Occupational nail fragility in a professional violist

Musicians are subject to many traumatic skin and nail problems from playing their instruments (2). Fiddler's neck commonly affects violin or viola players (3). Acroosteolysis of the distal fingers can occur in guitar players (1). The movements necessary to play the various instruments explain the different clinical features of occupational traumatic nail dystrophies in musicians (24). Our patient presented with an occupational nail fragility due to the repeated microtraumas of the nails on the strings. The clinical features correlate with the fingers used to play the strings of the instrument. To play the viola, one must in fact make a repetitive compression and plucking of the strings with the distal portion of the fingers, using especially the nails. The occupational origin of the nail dystrophies in our patient is further confirmed by the appearance of the symptoms in parallel with her increased frequency of viola playing. The chemical composition and physical structure of the nail plate make it remarkably resistant to exogenous trauma. However, because the nail plate is a dead structure, each successive damage to its structure cannot be repaired and is added to that before rendering the nail plate more and more weak. Nail brittleness and worn-down nails are the possible consequences of repetitive chemical or mechanical damage to the nails (5). We suggested that our patient wear sculptured nails in order to limit trauma to the nail plate and to be able to continue to play her viola. Although needing to have her sculptured nails maintained every 2 weeks, the patient was able to continue with her profession.