What is Yellow Nail Syndrome: Causes, Signs, Symptoms, Treatment, Complications

Yellow nail syndrome is a rare medical condition which is associated with yellow nails and pleural effusion. Yellow nail syndrome affects the fingernails and toenails and is usually a symptom of an underlying medical condition. People, who get this yellow nail syndrome, also have respiratory problems and lymphatic system problems with swelling in the lower parts of their body. Yellow nail syndrome can occur in anyone, but it is more commonly seen in people above the age of 50.

Yellow nail syndrome is characterized by swelling, which is a collection of lymph under the soft tissue of the skin. Lymph is a colorless fluid that circulates throughout the lymphatic system of your body, which is produced by the body tissues and travels through the body’s arteries and circulates through the tissues to cleanse them.

It has been observed in many studies that Yellow Nail Syndrome occurs with greater frequency in individuals with certain forms of cancer and other conditions/disorders like immunodeficiency syndromes, nephritic syndrome, thyroid disease and rheumatoid arthritis.

Unknown Etiology & Age: The exact cause of Yellow Nail Syndrome remains unknown till now. The cases of Yellow Nail Syndrome occur sporadically; however, this condition is more prevalent in individuals above the age of fifty.

Hereditary: Somewhere in the medical research literature, yellow nail syndrome is identified as a genetic disorder. Familial history is considered as one of the important causative factors of yellow nail syndrome. The transmission of the autosomal dominant trait is responsible for the transmission of the disease genetically. When a single gene, or a group of genes responsible for certain specific traits are transferred from one individual to other, it results in the transmission of a specific trait from one generation to another. The gene responsible for the transmission of yellow fever can be transmitted from parent to the children or else, it can be the result of a gene mutation as well. The frequency and possibility of a gene to get transferred from parent to children is 50%, which is irrespective of the sex of the child.

Other Medical Conditions: As stated above, Yellow Nail Syndrome occurs with greater frequency in individuals with certain forms of cancer and other conditions/disorders like immunodeficiency syndromes, nephritic syndrome, thyroid disease and rheumatoid arthritis.

Problems with Lymphatic System: It is also said that yellow nail syndrome sometime occurs because of a malfunction of the lymphatic system including yellow nails, lymph edema, and respiratory abnormalities. Our lymphatic system is a mesh of vessels that transmits the fluids from one part of the body to another and keeps it clean as well. Any abnormality in the lymphatic system might block certain lymph vessels, which could lead to a swelling under the soft tissue of the skin leading to such symptoms.

The characteristic features of Yellow Nail Syndrome are mentioned below:

Change in Appearance of the Nail: A characteristic appearance of yellow and thickened nail instead of a normal appearing nail is one of the most common sign and symptom of yellow nail syndrome. The nail when affected with this syndrome will be excessively curved. Loss of the strip of hardened skin at the base and sides of a fingernail or cuticles may also occur once affected with yellow nail syndrome.

Nail Stops Growing: The nail stops growing when affected with yellow nail syndrome.

Development of Onycholysis: Onycholysis is another salient feature of yellow nail syndrome. In this case, the nail will be separated from the nail bed and might start falling out in worst cases.

Development of Paronychia: In some of the cases, the nail bed and the soft tissue is also affected. The entire soft tissue or the soft tissue at the edge of the nails is affected in many cases. And both toenails and finger nails can be affected by Yellow Nail Syndrome. This condition is referred to as paronychia.

Respiratory Symptoms: Individuals with yellow nail syndrome may or may not have a history of respiratory problems before developing characteristic nail findings. The presence or absence of respiratory problems varies from one individual to another.

Yellow nail syndrome is also found to be present in people suffering from pleural effusion. Pleural effusion is the accumulation of fluid in the membranes surrounding the lungs and lining the chest cavity. Shortness of breath generally occurs in Pleural effusion. Additional respiratory problems that may occur in Yellow Nail Syndrome are chronic infection and inflammation of the main air passages, which are called bronchial tubes (bronchitis), destruction and widening of the small air passages out of the lung (bronchiectasis), ongoing inflammation of the membranes that line the sinus cavities or sinusitis and/or chronic inflammation or infection of the lungs or recurrent pneumonias.

Yellow nail syndrome is diagnosed on the basis of the presence of two of the three classic clinical manifestations, including nail changes, respiratory disorders and lymphedema; Or else, it is characterized by a remarkable change in the appearance of nail since it is not necessary for all of the above mentioned signs to be present in a single patient at the same time to confirm Yellow Nail Syndrome. So, the diagnosis can also be based on the basis of remarkable changes in the size and shape of the nail.

When the physician sees a considerable change in the shape and size of the nails, other systemic diseases are also suspected. Yellow nail syndrome is also associated with kidney diseases, diabetes and fungal infections. All these conditions should be treated by a physician after proper consultation. Another sign is the appearance of respiratory disease or respiratory difficulties when you have Yellow Nail Syndrome. When the above mentioned signs are seen in an individual, the physician orders pulmonary tests; fungal infections are checked and the samples are taken.

No specific treatment is available for yellow nail syndrome. The underlying signs and symptoms and associated disease need to be diagnosed and treated to treat yellow nail syndrome. The physician will provide specific treatments for diseases like pleural effusion, difficulty in breathing, immunodeficiency syndromes, nephritic syndrome, thyroid disease and rheumatoid arthritis. Lymph drainage will be advised to treat lymphedema.

For treating the affected nail in Yellow Nail Syndrome, the below mentioned treatment is effective and can be followed:

• Topical or oral vitamin E for nail discoloration.
• Corticosteroids to treat the infection.
• Oral zinc tablets.
• Antifungal medications to treat the fungal infection.
• Antibiotics in the case of other underlying infections.

One complication that can occur if yellow nail syndrome is left untreated is bronchiectasis. In bronchiectasis, the small airways or the alveoli in your lung become abnormally widened and weak and the airway mucus does not move. The patient has shortness of breath and chronic production of cough and mucus. When left untreated, the patient might end up developing pulmonary pneumonia of the lungs.