Characteristic

Fiddler’s neck - Type 1

Fiddler’s neck - Type 2

Instrument

Violin, viola

Violin, viola

Location

Left neck, submandibular area

Left neck, supraclavicular area

Source

Chin rest- solid base

Chin rest- metal brackets

Appearance

Lichenified plaque (a)

Eczematous plaque (b)

Etiology/pathogenesis

Irritant contact dermatitis

Allergic contact dermatitis

Diagnosis

Clinical history (c)

Clinical history (d)

Treatment

None or cushion

Replace chin rest (e) 

a.       The lesions of fiddler’s neck- type 1 appear as a lichenified plaque with or without hyperpigmentation. They may be accompanied by erythema, inflammatory papules or pustules, cysts or scarring.

b.       The lesions of fiddler’s neck - type 2 may be pruritic and can also present with erythema, scaling, and/or vesicles.

c.       Examination of the patient playing their instrument demonstrates that the lesion corresponds to the area that contacts the solid base of the chin rest.

d.       Examination of the patient playing their instrument demonstrates that the metal bracket of the chin rest contacts the lesion. The dimethylglyoxime test can be used to confirm that the identity of the metal is nickel. Patch testing of the patient to allergens, including nickel, can be used to establish an allergic contact dermatitis to nickel.

e.       Replace the nickel-containing chin rest with a composite chin rest which does not have a metal bracket.