A 57-year-old woman presents with all 20 nails looking like this. You immediately ask to see her feet and legs and ask her about any cough, SOB or lung problems. You order a CXR and refer her to pulmonary.

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.

• The nails grow slowly and turn yellow probably from lymphatic obstruction.
• Pulmonary disease may include pleural effusion, chronic bronchitis, and bronchiectasis.
• It is thought caused by malformations of the lymphatic system.
• The yellowish color is probably due to lipofuscin pigment, resulting from lipid oxidation of free radicals
• In one study of 20 patients, the average age at diagnosis was 57 and most had involvement of all 20 nails. 16/20 had chronic respiratory manifestations and 6/20 had lymphedema.
  
• The lymphedema affects the lower extremities.
• The pleural effusion is exudative, lymphocyte-predominant, bilateral, and recurrent in the majority of cases.

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.

Additional Photographs

RegionalDerm

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