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Contact Cheilitis in a Saxophonist

Musicians are a risk group for various skin diseases because intense contact between the instrument and the skin is usually needed during playing. Clinical presentation and localization are related to the specific instrument. Cheilitis in woodwind players (eg, saxophonists, flautists, and clarinetists) and brass instrumentalists (eg, trumpeters) is frequently observed. It is mostly an irritant dermatitis, but allergic contact sensitization (eg, to colophony, nickel, and exotic woods) has been described. A 26-year-old saxophonist was first referred to us with a 6-month history of a patch of erythema, desquamation, hyperkeratosis, and peripheric vesiculation of the median area of the lower lip (Fig 1). The disease developed about 2 months after he replaced the plastic reed on his saxophone with a wood reed. The result of patch tests with the Società Italiana di Dermatologia Allergologica Professionale e Ambientale standard series was negative. The result of patch testing with fragments of the wood reed wetted with water was positive (++). The same test was performed in 10 volunteers, including another saxophonist, and showed negative results. The patient returned to playing with plastic reeds, and the cheilitis subsided after a few weeks.