YELLOW NAIL SYNDROME

By Gary M. White, MD

Yellow Nail Syndrome


Yellow nail syndrome (YNS) is the triad of deformed yellow nails, primary lymphedema, and pulmonary disease. Strictly, two of the three are required for diagnosis.

Clinical

The nails grow slowly and become quite thickened and yellow. For some patients, the condition becomes painful as the nail digs into the tissue. The yellow nails may turn brown. In one study of 20 patients [J Dtsch Dermatol Ges. 2014 Feb;12(2):131-7], the average age at diagnosis was 57 and most had involvement of all 20 nails. Sixteen patients had chronic respiratory manifestations and 6 had lymphedema. The primary lymphedema affects the lower extremities. The pleural effusion is exudative, lymphocyte-predominant, bilateral, and recurrent in the majority of cases.

Treatment

There is no reliable therapy. DMSO and vitamin E have been reported helpful anecdotally, but this author has not had good results. In one study, 10/20 patients had a good response to systemic vitamin E 200 IU/day [J Dtsch Dermatol Ges 2014 Feb;12:131-7]. Nail avulsion with permanent ablation of the matrix for both great toes has been helpful in one patient in order to reduce the pain.

Additional Pictures

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