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

Abstract

"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.

Fiddler’s neck: Cultural influences modify clinical presentation influences

“…The submandibular location is due to mechanical pressure and shearing forces acting on the skin. Predisposing factors include prolonged duration of contact, poor hygiene, excessive perspiration and poor technique of instrument placement [7,12,14,16 ] . It has been hypothesized that the instruments which are bigger in size like the violin have a greater tendency to cause this pathology in comparison to smaller instruments [12,16] .…”

“…As this condition is provoked by physical forces of pressure and shear, local erythema, hyperpigmentation and lichenification are more commonly seen than an eczematous lesion [8,12] . Occasionally, however, edema, inflammatory papules, pustules and scaling may develop resulting in consequent scarring [7,8,12] . Histology of lesion commonly shows hyperkeratosis, acanthosis and follicular plugging [12] .…”

“…The use of various musical instruments may be associated with certain skin conditions like contact dermatitis of the hands and lips, callosities, cellist's chest, guitar nipple and Garrod's pads. Musicians can develop skin lesions associated with the type, size, positioning and duration of the usage of their instruments [1][2][3][4][5][6][7][8] . Fiddler's neck is a dermatologic entity associated with the use of instruments like the violin, viola and cello [6,7] .…”

“…Musicians can develop skin lesions associated with the type, size, positioning and duration of the usage of their instruments [1][2][3][4][5][6][7][8] . Fiddler's neck is a dermatologic entity associated with the use of instruments like the violin, viola and cello [6,7] . It usually manifests as a red mark which subsequently heals with hyperpigmentation or develops into an eczematous lesion in the submandibular and/or the supraclavicular region.…”

Musical Instrument-Associated Health Issues and Their Management

“…Skin conditions associated with musical instruments include a variety of allergic contact sensitizations (e.g., colophony (Murphy et al 1999) and nickel (Jue et al 2010)). In addition, the localization of dermatitis tends to be instrument-specific (e.g., "fiddler's neck" (Peachey and Matthews 1978;Jue et al 2010;Caero and Cohen 2012), "cellist's chest" (Mandell 1962), "guitar nipple" (Curtis 1974), and "flautist's chin" (Dahl 1978)). …”