Fiddler’s Neck and Nickel
Review of: Fiddler’s neck: Chin rest-associated irritant contact dermatitis and allergic contact dermatitis in a violin player
Original Article: Caero, Jennifer E & Cohen, Philip R. (2012). Fiddler’s neck: Chin rest-associated irritant contact dermatitis and allergic contact dermatitis in a violin player. Dermatology Online Journal, 18(9).
Reviewed by: Jacqueline Chen, BA. MSII
- String players such as violinists and violists can develop dermatitis (inflammatory skin disease), colloquially called ‘Fiddler’s Neck, which may occur on the submandibular region (just below the jaw) or the supraclavicular (on the neck) region.
- Submandibular Fiddler’s neck, or Fiddler’s neck type 1, refers to the irritation caused by mechanical frictional that occurs following prolonged contact with the chinrest.
- Submandibular Fiddler’s neck is often described as a lichenified (thickened) plaque that may be darker than the surrounding skin.
- Four main factors contribute to Fiddler’s neck Type I: pressure of the fiddle, friction, hygiene, and the instrument position.
- A barrier cushion and adjustment to more horizontal positioning of the instrument has been recommended between the chinrest and submandibular neck to avoid fiddler’s neck type 1
- Supraclavicular Fiddler’s neck, or Fiddler’s neck Type II occurs from contact allergy to the materials in the chinrest apparatus on the instrument.
- Supraclavicular dermatitis usually presents as a pruritic (itchy) and erythematous (red) eczematous plaques.
- Allergic contact dermatitis (the allergic skin response) to the chinrest is most often caused by nickel sulfate in the bracket that holds the chinrest to the instrument, but can also be caused by allergens in the composite woods.
- The diagnosis of Fiddler’s neck Type 2 is often made based on the patient history and through observing the musician playing his/her instrument to evaluate the contact point of the rash with the instrument.
- A patch test is the diagnostic test to confirm allergic contact dermatitis
- Notably, sweat can dissolve nickel, contributing to its corrosion and increasing nickel absorption by skin.
- To confirm nickel release, the dimethylglyoxime (DMG) test can be used
- https://www.youtube.com/watch?v=dJFcHo5fDbY
- Treatment of supraclavicular Fiddler’s neck should be focused on avoidance of the component in the chinrest containing the allergenic material.
- Submandibular Fiddler’s neck, or Fiddler’s neck type 1, refers to the irritation caused by mechanical frictional that occurs following prolonged contact with the chinrest.
To read the article by Caero and Cohen please click here.
If you suffer from an allergy to your musical instrument, and would like to participate in a nickel allergy awareness survey, please click here.
