Fiddler's neck

Last updated
Fiddler's neck
Other namesViolin hickey, viola love bite
Specialty Occupational health

Fiddler's neck is an occupational disease that affects violin and viola players. [1]

Contents

It is a cutaneous condition usually characterized by redness, thickening, and inflammation on the left side of the neck below the angle of the jaw where the instrument is held. [1] Acne-like lesions and cysts may form at the site due to foreign body reactions, and infections may also occur due to poor hygiene. [1] The primary causes of fiddler's neck are constant friction and local pressure. [2] It is well known among professional orchestra musicians but is "not well recognized by dermatologists", [2] and a red mark on the left side of the neck under the jaw "functions as an identifying sign" of a violinist or violist "in public without seeing the instrument". [3]

Although the presence of fiddler's neck is sometimes used as an indicator of a violinist's skill, or 'battle scars' from constant practice, many violinists never develop fiddler's neck, due to differences in skin sensitivity, playing habits, and the materials used in the construction of the instrument. An accomplished professional player could practice hard their whole life and never develop fiddler's neck.

Signs and symptoms

Fiddler's neck usually involves highly localized lichenification, mild hyperpigmentation, and erythema where the chin rest or instrument body presses against the skin of the neck. [2] Other signs and symptoms include scale buildup, cyst and scar formation, papules and pustules related to local infection, and focal edema. [1] In Blum & Ritter's study in West Germany (1990), they found that 27% of their population had only minor issues, 72% had a palpable mass at the site, and 23% reported pain and other signs of inflammation such as hyperthermia, pulsation, and cystic, pustular, or papular lesions. [3] Size of masses were an average of 2 cm in diameter ranging up to 4 cm, some being associated with purulent drainage, continuous discharge, and crusting. Dystrophic calcinosis cutis has also been reported. [4] Other serious sequelae include sialolithiasis of the submandibular gland and adenolymphoma of the parotid gland. [3]

The histopathology of fiddler's neck frequently shows hyperkeratosis and acanthosis, along with plugging of follicles. [2] Histiocytic infiltration with granulomas to foreign body and follicular cysts are also common. [3] Foreign body granulomas are thought to derive from abrasion of the wooden surface of the chin rest and its absorption into the superficial dermis. [3] The location and complex mechanism of causation for fiddler's neck give rise to a wider spectrum of skin changes when compared to contact dermatitis from more common irritants. [1] Fiddler's neck can be differentiated from rosacea and sarcoid reaction with granulomas. [1]

Causes

The proximal causes of fiddler's neck are friction and pressure, but both repetitive shearing stress and occlusion with consequent trapping of sweat give rise to progressive damage. [1] This damage along with poor hygiene predisposes the area to local infection, and such infection can progress to scarring and other long-term effects. [1] Hot weather is reported to exacerbate fiddler's neck, as are tiredness, playing emotional music, and playing in smaller groups where individual stress is higher. [2] Type I hypersensitivity reactions may also be involved, particularly to rosewood and ebony in the chinrest and tailpiece, as well as to varnish of the instrument body when chinrests are not used and to rosin deposits on the instrument and on chin cloths. [3] Nickel or other metal allergies are common causes if the chin rest has a metal clip that comes into constant contact with the skin. Rosin exposure in particular may lead to abietic acid dermatitis. [3]

Diagnosis

Differential diagnoses

The differential diagnoses of fiddler's neck include branchial cleft cyst, disease of the salivary glands, tumors of the parotid gland, psoriasis, lichen planus, contact dermatitis, herpes simplex and similar infections, and insect bites and stings especially from fleas. [1] [3]

Treatment

Treatment for fiddler's neck is unnecessary if it is painless and shows minimal swelling, [3] particularly since minor cases are taken as a mark of pride. But fiddler's neck may lead to worse disorders. The primary methods of treatment involve adjustments to playing of the instrument: [3] [5]

Surgery is necessary for sialolithiasis, parotid tumors, and cysts. [3] Cervical lymph nodes that are larger than 1 cm must be biopsied. [3] Connective tissue can be removed by excision when a non-inflamed mass is large, and there is generally little recurrence. [3] Infections should be treated conservatively, and causative species should be identified through smear and culture for appropriate antibiotic selection. [3] Reduction of playing time may be helpful for cases without inflammation, but in 30% of cases this did not improve the symptoms. [3]

Prevalence

Fiddler's neck does not usually form unless the musician is practicing or playing for more than a few hours each day, and only seems to develop after a few years of serious playing. [2] Thus, when not infected or otherwise problematic, fiddler's neck may be known as a benign practice mark and may be worn proudly as an indication of long hours of practice. [3] Blum & Ritter (1990) found that 62% of 523 professional violinists and violists in West Germany experienced fiddler's neck, with the percentage among violists being higher (67%) than among violinists (59%). [3] Viola players are believed to be more predisposed to developing fiddler's neck than violinists because the viola is larger and heavier, but this has not been empirically confirmed. [2]

The development of fiddler's neck does not depend on preexisting skin problems, and Blum & Ritter find that only 23% of men and 14% of women in their study reported cutaneous disorders in other parts of the face (mainly acne and eczema) that were independent of playing the violin or viola. [3] Fiddler's neck may exacerbate existing acne, but acne may also be limited solely to the lesion and not appear elsewhere. [2] Nonetheless, musicians with underlying dermatologic diseases like acne and eczema are more endangered by fiddler's neck than others. [3] Males may develop folliculitis or boils due to involvement of beard hair. [3]

Related Research Articles

<span class="mw-page-title-main">Parotid gland</span> Major salivary gland in many animals

The parotid gland is a major salivary gland in many animals. In humans, the two parotid glands are present on either side of the mouth and in front of both ears. They are the largest of the salivary glands. Each parotid is wrapped around the mandibular ramus, and secretes serous saliva through the parotid duct into the mouth, to facilitate mastication and swallowing and to begin the digestion of starches. There are also two other types of salivary glands; they are submandibular and sublingual glands. Sometimes accessory parotid glands are found close to the main parotid glands.

<span class="mw-page-title-main">Folliculitis</span> Human and animal disease of follicles

Folliculitis is the infection and inflammation of one or more hair follicles. The condition may occur anywhere on hair-covered skin. The rash may appear as pimples that come to white tips on the face, chest, back, arms, legs, buttocks, or head.

<span class="mw-page-title-main">Sebaceous gland</span> Gland to lubricate the hair and skin

A sebaceous gland or oil gland is a microscopic exocrine gland in the skin that opens into a hair follicle to secrete an oily or waxy matter, called sebum, which lubricates the hair and skin of mammals. In humans, sebaceous glands occur in the greatest number on the face and scalp, but also on all parts of the skin except the palms of the hands and soles of the feet. In the eyelids, meibomian glands, also called tarsal glands, are a type of sebaceous gland that secrete a special type of sebum into tears. Surrounding the female nipple, areolar glands are specialized sebaceous glands for lubricating the nipple. Fordyce spots are benign, visible, sebaceous glands found usually on the lips, gums and inner cheeks, and genitals.

<span class="mw-page-title-main">Rosacea</span> Skin condition resulting in redness, pimples and swelling, usually on the face

Rosacea is a long-term skin condition that typically affects the face. It results in redness, pimples, swelling, and small and superficial dilated blood vessels. Often, the nose, cheeks, forehead, and chin are most involved. A red, enlarged nose may occur in severe disease, a condition known as rhinophyma.

<span class="mw-page-title-main">Pseudofolliculitis barbae</span> Medical condition

Pseudofolliculitis barbae (PFB) is a type of irritant folliculitis that commonly affects people who have curly or coarse facial hair. It occurs when hair curls back into the skin after shaving, causing inflammation, redness, and bumps. This can lead to ingrown hairs, scarring, and skin discoloration. PFB can be treated with various methods, including changing shaving habits, using topical creams or ointments, and undergoing laser hair removal. Prevention measures include proper shaving techniques, using sharp razors, and avoiding too close a shave.

<span class="mw-page-title-main">Acne keloidalis nuchae</span> Medical condition

Acne keloidalis nuchae (AKN), also known as "acne keloidalis", "dermatitis papillaris capillitii", "folliculitis keloidalis", "folliculitis keloidis nuchae", and "nuchal keloid acne", is a destructive scarring folliculitis that occurs almost exclusively on the occipital scalp of people of African descent, primarily men.

<span class="mw-page-title-main">Comedo</span> Medical condition

A comedo is a clogged hair follicle (pore) in the skin. Keratin combines with oil to block the follicle. A comedo can be open (blackhead) or closed by skin (whitehead) and occur with or without acne. The word "comedo" comes from the Latin comedere, meaning "to eat up", and was historically used to describe parasitic worms; in modern medical terminology, it is used to suggest the worm-like appearance of the expressed material.

<span class="mw-page-title-main">Chinrest</span>

A chinrest is a shaped piece of wood attached to the body of a violin or a viola to aid in the positioning of the player's jaw or chin on the instrument. The chinrest may be made of ebony, rosewood, boxwood, or plastic.

<span class="mw-page-title-main">Sialadenitis</span> Medical condition

Sialadenitis (sialoadenitis) is inflammation of salivary glands, usually the major ones, the most common being the parotid gland, followed by submandibular and sublingual glands. It should not be confused with sialadenosis (sialosis) which is a non-inflammatory enlargement of the major salivary glands.

Hidradenitis is any disease in which the histologic abnormality is primarily an inflammatory infiltrate around the eccrine glands. This group includes neutrophilic eccrine hidradenitis and recurrent palmoplantar hidradenitis.

<span class="mw-page-title-main">Feline acne</span> Medical condition

Feline acne is a problem seen in cats primarily involving the formation of blackheads accompanied by inflammation on the cat's chin and surrounding areas that can cause lesions, alopecia, and crusty sores. In many cases symptoms are mild and the disease does not require treatment. Mild cases will resemble dirt on the cat's chin, but the "dirt" will not brush off. More severe cases, however, may respond slowly to treatment and seriously detract from the health and appearance of the cat. Feline acne can affect cats of any age, sex or breed, although Persian cats are also likely to develop acne on the face and in the skin folds. This problem can happen once, be reoccurring, or even persistent throughout the cat's life.

<span class="mw-page-title-main">Neonatal acne</span> Medical condition

Neonatal acne, also known as acne neonatorum, is a type of acne that develops in newborns, typically before 6 weeks of life. It presents with open and closed comedones on the cheeks, chin and forehead.

Acne mechanica is an acneiform eruption that has been observed after repetitive physical trauma to the skin such as rubbing, occurring from clothing or sports equipment. In addition to those mechanisms, the skin not getting enough exposure to air also contributes to the formation of acne mechanica. It is often mistaken as a rash that forms on sweaty skin that is constantly being rubbed, but in reality, it is a breakout of acne mechanica. The term "acne" itself describes the occurrence in which hair follicles in the skin get clogged by oil, dead skin cells, dirt and bacteria, or cosmetic products and create a pimple. Pimples can vary in type, size, and shape, but the sole basis of them occurring is the same - the oil gland in the pore becomes clogged and sometimes infected, which creates pus in order to fight the infection and subsequently causes the development of swollen, red lesions on the skin.


Acne necrotica presents with a primary lesion that is a pruritic or painful erythematous follicular-based papule that develops central necrosis and crusting and heals with a varioliform scar.

<span class="mw-page-title-main">Malassezia folliculitis</span> Medical condition

Malassezia folliculitis or Pityrosporum folliculitis, is a skin condition caused by infection by Malassezia yeast.

<span class="mw-page-title-main">Abietic acid dermatitis</span> Medical condition

Abietic acid dermatitis is a contact dermatitis often seen in association with musical instruments.

Sodium hypochlorite washes are skin cleansers formulated with sodium hypochlorite (NaOCl) and surfactants. These cleansing liquids or gels are lathered onto wet skin and rinsed off. They are recommended for inflammatory skin conditions, microbial driven skin disorders and body odor.

The intense contact between a musical instrument and skin may exaggerate existing skin conditions or cause new skin conditions. Skin conditions like hyperhidrosis, lichen planus, psoriasis, eczema, and urticaria may be caused in instrumental musicians due to occupational exposure and stress. Allergic contact dermatitis and irritant contact dermatitis are the most common skin conditions seen in string musicians.

References

  1. 1 2 3 4 5 6 7 8 9 Gambichler, T.; Boms, S.; Freitag, M. (2004). "Contact dermatitis and other skin conditions in instrumental musicians". BMC Dermatology. 4: 3. doi: 10.1186/1471-5945-4-3 . PMC   416484 . PMID   15090069.
  2. 1 2 3 4 5 6 7 8 Peachey, R. D.; Matthews, C. N. (1978). "'Fiddler's neck'". The British Journal of Dermatology. 98 (6): 669–674. doi:10.1111/j.1365-2133.1978.tb03586.x. PMID   150281. S2CID   32261268.
  3. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Blum, Jochen; Ritter, G. (December 1990). "Violinists and violists with masses under the left side angle of the jaw known as "fiddler's neck"". Medical Problems of Performing Artists. 5 (4): 155–160. ISSN   0885-1158. Archived from the original on 2013-12-02. Retrieved 2013-11-26.
  4. ↑ Oga, A.; Kadowaki, T.; Hamanaka, S.; Sasaki, K. (1998). "Dystrophic calcinosis cutis in the skin below the mandible of a violinist". The British Journal of Dermatology. 139 (5): 940–941. doi:10.1046/j.1365-2133.1998.02544.x. PMID   9892983. S2CID   46091824.
  5. ↑ Myint, Calvin W.; Rutt, Amy L.; Sataloff, Robert T. (February 2017). "Fiddler's Neck: A Review". Ear, Nose & Throat Journal. 96 (2): 76–79. doi:10.1177/014556131709600210. ISSN   0145-5613. PMID   28231367. S2CID   11454026.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.