Yellow nail syndrome is a serious condition that can cause yellowed or stained nails after removing dark polish.

Despite its rarity and life-threatening symptoms, it’s vital to be familiar with YNS.

History and Cause

The YNS affects fingernails, toenails, and even newborns. Most commonly, it affects adults older than 50 years old. However, children and newborns are also susceptible.

Orphanet’s Journal of Rare Diseases cited less than 400 cases in 2017; the earliest was published in 1927. In 1964, a more detailed analysis of 13 YNS patients was published. This gave doctors a better understanding of the rare condition.

It’s unlikely that YNS can be inherited. Some studies have connected the disease with abnormal lymphatic drainage, while others suggest that the development of YNS is linked to exposure to dental implants containing titanium.

Diagnosis

Dr. Patricia Gaile Espinosa, a board-certified dermatologist, stresses the importance of an accurate history and physical examination to prevent a misdiagnosis. Espinosa says that there is no specific test to diagnose YNS, but tests for infection, chest radiography, and analysis of nail scrapings are all possible.

Doctors must eliminate any nail infections that could cause yellow nails before diagnosing the patient with YNS. Some individuals with YNS can develop paronychia, or nail fold infection.

A nail biopsy is performed to determine if there are any fungus, yeast or mold present. A negative biopsy, which indicates the absence of mold, yeast and fungus, will lead a physician to diagnose a systemic condition such as lymphedema. Dr. Bruce Pinker, a foot and ankle surgeon, says that if these conditions are present but a toenail biopsied is negative, a diagnosis of lymphedema should be considered.

YNS Symptoms and Signs

Lymphedema – A swelling caused by a buildup of lymphatic fluid in the body.

Sinusitis – A sinus infection that results in a blocked nose or a stuffy nose.

Bronchiectasis– The symptoms include frequent infections and a persistent cough.

Pleural effusion– A condition where excess fluid accumulates around the lung.

Onycholysis– Nail separation.

Yellow nail syndrome is a serious condition that can cause yellowed or stained nails after removing dark nail polish. YNS is a rare condition, but its symptoms are life-threatening.

Symptoms

The nails may become thicker, curled, or separated from the nailbed.

The nails of those with YNS are not always yellow. They may appear normal or pale yellow, or even dark green. As indicated in Orphanet Journal’s review of YNS, a doctor may have trouble diagnosing YNS without the nail discoloration. This is true even if there are respiratory or lymphatic health issues.

In one third of YNS cases, lymphedema was the initial symptom. YNS patients also often have respiratory issues, including a chronic cough or fluid in the lungs, or swelling in the lower extremities. The journal Chest examined 41 cases of YNS in 2008 and found that 63 per cent of patients had lymphedema, and all but one of them suffered from chronic respiratory problems. More than 40% of these patients had fluid in the lungs and similar numbers had a persistent cough.

Pinker says that a single symptom is a sure sign of YNS. If the nail is thick and partially or completely detached, without a curticle, it is most likely YNS.

Treatment

Treatment of YNS symptoms may include antibiotics, corticosteroid treatment and surgery for respiratory issues. In the Chest study, more than half of the patients with YNS managed their symptoms successfully using these treatments. Espinosa says that the goal of treatment is managing symptoms as there is no cure for YNS.

Orphanet Journal reported vitamin E is more effective when combined with antifungal medication in treating YNS. Some cases of YNS have spontaneously stopped.

Supplementing with biotin may help slow-growing nail, but it will have no effect on nails that are already stopped in their growth. Pinker says that there are few treatment options if the nail is traumatized and yellow, or if it grows slowly. Some patients remove their nails if the nail is unsightly, or causes pain or discomfort.

The symptoms of YNS are common and can have a negative impact on quality of life. A doctor’s diagnosis is crucial.

By the Numbers: YNS

1964 : First analysis of known YNS Cases published

400 : number of confirmed cases of YNS worldwide reported as of 2017.

50+: Age group most at risk for YNS

1/3 : Percentage people with YNS reporting swelling as the first symptom