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Yellow Nail Syndrome: Analysis of 41 Consecutive Patients

Fabien Maldonado, MD^*; Henry D. Tazelaar, MD; Chih-Wei Wang, MD and Jay H. Ryu, MD^*

^*Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN Division of Anatomic Pathology, Mayo Clinic, Scottsdale, AZ Department of Pathology, Chang Gung Memorial Hospital, Taoyuan, Taiwan

ryu.jay{at}mayo.edu

Abstract

Background: Yellow nail syndrome is a rare condition defined by the presence of yellow nails associated with lymphedema and/or chronic respiratory manifestations. Several aspects of this disorder remain poorly defined.

Methods: We sought to clarify the clinical features and course associated with yellow nail syndrome by analyzing 41 consecutive cases evaluated at a tertiary referral medical center.

Results: There were 20 men and 21 women; the median age at diagnosis was 61 years (range, 18 to 82 years). None had a family history of yellow nail syndrome. All but one patient had chronic respiratory manifestations that included pleural effusions (46%), bronchiectasis (44%), chronic sinusitis (41%), and recurrent pneumonias (22%); 26 patients (63%) had lymphedema. Treatment included rotating antibiotic therapy for bronchiectasis, thoracenteses, oral vitamin E and corticosteroid therapy. Eight patients underwent surgical management of recurrent pleural effusions including pleurodesis and decortication; 2 additional patients underwent pleurodesis via tube thoracostomy. The yellow nails improved or resolved in 14 of 25 patients (56%) for whom the relevant data were available. Median survival of this cohort using the Kaplan-Meier method was 132 months, significantly lower than (p=0.01) the control population. Among those still alive (20 patients), the disease appeared stable.

Conclusions: In most cases yellow nail syndrome is an acquired disorder and associated respiratory manifestations are generally manageable with a regimen of medical and surgical treatments. Yellow nails improve in about one-half of patients, often without specific therapy.

Key Words: Chylothorax • Lymphedema • Pleural effusion • Yellow nail syndrome