Yellow nail syndrome

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 22/04/2025

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234 Yellow nail syndrome

Instruction

Look at this patient’s hands.

Salient features

History

• Ask about past history of sinusitis

• History of chronic cough, bronchiectasis, pleural effusion, recurrent lung infections

• History of lymphoedema

• Ask about associated disorders:

• Malignancy: melanoma, carcinoma of larynx, lung and breast, Hodgkin’s disease
• Thyroid disease: Hashimato’s thyroiditis, hypothyroidism, thyrotoxicosis
• Hypogammaglobulinaemia
• Rheumatoid arthritis.

Examination

• Yellow discoloration of all the nails. The nails are often smooth, thickened and overcurved. There is no involvement of the skin.

Proceed as follows:

• Tell the examiner that you would like to:

• examine the chest (for pleural effusion, bronchiectasis)
• examine the legs for lymphoedema.

Remember: Yellow nail syndrome is the differential diagnosis of chronic pleural effusions that has been present for >1 year, for bronchiectasis and rhinosinusitis.

Diagnosis

This patient has yellow nail syndrome (lesion) complicated by severe bronchiectasis (functional status).

Advanced-level questions

What is the pathogenesis?

The pathogenic mechanism underlying the yellow nail syndrome has not been defined. Abnormality of lymphatic vessels was suggested as the cause by Samman and White in their original description of the syndrome (Br J Dermatol 1964;76:153–7). This theory is supported by lymphangiographic findings which in most patients showed few, hypoplastic or dilated, deficient lymphatics. Electron microscopy in two cases noted dilated but otherwise normal lymphatics (J Am Acad Dermatol 1983;10:187–92).

What is the treatment?

Therapy (Chest 2008;134:375–381) includes:

• Bronchopulmonary hygiene (e.g. postural drainage)

• Symptomatic exacerbations: inhaled steroids and antibiotics

• Pleural effusions: serial thoracocentesis or pleurodesis

• Lymphoedema: compression stockings, postural therapy, low-salt diet and diuretics

• Yellow nails: often improves spontaneously; treatment with vitamin E has been proposed.

This syndrome was first described in 1964 by PD Samman and WF White.

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