Yellow nail syndrome: clinical experience in a series of 21 patients

BACKGROUND AND OBJECTIVES: The pathogenesis and the therapy of the yellow nail syndrome (YNS) are poorly defined. Our aim was to assess the clinical features, associated diseases and response to treatment of patients with YNS, to help clinicians to better diagnose and treat YNS patients. PATIENTS AND METHODS: We studied the medical records of all patients with YNS diagnosed at the Outpatient Nail Clinic of the University of Bologna in the last 28 years. All patients were re-evaluated to assess the evolution of the disease. RESULTS: We diagnosed YNS in 21 patients; average age was 57 ± 12.3 years at the time of diagnosis. In most patients YNS involved all 20 nails. Sixteen patients had chronic respiratory manifestations and 6 had lymphedema; 12 patients had other concomitant diseases. Ten of the 20 patients treated had a good nail response to systemic vitamin E 1 200 IU/day, while other symptoms were not modified. CONCLUSIONS: YNS is a rare disorder in which the nail alterations are often the symptom that leads to medical consultation. Due to its association with potential serious comorbidity, physicians should be able to diagnose and order further investigations to assess presence of lymphedema and/or lung disease.