While handling musical instruments there is a greater or lesser degree of direct contact between the skin and the instrument, which makes this collective to be more prone to develop some skin conditions.

Allergic contact dermatitis, irritant/traumatic dermatitis, infectious events and miscellaneous skin conditions may occur in brass musicians123.

We report a 21-year-old man who works as a trumpeter in the Spanish Orchestra since 2006. Shortly after he began playing the trumpet in the orchestra, he presented upper lip and tongue lesions, which he related with playing the trumpet (Fig. 1).

The patient plays a trumpet of the brand Stomvi®. The trumpet contains three valves which are greased with lubricant oils in order to propel the sound through the instrument. The patient first developed skin lesions with a gold mouthpiece (Stomvi®; Stomvi, Valencia, Spain), which persisted despite changes to other mouthpieces of the same brand containing silver or titanium. The patient previously used five lubricant oils consecutively (Stomvi® and Premium®; Stomvi), Hetman slide gel® (Hetman), Holton key oil® (Holton, Elkhart, IN, USA), Fast al Cass® (Fast, USA) and he applied moisturizer (Eucerin ph5®; Eucerin, Barcelona, Spain) to the lips before playing the trumpet. Epicutaneous tests were performed with True Test® (Martitor, Barcelona, Spain) and Chemotechnique Diagnostics® (Dormer Laboratories Inc., FL, USA) reagents, a metal series (Chemotechnique Diagnostics®), the patient's own oils and topical lip ointments.

Readings were negative after 48 and 96 hours for all the allergens, except for an irritant reaction to all lubricant oils (Fig. 2). Lubricant oils were tested in five healthy volunteers, observing the same reaction but shorter in duration and intensity.

The patient avoided the use of all lubricant oils and changed to lanoline oil, tolerated by other musicians reporting the same problem and currently, is completely asymptomatic.

We contacted oil manufacturers; however, we only obtained the makeup of Stomvi® lubricant oil, which was made up of 100% aliphatic hydrocarbons. Few cases of contact allergy to industrial water-insoluble greases and lubricant oils have been described in the literature45.

We report the first case of irritant contact dermatitis in a brass musician due to lubricant oils used to grease the trumpet valves.

The diagnose was based on the irritant reactions observed to lubricant oils and negative results to other reagents in patch testing and finally, due to the cause-effect relationship in using lubricant oil as etiological agent of the skin lesions. Considering that patient co-workers have presented similar reactions, it may be a frequent complaint in brass musicians and therefore, lanoline oil should be considered as an alternative brass lubricant in patients with negative patch testing for this allergen. In addition, we should be aware about the possibility that certain factors123 in conjunction with irritant oils might help in developing irritant contact dermatitis.

We believe that this case report can alert of the possibility of irritant contact dermatitis due to lubricant oils, so manufacturers could develop oils with a more suitable composition. This, along with adopting proper preventive measures in relation to the practice of the instrument, could reduce this skin conditions, and potential work impairment and incapacity.