Yellow Nail Syndrome (YNS) is a rare disorder characterized by a triad of symptoms: yellow nails, lymphedema, and respiratory tract involvement. This syndrome often presents with a combination of these features, though not all patients exhibit the full triad.

Triad of Symptoms

1. Nail Changes:

• Nail Appearance: All nails may be affected. They typically grow slowly or may appear to stop growing altogether. The nails become thicker and exhibit a pale yellow or greenish-yellow color, with edges that are slightly darker.
• Nail Texture: Nails often remain smooth but may display cross-ridging and become humped with loss of cuticles.
• Onycholysis: Separation of the nail from the nail bed may occur, extending from the tip to the base, which can cause nail shedding.

2. Lymphedema:

• Swelling: Affects approximately 80% of patients, primarily in the legs, and is typically symmetric and non-pitting. Swelling may appear after nail changes and can sometimes be delayed by several months.
• Affected Areas: While the lower extremities are most commonly affected, swelling in the hands, face, or genitals is less frequent.

3. Respiratory Tract Involvement:

• Pleural Effusions: Occur in about 36% of patients, with approximately 30% experiencing pleural effusions as an initial symptom.
• Other Respiratory Issues: Patients may also experience recurrent bronchitis, chronic sinusitis, pneumonia, or bronchiectasis (chronic dilation of the larger airways).

Clinical Features

• Nail Features: Nails are thickened and strikingly yellow, with increased longitudinal and transverse curvature. There may be a lack of visible lunula (the white area at the base of the nail). The nail fold can be red and inflamed, and onycholysis is common.
• Dermoscopy: May reveal dilated and tortuous capillary loops in the nail fold.

Pathophysiology

The pathophysiology of Yellow Nail Syndrome is not well understood. Both microangiopathy and titanium exposure have been suggested as potential factors, but conclusive evidence is lacking.

Diagnosis and Management

• Diagnosis: Based on the presence of the characteristic triad and supported by dermoscopy findings.
• Treatment:
  • Nail Treatment: Topical vitamin E solutions and oral itraconazole are used to stimulate nail growth. Although YNS is not caused by fungal infections, itraconazole and fluconazole, which are antifungal agents, may promote nail growth.
  • Respiratory Improvement: Improvement in respiratory symptoms often correlates with better nail condition.

Once established, the nail changes associated with YNS are usually permanent, though management can help alleviate symptoms and potentially improve nail appearance.

Prognosis

The prognosis of Yellow Nail Syndrome varies depending on the severity of symptoms and response to treatment. Management focuses on symptomatic relief and monitoring for potential complications.

Back to Index

The medical information provided in this site is for educational purposes only and is the property of the American Osteopathic College of Dermatology. It is not intended nor implied to be a substitute for professional medical advice and shall not create a physician - patient relationship. If you have a specific question or concern about a skin lesion or disease, please consult a dermatologist. Any use, re-creation, dissemination, forwarding or copying of this information is strictly prohibited unless expressed written permission is given by the American Osteopathic College of Dermatology.