytes controlled by autonomic innervation, which is regulating the quantity of distinct tissues in vivo. Lack of proper differentiation of tissue cells by TCS causes either tissue underdevelopment, e.g., muscular dystrophy, or degenerative functional failures, e.g., type 1 diabetes and age-associated diseases. With the gradual IMS regression after 35 years of age the gonadal infertility develops, followed by a growing incidence of age-associated diseases and cancers. Without restoring an altered TCS function in a degenerative disease, the implantation of tissue-specific stem cells alone by regenerative medicine can not be successful. Transfused young blood could temporarily restore fertility to enable parenthood. The young blood could also temporarily alleviate aging diseases, and this can be extended by substances inducing IMS regeneration, like the honey bee propolis. The local and/or systemic use of honey bee propolis stopped hair and teeth loss, regressed varicose veins, improved altered hearing, and lowered high blood pressure and sugar levels. Complete regression of stage IV ovarian cancer with liver metastases after a simple elaborated immunotherapy is also reported.

Musician Health and Safety

Musicians are exposed to high-risk musculoskeletal activities such as repetition, hours of exposure, and awkward postures when playing instruments. These activities may result in playing-related musculoskeletal disorders. Musicians often work part-time or seasonally or are self-employed. Thus, they may be uninsured or underinsured and may delay seeking care for these painful and potentially disabling conditions. Prevention of playing-related musculoskeletal disorders includes identification of both intrinsic (e.g., musician strength and flexibility) and extrinsic (e.g., musician posture while playing an instrument) factors involved in the interface between musicians and their instruments and the playing environment (e.g., rest breaks or hours of practice). Student occupational health nurse practitioners in this pilot project performed outreach and comprehensive screening and treatment for a small group of musicians diagnosed as having playing-related musculoskeletal disorders. Tendon and nerve gliding exercises were a key component of the treatment plan.

Fragrance allergic contact dermatitis

Fragrances are a common cause of allergic contact dermatitis in Europe and in North America. They can affect individuals at any age and elicit a spectrum of reactions from contact urticaria to systemic contact dermatitis. Growing recognition of the widespread use of fragrances in modern society has fueled attempts to prevent sensitization through improved allergen identification, labeling, and consumer education. This review provides an overview and update on fragrance allergy. Part 1 discusses the epidemiology and evaluation of suspected fragrance allergy. Part 2 reviews screening methods, emerging fragrance allergens, and management of patients with fragrance contact allergy. This review concludes by examining recent legislation on fragrances and suggesting potential additions to screening series to help prevent and detect fragrance allergy.

Seborrheic dermatitis due to Malassezia species in Ahvaz, Iran

BACKGROUND AND OBJECTIVE

Seborrheic dermatitis (SD) is a frequent disorder of the skin that is distinguished by the development of erythematous patches and yellow-gray scales. It is a multifactor disease that requires predisposing factors for its progress. Presence of these factors leads to reproduction of opportunistic yeast Malassezia spp. The aim of the present study was to isolate and identify distribution of Malassezia species on the scalp of SD patients in Ahvaz using modified Dixons agar.

MATERIALS AND METHODS

A total of 110 patients diagnosed with SD were sampled. The sampling was carried out by brushing the hair and collecting the dandruff in paper pockets. For identification of Malassezia species, the scalp scales were cultured in Dixons agar. A combination of different characteristics including yeast cell morphology, ability to grow on Sabouraud dextrose agar, catalase test and ability to utilize individual Tweens (20, 40, 60 & 80) were used for identification of species.

RESULTS

Twenty-seven of 110 (24.5%) SD patients had positive cultures for Malassezia species of which 17 (63%) were male and 10 (37%) were female. The most commonly identified Malassezia species was M. globosa (40.7%) followed by M. pachydermatis (22.2%), M. furfur (11.1%) and M. restricta(7.4%) and Malassezia species (18.5%).

CONCLUSION

Malassezia globosa was considered to be the most important orgaism involved in cases with Seborrheic dermatitisin this study.

Prevalence of dermatitis in the working population, United States, 2010 National Health Interview Survey

BACKGROUND

Prevalence patterns of dermatitis among workers offer clues about risk factors and targets for prevention, but population-based estimates of the burden of dermatitis among US workers are lacking.

METHODS

Data from an occupational health supplement to the 2010 National Health Interview Survey (NHIS-OHS) were used to estimate the prevalence of dermatitis overall and by demographic characteristics and industry and occupation (I&O) of current/recent employment.

RESULTS

Data were available for 27,157 adults, including 17,524 current/recent workers. The overall prevalence rate of dermatitis among current/recent workers was 9.8% (range among I&O groups: 5.5-15.4%), representing approximately 15.2 million workers with dermatitis. The highest prevalence rates were among I&O groups related to health care. Overall, 5.6% of dermatitis cases among workers (9.2% among healthcare workers) were attributed to work by health professionals.

CONCLUSIONS

Dermatitis affected over 15 million US workers in 2010, and its prevalence varied by demographic characteristics and industry and occupation of employment. The prevalence rate of work-related dermatitis based on the NHIS-OHS was approximately 100-fold higher than incidence rates based on the Bureau of Labor Statistics' Survey of Occupational Illness and Injury.

Air guitarist's knee--a new musical injury

Rock music may be bad for your knees as well as your ears.

Fiddler's Neck Accompanied by Allergic Contact Dermatitis to Nickel in a Viola Player

"Fiddler's neck" is an irritant contact dermatitis that frequently affects violin and viola players. The etiology of the skin changes associated with this condition are probably attributable to a combination of factors--including increased pressure, friction, poor hygiene, and excessive perspiration. Clinically, the lesions generally consist of a localized area of lichenification on the left side of the neck just below the angle of the jaw. Herein, we report a case of fiddler's neck in a viola player, attended by allergic contact dermatitis to the nickel in the metal fixtures of a viola. We hope that our case report draws the attention of dermatologists toward this, and many other skin problems that affect musicians.

The Treatment Dilemma Caused by Lumps in Surfers’ Chins

This is an account of 2 male surfing enthusiasts who recently sought care at our hospital after developing tumorous masses on their chins. Although the lesions appeared grossly benign, establishing a definitive treatment plan was perplexing because of the insidious nature of the protuberances. The lesion in the first patient was managed surgically. The approach was modified for the second patient because of information learned from the first. While the technical aspects of care management were simple, once the histologic structure of the tumor was defined, establishing an accurate clinical diagnosis before surgery was troublesome. The histologic findings for the lesion removed from the first patient consisted of primarily parenchymal fibrosis without concomitant structural abnormalities in overlying epidermis, suggesting that repetitive blunt trauma to the chin area while paddling the surfboard was probably the factor responsible for the pathogenesis of tumor formation. These findings and our experience in managing the 2 patients have formed the basis of this report.

Airborne contact dermatitis in gaitas (flageolets) constructors after exposure to sawdust of caviuna

Exotic wood species are used in the manufacture of furniture, musical instruments, tool handles, and other wooden items. Exposure to sawdust of the wood can produce dermatitis on exposed areas in woodworkers. We studied 7 patients, gaitas constructors who used caviuna wood to make their instruments. They developed dermatitis on exposed areas hours after they had begun to work with caviuna. We performed patch tests using the European standard series, caviuna sawdust sample, and a series of dalbergiones. 15 controls were performed. Two caviuna samples provided by a patient were analysed by thin-layer chromatography (TLC). Patch test with caviuna sawdust yielded positive reactions in all patients. 5 of the 7 sufferers reacted strongly to obtusaquinine and (R)-4-methoxydalbergione deriving from Dalbergia retusa, but also to sensitizers present in other rosewoods. Patch tests with R-3,4-dimethoxydalbergione deriving from Machaerium scleroxylum remained negative in the patients, as well as in control subjects. The TLC analysis of the samples showed that the woods could have been M. scleroxylum, D. cearensis or D. frustescens, but not D. retusa. In our patients, airborne contact dermatitis was caused by exposure to caviuna sawdust. The patients must have been in contact with different Dalbergia species and especially with D. retusa.