View source for Yellow nail syndrome

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{{Infobox medical condition (new)
| name            = Yellow nail syndrome
| image           = Yns.jpg
| caption         = Yellow nail syndrome: This patient has a 20-year history of severe lymphedema of her legs; thick, ridged, yellowish, hypercurved thumbnails (top right); similarly affected, yellow-green to brown toenails (bottom right); and bilateral, chylous pleural effusions. A sample of her chylous pleural fluid is shown to the left of the radiograph.
|
| pronounce       = 
| field           = 
| synonym     = primary lymphedema
| symptoms        =
| complications   =
| onset           =
| duration        =
| types           =
| causes          =
| risks           =
| diagnosis       =
| differential    =
| prevention      =
| treatment       =
| medication      =
| prognosis       =
| frequency       =
| deaths          =
}}
'''Yellow nail syndrome''', also known as "'''primary lymphedema associated with yellow nails and pleural effusion'''",<ref name="Andrews">{{cite book |author=James, William D. |author2=Berger, Timothy G.|title=Andrews' Diseases of the Skin: clinical Dermatology |publisher=Saunders Elsevier |year=2006 |isbn=978-0-7216-2921-6 |display-authors=etal}}</ref>{{rp|849}} is a very rare [[medicine|medical]] [[syndrome]] that includes [[pleural effusion]]s, [[lymphedema]] (due to under development of the [[lymphatic vessel]]s) and yellow [[:wikt:dystrophy|dystrophic]] nails.<ref>{{Cite web|url=https://rarediseases.info.nih.gov/diseases/184/yellow-nail-syndrome|title=Yellow nail syndrome {{!}} Genetic and Rare Diseases Information Center (GARD) – an NCATS Program|website=rarediseases.info.nih.gov|language=en|access-date=2018-04-17}}</ref> Approximately 40% will also have [[bronchiectasis]]. It is also associated with chronic [[sinusitis]] and persistent coughing.  It usually affects adults.<ref name="titleYellow nail syndrome. DermNet NZ">{{cite web |url=http://www.dermnet.org.nz/hair-nails-sweat/yellow-nails.html |title=Yellow nail syndrome. DermNet NZ |access-date=2008-03-19 |archive-date=2013-11-15 |archive-url=https://web.archive.org/web/20131115033731/http://www.dermnet.org.nz/hair-nails-sweat/yellow-nails.html |url-status=dead }}</ref><ref name="Fitz2">Freedberg, et al. (2003). ''Fitzpatrick's Dermatology in General Medicine''. (6th ed.). McGraw-Hill. {{ISBN|0-07-138076-0}}.</ref>{{rp|665}}<ref name=Maldonado2009>{{cite journal|last1=Maldonado|first1=Fabien|last2=Ryu|first2=Jay H|title=Yellow nail syndrome|journal=Current Opinion in Pulmonary Medicine|date=July 2009|volume=15|issue=4|pages=371–375|doi=10.1097/MCP.0b013e32832ad45a|pmid=19373089|s2cid=24728854 }}</ref>

==Signs and symptoms==
The nails are markedly thickened with yellow to yellow-green discoloration of the nails.<ref name="Andrews"/>{{rp|792}}<ref name="Bolognia">{{cite book |author=Rapini, Ronald P. |author2=Bolognia, Jean L. |author3=Jorizzo, Joseph L. |title=Dermatology: 2-Volume Set |publisher=Mosby |location=St. Louis |year=2007 |pages=1020 |isbn=978-1-4160-2999-1 }}</ref> They grow slowly, at a rate of 0.25&nbsp;mm/week or less. The nails may have ridges and increased side-to-side curvature, reduction of the [[Lunula (anatomy)|white crescent]] and [[Onycholysis|detachment of the nail from the nailbed]].<ref name=Maldonado2009/> These nail abnormalities may also change over time.<ref name=Maldonado2009/>

Most people with yellow nail syndrome (four fifths) have lymphedema; it is symmetrical and typically affects both legs. It is the first symptom of the condition in about a third. Involvement of the arms and face is more unusual, as is lymphedema of the abdomen with [[ascites]] (fluid collection in the abdominal cavity) and [[Pericardial effusion|fluid collection around the heart]].<ref name=Maldonado2009/>

Various lung problems can occur in people with yellow nail syndrome. Many experience cough and [[dyspnea|shortness of breath]]. Forty percent of cases develop [[pleural effusion]]s, which are collections of fluid in the [[pleural cavity]] (the space that contains the lungs and normally only has a minimal amount of fluid in it).<ref name=Maldonado2009/> About half of all people with yellow nail syndrome have either recurrent [[Lower respiratory tract infection|chest infections]] or a chronic lung condition known as [[bronchiectasis]] which causes chronic production of [[sputum]] with episodes of worsening. Forty percent of people with yellow nail syndrome have chronic [[sinusitis]].<ref name=Maldonado2009/>

Yellow nail syndrome has been associated with some drugs, ''e.g.'' [[penicillamine]], [[bucillamine]] and [[gold sodium thiomalate]].<ref>{{cite journal|author=Nanda S|author2=Dorville F|year=2009|title=Yellow nail syndrome|journal=Canadian Medical Association Journal|volume=181|issue=9|pages=614|doi=10.1503/cmaj.080255|pmid=19770240|pmc=2764757}}</ref>

It has also been associated with exposure to titanium from dental implants or consuming food containing titanium dioxide.<ref>{{Cite journal|pmc = 3176400|year = 2010|last1 = Berglund|first1 = F|title = Titanium, Sinusitis, and the Yellow Nail Syndrome|journal = Biological Trace Element Research|volume = 143|issue = 1|pages = 1–7|last2 = Carlmark|first2 = B|pmid = 20809268|doi = 10.1007/s12011-010-8828-5}}</ref>

==Genetics==
Although it has been described in families, it has been suggested that it might not have a genetic link.<ref name="pmid17459037">{{cite journal |vauthors=Hoque SR, Mansour S, Mortimer PS |title=Yellow nail syndrome: not a genetic disorder? Eleven new cases and a review of the literature |journal=Br. J. Dermatol. |volume=156 |issue=6 |pages=1230–4 |date=June 2007 |pmid=17459037 |doi=10.1111/j.1365-2133.2007.07894.x |s2cid=44505270 }}</ref>

==Diagnosis==
The diagnosis is based on the combination of the symptoms. Generally, people are diagnosed with yellow nail syndrome if they have two or three of the three classical symptoms (yellow nails, lymphedema and pleural effusion). The nail changes are considered essential for the diagnosis, but they can be subtle.<ref name=Maldonado2009/>

[[Pulmonary function testing]] can show obstruction of the airways. People with pleural effusions may show evidence of restriction in lung volumes due to the fluid. Analysis of the fluid in pleural effusions generally shows high levels of protein but low levels of cholesterol and [[lactate dehydrogenase]], but about 30% of effusions are [[chyle|chylous]] ([[chylothorax]]) in that they have the characteristics of [[lymph]].<ref name=Maldonado2009/>

A [[lymphogram]] may be performed in people with lymphedema. This can show both under developed (hypoplastic) lymphatic ducts and dilated ducts. Dye may be found in the skin months after the initial test. [[Scintigraphy]] of lymph flow (lymphoscintigraphy) shows delays in drainage of lymph (sometimes asymmetrically), although this test can also be normal.<ref name=Maldonado2009/>

==Treatment==
Normal treatment for swelling and any respiratory problems is appropriate.  Nutritional supplementation with [[Vitamin E]] in some studies has been shown to be effective in controlling nail changes.<ref name="titleYellow nail syndrome. DermNet NZ"/>

==Prognosis==
People with yellow nail syndrome have been found to have a moderately reduced lifespan compared to people without the condition.<ref name=Maldonado2009/>

==Epidemiology==
The condition is thought to be rare, with approximately 150 cases described in the medical literature.<ref name=Maldonado2009/>

==History==
The condition was first reported by Heller in 1927 and the first case series was described in a publication in 1964 by London physicians [[Peter Derrick Samman|Peter Samman]] and William White.<ref name=Baran2021>{{cite book |last1=Baran |first1=Robert L. |last2=Vignes |first2=Stefane |editor1-last=Baran |editor1-first=Robert L. |title=Advances in Nail Disease and Management |date=2021 |publisher=Springer |location=Switzerland |isbn=978-3-030-59996-6 |chapter-url=https://books.google.com/books?id=j4YbEAAAQBAJ&pg=PA1 |language=en |chapter=1. Yellow Nail Syndrome |pages=1-4 }}</ref><ref>{{cite journal|last1=Samman|first1=PD|last2=White|first2=WF|title=The "yellow nail" syndrome|journal=The British Journal of Dermatology|date=April 1964|volume=76|issue=4|pages=153–7|doi=10.1111/j.1365-2133.1964.tb14499.x|pmid=14140738|s2cid=35463634 }}</ref><ref name=Cheslock2023>{{cite journal |last1=Cheslock |first1=Megan |last2=Harrington |first2=Douglas W. |title=Yellow Nail Syndrome |journal=StatPearls |date=2023 |url=https://www.ncbi.nlm.nih.gov/books/NBK557760/#:~:text=Yellow%20nail%20syndrome%20(YNS)%20is,reported%20by%20Heller%20in%201927. |publisher=StatPearls Publishing}}</ref> Other cases may have been recorded in 1962.<ref name=Maldonado2009/>

==References==
{{Reflist}}

== External links ==
{{Medical resources
| ICD10           = {{ICD10|L|60|5|l|60}}
| ICD9            =
| ICDO            =
| OMIM            = 153300
| MedlinePlus     = 003247
| eMedicineSubj   = article
| eMedicineTopic  = 109403
| DiseasesDB      =
| SNOMED CT       = 400211001
| Orphanet        = 662
}}
{{Disorders of skin appendages}}

{{DEFAULTSORT:Yellow Nail Syndrome}}
[[Category:Conditions of the skin appendages]]
[[Category:Respiratory diseases]]
[[Category:Syndromes]]

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