Yellow nail syndrome

Yellow nail syndrome is a rare condition that affects the fingernails and toenails. People who develop this condition also have respiratory problems and lymphatic system problems with swelling in the lower parts of their body.

Swelling is caused by a buildup of lymph under the soft tissue of the skin. Lymph is a colorless fluid that circulates throughout your body and helps cleanse it. Yellow nail syndrome can occur in anyone, but usually occurs in adults over the age of 50.

Yellow nail syndrome is when nails gradually turn yellow and thicken. Symptoms also include:

  • the loss of the cuticle, which is part of the protective skin covering the nail
  • nails that curve
  • nails that stop growing
  • nails that separate from the nail bed
  • nail loss

Yellow nail syndrome sometimes increases the risk for an infection around the soft tissue of the nails.

Fluid accumulation often accompanies yellow nail syndrome. So you may develop fluid between the membranes that surround the outside of your lungs, a condition known as pleural effusion. This can cause several respiratory problems, such as:

  • chronic cough
  • shortness of breath
  • chest pains

Respiratory problems may occur before or after your nails begin to change in color and shape.

In addition to having a pleural effusion and its associated respiratory difficulty, other breathing problems may occur in yellow nail syndrome. These include chronic sinusitis or recurrent respiratory infections such as pneumonia.

Lymphedema is also associated with yellow nail syndrome. This condition arises from an accumulation of lymph. Signs include swelling mainly in your legs, but possibly also in your arms.

The exact cause of yellow nail syndrome is unknown.

This condition can start sporadically for no apparent reason, which occurs in most cases. Even so, in rare cases, it’s believed it may run in families. A mutation of the FOXC2 gene — which causes a disorder called lymphedema-distichiasis syndrome — may play a role in developing yellow nail syndrome. More research is needed to confirm this, as other literature currently reports that there is no known genetic factor for yellow nail syndrome.

Another belief is that yellow nail syndrome results from problems with lymphatic drainage. Improper circulation and drainage of lymph allows fluid to collect in the soft tissue under the skin, which may slowly turn nails yellow.

Yellow nail syndrome can also develop on its own or occur with certain types of cancers, autoimmune diseases like rheumatoid arthritis, and immunodeficiencies.

You shouldn’t ignore a change in nail color or shape, especially if your nails turn yellow. Yellow nails can indicate a problem with your liver or kidney, diabetes mellitus, fungal infections, or psoriasis, which need to be treated by a doctor.

If you develop yellow nails along with swelling or respiratory problems, see a doctor.

A doctor may diagnose yellow nail syndrome if you exhibit primary symptoms of the condition. Your doctor may also order a pulmonary function test to measure how well your lungs work or take a sample of your nail to check for fungus.

Yellow nail syndrome is also associated with bronchiectasis, which is when the small airways in your lung become abnormally widened, weak, and scarred. In bronchiectasis, airway mucus can’t be properly moved. As a result, you could end up developing pneumonia if your lungs fill up with germy mucus and become infected. This bronchiectasis, in addition to the fluid that builds up in the pleural space outside of the lungs, causes lung problems.

There’s no one treatment for yellow nail syndrome. Treatment addresses specific symptoms of the condition and may include:

  • topical or oral vitamin E for nail discoloration
  • corticosteroids
  • oral zinc
  • antifungal medications
  • antibiotics in the case of bacterial sinusitis, lung infections, or excess mucus production
  • diuretics, which remove excess fluid
  • tube thoracostomy, a procedure to drain fluid from the pleural space

If yellow nail syndrome occurs with an associated disease like cancer, arthritis, or AIDS, symptoms may improve after treating the underlying disease.

To treat lymphedema-distichiasis syndrome, your doctor may recommend manual lymph drainage, which is a specialized massage technique to improve circulation and reduce puffiness. You can also reduce lymphedema at home by wearing elastic compression garments. Compression encourages better lymph flow through your lymphatic vessels.

There’s no way to prevent yellow nail syndrome, but the symptoms can be manageable with medication, fluid removal, and supplementation. As lymph drainage improves, nails may return to a normal color. One study found that nail symptom improvement may occur in 7 to 30 percent of those with yellow nail syndrome.

Because lymphedema can become a chronic condition, some people require ongoing therapy to manage swelling and fluid accumulation.