Yellow Nail Syndrome – Diagnosis, Differential Diagnosis, Treatment Options

Eckart Haneke


Yellow nail syndrome (YNS) is a rare, but relatively well characterized triad of slow growing yellow nails, lymphedema of the distal portions of the upper and lower limbs as well as chronic infection of the respiratory tract and/or pleural effusion. The most characteristic features of this syndrome are the nail changes that allow the diagnosis to be made even if the triad is not complete. Yellow discoloration of the nails is nonspecific and often seen in onychomycosis, nail psoriasis, a variety of other conditions that are associated with onycholysis. Distal limb edema may not be very pronounced. In addition to the bronchopulmonary disorders, malignancies, chronic heart conditions and gastrointestinal diseases may occur. Treatment after exclusion of non-YNS conditions is aimed at finding the underlying systemic disorder, which usually requires a very long therapy and a lot of patience both from the patient as well as the treating physician.



Yellow nails, lymphedema, pleural effusion, sinubronchial syndrome, nail growth rate, chronic infection, long-term antibiosis, clarithromycin, azole antifungals

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Heller J. Die Krankheiten der Nägel. In Jadassohn’s Handbuch der Haut- und Geschlechtskrankheiten. Vol 13/2, Springer, Berlin 1927:118

Samman PD, White WF. WF. The “yellow nail” syndrome. Br J Dermatol. 1964;76:153–157

Emerson PA. Yellow nails, lymphoedema and pleural effusions. Thorax. 1966;21:247-253

Maldonado F, Tazelaar HD, Wang CW, Ryu JH. Yellow nail syndrome: analysis of 41 consecutive patients. Chest. 2008;134(2):375–381

Magid M, Esterly NB, Prendiville J, Fujisaki C. The yellow nail syndrome in an 8-year-old girl. Pediatr Dermatol. 1987;4:90-93

Govaert P, Leroy JG, Pauwels R, et al. Perinatal manifestations of maternal yellow nail syndrome. Pediatrics. 1992;89:1016-1018

Hoque SR, Mansour S, Mortimer PS. Yellow nail syndrome: not a genetic disorder? Eleven new cases and a review of the literature. Br J Dermatol. 2007;156:1230-1234

Rezaie T, Ghoroghchian R, Bell R, et al. Primary non-syndromic lymphoedema (Meige disease) is not caused by mutations in FOXC2. Eur J Hum Genet. 2008;16:300-304

Ichikawa Y, Shimizu H, Arimori S. "Yellow nail syndrome" and rheumatoid arthritis. Tokai J Exp Clin Med. 1991;16:203-209

Berglund F, Carlmark B. Titanium, sinusitis, and the yellow nail syndrome. Biol Trace Elem Res. 2011;143:1–7

Decker A., Daly D., Scher R.K. Role of titanium in the development of yellow nail syndrome. Skin Appendage Disord. 2015;1:28–30

Hsu TY, Lin CC, Lee MD, Chang BP, Tsai JD. Titanium dioxide in toothpaste causing yellow nail syndrome. Pediatrics. 2017;139:e20160546

Dos Santos VM. Titanium pigment and yellow nail syndrome. Skin Appendage Disord. 2016;1:197

Ataya A, Kline KP, Cope J, Alnuaimat H. Titanium exposure and yellow nail syndrome. Respir Med Case Rep. 2015;16:146-147

DeCoste SD, Imber MJ, Baden HP. Yellow nail syndrome. J Am Acad Dermatol. 1990;22:608-611

Norton L. Further observations on the yellow nail syndrome with therapeutic effects of oral alpha-tocopherol. Cutis. 1985;36:457-462

Jiyad Z, Cousins E, Stanton A, Mortimer P. Yellow nail syndrome: a primary lymphatic disorder? Br J Dermatol. 2014;171, Suppl 1:9

Gupta S, Samra D, Yel L, Agrawal S. T and B cell deficiency associated with yellow nail syndrome. Scand J Immunol. 22;75:329-335

Vignes S, Baran R. Yellow nail syndrome: a review. Orphanet J Rare Dis. 2017;12:42

Hiller E, Rosenow 3rd ED, Olsen AM. Pulmonary manifestations of the yellow nail syndrome. Chest. 1972;61:452-458

Polat AK, Dang HT, Soran A. Yellow nail syndrome: treatment of lymphedema using low pressure compression. Lymphat Res Biol. 2012;10:30-32

Hillerdal G. Yellow nail syndrome: treatment with octreotide. Clin Respir J. 2007:1:120-121

Williams HC, Buffham R, du Vivier A. Successful use of topical vitamin E solution in the treatment of nail changes in yellow nail syndrome. Arch Dermatol. 1991;127:1023-1028

Lambert EM, Dziura J, Kauls L, Mercurio M, Antaya RJ. Yellow nail syndrome in three siblings: a randomized double-blind trial of topical vitamin E. Pediatr Dermatol. 2006;23:390-395

Luyten C, André J, Walraevens C, De Doncker P. Yellow nail syndrome and onychomycosis. Experience with itraconazole pulse therapy combined with vitamin E. Dermatology. 1996;192:406-408

Abell E, Samman PD. Yellow nail syndrome treated by intralesional triamcinolone acetonide. Br J Dermatol. 1973;88:200-201

Woodfield G, Nisbet M, Jacob J, Mok W, Loebinger MR, Hansell DM, Wells AU, Wilson R. Bronchiectasis in yellow nail syndrome. Respirology. 2017;22:101-107

MatsubayashiS, Suzuki M, Suzuki T, Shiozawa A, Kobayashi K, Ishii S, Iikura M, Shinyu Izumi S, Kudo K, Sugiyama H. Effectiveness of clarithromycin in patients with yellow nail syndrome. BMC Pulm Med. 2018;18:138

Vollono L, Chessa MA, Bruno A, Starace M, Alessandrini A, Piraccini BM. Nails: The window to the nose? Update on yellow nail syndrome. Dermatol Pract Concept. 2020;10(2):e2020031

Iqbal M, Rossoff LJ, Marzouk KA, Steinberg HN. Yellow nail syndrome: resolution of yellow nails after successful treatment of breast cancer. Chest. 2000;117:1516-1518

Tosti A, Piraccini BM, Iorizzo M. Systemic itraconazole in the yellow nail syndrome. Br J Dermatol. 2002;146:1064-1067

Baran R, Thomas L. Combination of fluconazole and alpha-tocopherol in the treatment of yellow nail syndrome. J Drugs Dermatol. 2009;8:276-278

Arroyo JF, Cohen ML. Improvement of yellow nail syndrome with oral zinc supplementation. Clin Exp Dermatol. 1993;18:62-64

Itagaki H, Katuhiko S. Yellow nail syndrome following multiple orthopedic surgeries: a case report. J Med Case Rep. 2019;13:200



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