jwilzewske: ‘Tis the Season for Violin Hickeys

A common skin condition experienced by violinists and violists at both the amateur and professional level is ‘fiddlers’ neck’, an area of hyperpigmentation and lichenification on the left side of the neck, below the angle of the jaw. Erythema, scaling, cyst formation, scarring, and inflammatory papules or pustules [of the skin that experiences prolonged contact with the instrument/chinrest] also occur. Focal neck edema can lead to concerns about the cosmetic appearance ... These skin changes have been attributed to a number of factors, including poor technique leading to increased pressure of the instrument on the skin of the neck, increased friction between the instrument and the skin caused by a poorly fitting chin rest or an inadequate shoulder rest, poor hygiene, and even the size of the instrument. Viola players may be more prone to have fiddlers’ neck than violinists because the instrument is larger and heavier [and imposes proportionately larger biomechanical stresses on the cervical skin, that augment the contact intensity under which contact dermatitis arises and that impair skin integrity and/or compromise the skin’s compensatory repair processes in proportion to the greater pressure of skin contact associated with the heavier instrument—leading to greater prevalence of the problem among violists and to greater severity and chronicity of the lesions in violists who experience the condition, compared to violinists who have similar weekly contact time-exposure profiles with their instruments].”
— Liu S, Hayden G. Maladies in musicians. Southern Med J 2002; 95:727-34. (citing Peachey & Matthews 1978).

S everal emails to CMT recently have asked about ‘fiddlers’ neck’—inquiring about whether there are any new treatments for it, or asking about the effectiveness (or lack thereof) of specific skin-care products.

B arrier cream for allergic contact dermatitis doesn’t really help—it’s not effective for mechanical dermatitis like what happens with violin and viola. Emollient creams and emollient soap substitutes are pretty effective in managing the condition, as are topical steroids and antibiotics if the area becomes infected.

H ere are things that actually work, for most people:

Minimize washing of the affected skin—Frequent or prolonged water exposure actually dries out the skin and disrupts the barrier function of the epidermis.
Apply moisturizing lotion/cream on the affected skin—Frequent moisturization improves the barrier function of the skin. Avoid the use of moisturizers with perfumes since these may also act as irritants.
Apply topical steroid cream/lotion—Potent topical steroid (e.g., 0.2% to 1.0% hydrocortisone or equivalent) help to reduce inflammation.
Apply topical analgesics—Pramoxine or similar compounds—can relieve itching or irritation, which can in turn help to minimize the severity of continued mechanical trauma to the affected area.

O vertreatment dermatitis’ or ‘iatrogenic dermatitis’ is a form of secondary dermatitis that occurs when treatment for another skin disorder causes irritation. The case of someone in whom treatment of violin hickey with hydrocortisone causes worsening, rather than improvement, of the hickey, would be termed an iatrogenic secondary dermatitis complicating the primary violin contact dermatitis.

The information on this page is not intended as medical advice and is not meant to be a substitute for individual medical judgment by a physician or other medical healthcare professional. The aim is to provide information and help in suggesting considerations for preventive care. Some products, such as corticosteroids, should be used only after a medical examination and under the supervision of a doctor. Always consult a licensed healthcare provider for individualized advice on your health decisions.

ic1805 valentine nebula, NASA photo (c) Matt Russell

jwilzewske

Monday, February 9, 2009

‘Tis the Season for Violin Hickeys

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