title: Fiddler's neck: Chin rest-associated irritant contact dermatitis and allergic contact dermatitis in a violin player.
abstract: Fiddler's neck refers to an irritant contact dermatitis on the submandibular neck of violin and viola players and an allergic contact dermatitis to nickel from the bracket attaching the violin to the chin rest on the violinist's supraclavicular neck. A 26-year-old woman developed submandibular and supraclavicular left neck lesions corresponding to the locations of the chin rest and bracket that was attached to her violin that held it against her neck when she played. Substitution of a composite chin rest, which did not contain nickel, and the short-term application of a low potency topical corticosteroid cream, resulted in complete resolution of the allergic contact dermatitis supraclavicular neck lesion. The irritant contact dermatitis submandibular neck lesion persisted. In conclusion, violin players are predisposed to developing irritant contact dermatitis or allergic contact dermatitis from the chin rest. We respectfully suggest that the submandibular neck lesions from contact with the chin rest be referred to as 'fiddler's neck - type 1,' whereas the supraclavicular neck lesions resulting from contact of the bracket holding the chin rest in place be called 'fiddler's neck - type 2.' A composite chin rest should be considered in patients with a preceding history of allergic contact dermatitis to nickel.
authors.affiliation: The University of Texas Medical School at Houston, Houston, Texas, USA.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Caero
authors.forename: Philip R
authors.initials: PR
authors.lastname: Cohen
mesh_terms: D000328:Adult; D002680:Chin; D017449:Dermatitis, Allergic Contact / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology*; D017453:Dermatitis, Irritant / Q000175:diagnosis*; D009783:Dermatitis, Occupational / Q000175:diagnosis* / Q000188:drug therapy; D003879:Dermatologic Agents / Q000627:therapeutic use; D003898:Desonide / Q000627:therapeutic use; D005260:Female; D006801:Humans; D009146:Music; D009333:Neck; D009532:Nickel / Q000009:adverse effects*; D063465:Skin Cream / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D003879:Dermatologic Agents; D009532:Nickel; D003898:Desonide