Yellow nail syndrome (YNS) is a rare condition that primarily affects the nails, giving them a characteristic yellow discoloration. It’s often linked to problems with the respiratory and lymphatic systems, though the exact connection isn’t fully understood.
This article will give you a complete overview of yellow nail syndrome, including what causes it, what the symptoms are, how it’s diagnosed, and how it’s managed. We’ll present this information following the style guidelines of DermNet, a trusted source for dermatological information, hence the target keyword, yellow nail syndrome dermnet.
This article is intended for medical professionals, as well as informed patients who want to learn more about this unusual condition.
Who gets yellow nail syndrome?
Yellow nail syndrome is rare, so we don’t have reliable numbers about its prevalence. It affects people of all ages, but it’s more commonly diagnosed in adults than in children.
It’s been reported all over the world, so it doesn’t seem to have a specific geographic distribution.
What causes yellow nail syndrome?
Most cases of yellow nail syndrome appear to be sporadic, meaning they occur randomly without a clear cause. However, there have been some familial cases reported, suggesting that genetics could play a role in some instances.
Researchers have found strong links between yellow nail syndrome and other conditions:
- Lymphedema
- Respiratory issues like pleural effusions, bronchiectasis, and sinusitis
- Autoimmune disorders
- Immunodeficiency
- Malignancy
Some medications, such as bucillamine and gold, have also been implicated in the development of yellow nail syndrome.
What does yellow nail syndrome look like?
Yellow nail syndrome involves changes to the nails, along with other symptoms in the body.
Nail changes
- Yellow discoloration: Nails are typically yellow, but the shade can be more greenish or brownish in some cases. The intensity of the yellow color can vary.
- Slow growth: Nails grow much more slowly than usual.
- Nail thickening: Nails may get thicker and have ridges running across them.
- Nail loss: The nail plate can separate from the nail bed, a condition called onycholysis, and the nail may fall off.
- Cuticle changes: The cuticle, the skin at the base of the nail, may disappear.
Associated features
- Lymphedema: Swelling, usually in the legs and feet, can happen before, after, or at the same time as the nail changes.
- Respiratory issues: People may have a cough that doesn’t go away, feel short of breath, and get respiratory infections often. They might also have fluid around the lungs (pleural effusions), widening of the airways (bronchiectasis), or sinus infections (sinusitis).
- Other possible symptoms: Some people may develop anemia, a condition where the body doesn’t have enough healthy red blood cells.
If you notice these symptoms, it’s important to see a doctor for proper diagnosis and care.
Pathogenesis
The exact cause of yellow nail syndrome isn’t fully understood, but here’s what the science currently suggests.
Impaired Lymphatic Drainage
One leading theory is that yellow nail syndrome results from a problem with your lymphatic system, specifically, impaired lymphatic drainage in the nail bed. Basically, fluid isn’t draining away properly.
Microvascular Changes
Another possible contributing factor involves abnormalities in the microvasculature, the tiny blood vessels in your nail bed.
Genetic Predisposition
While most cases aren’t genetic, there might be a genetic component in some rare instances, meaning you could be predisposed to developing it.
How is yellow nail syndrome diagnosed?
There’s no single test that can tell you whether you have yellow nail syndrome (YNS). Your healthcare team will likely use a combination of strategies to make a diagnosis.
Clinical evaluation
Your doctor will likely start with a thorough history and physical exam.
They’ll want to know about any nail changes you’ve noticed, as well as whether you’ve experienced any swelling (lymphedema) or respiratory problems.
Your doctor might order a nail biopsy to rule out other conditions. However, a biopsy isn’t always helpful for diagnosing YNS.
Investigations
Your doctor may order pulmonary function tests to check how well your lungs are working. They might also order a chest X-ray or CT scan to look for any fluid buildup in your lungs or signs of bronchiectasis.
Another test is lymphoscintigraphy, which evaluates how well your lymphatic system is draining fluids. Blood tests, such as a complete blood count and serum protein electrophoresis, might also be part of the workup.
Ruling out other conditions
Your doctor will also want to rule out other conditions that can cause similar symptoms, such as: fungal nail infection.
- Onychomycosis (fungal nail infection)
- Drug-induced nail changes
- Psoriasis
- Lichen planus
- Other causes of lymphedema
How is yellow nail syndrome managed?
There isn’t a single, surefire treatment for yellow nail syndrome (YNS). Caregivers and doctors often focus on treating the underlying conditions and the symptoms of YNS individually.
Treating the underlying conditions
If YNS is related to lymphedema or other health problems, doctors may recommend:
- Compression therapy or manual lymphatic drainage for lymphedema
- Antibiotics for lung infections or bronchodilators for airway obstruction if YNS is associated with respiratory issues
- Thoracentesis to drain fluid from around the lungs (pleural effusion)
Treating the nails
To address the nail symptoms, doctors may suggest:
- Topical antifungal medications (to rule out fungal infections, even if YNS is suspected)
- Oral vitamin E (which has helped some people)
- Topical or injected corticosteroids (to improve nail growth)
- Other treatments that have had mixed results, such as itraconazole, clarithromycin, or zinc supplements
Supportive care
People with YNS can also take steps to care for their nails, like preventing toenail fungus.
- Trimming their nails regularly
- Avoiding injury to the nails
If you suspect you have YNS, talk with your healthcare provider. They can help you figure out the best course of action.
Wrapping Up
Yellow nail syndrome is rare. It’s characterized by yellow nails as well as lymphedema and respiratory problems.
If you think you might have yellow nail syndrome, it’s important to get an accurate diagnosis. Early diagnosis and treatment of any underlying conditions can help improve your outcome.