Yellow Nail Syndrome

By | June 10, 2022

The doctor speaks of yellow nail syndrome when there is a triad of symptoms consisting of thickened, yellow discolored nails, pleural effusions and primary lymphedema. Sometimes, but not always, yellow nail syndrome is the symptom of higher-level diseases such as malignant cancer. The causal treatment depends on the underlying disease, but always includes a puncture of the pleura on the symptomatic side.

What is yellow nail syndrome?

Like hair, nails are appendages to the skin. These are keratin plates that show pathological changes in the context of various diseases. Yellow discolored nails can indicate malnutrition. They can occur with tobacco use or be the symptom of certain syndromes. For meaning of cat allergy in English, please visit

They correspond to an independent clinical picture within the framework of the so-called yellow nail syndrome. This clinical picture was first described in 1964. Samman and White are considered to be the first to describe it. In addition to the term yellow nail syndrome, terms such as scleronychia syndrome are also common in the medical literature.

In addition to discoloration of the nails, the syndrome manifests itself through characteristic symptoms in the lungs. With a prevalence of around one case in 500,000 to 1,000,000 people, it is a rather rare disease that affects women slightly more often than men. The median age at onset is 60 years. In principle, patients develop the disease between the ages of 41 and 80.


In many cases, yellow nail syndrome corresponds to an independent disease. In individual cases, however, the symptoms of the syndrome have also been observed in cancer patients or those affected by immunological, rheumatological and endocrine diseases. Kidney diseases or tuberculosis can also be associated with yellow nail syndrome in individual cases.

The same applies to taking medications such as penicillamine. Apparently, the lymphedema distichiasis syndrome can also be associated with a yellow nail syndrome. This overarching disease is based on a primary causative mutation in the FOXC2 gene. In the context of cancer, yellow nail syndrome has been observed primarily in malignant patients.

For the majority of all cases, however, the etiology remains unclear. From a pathophysiological point of view, symptomatic pleural effusions are the result of disturbed lymphatic drainage or protein losses. The typical yellowing and thickening of the nails is pathophysiologically mostly due to slowed nail growth.

Symptoms, Ailments & Signs

Patients with yellow nail syndrome suffer from growth disorders of the nails. In addition to the nails of the fingers, the toenails are also often affected. Because of a slowdown in growth, the nails thicken bit by bit.

Over time, the growth disturbance also leads to the yellowing of the nails, which has given the syndrome its name. Sometimes the nails detach from the nail bed. In some cases, they are not yellow but turned green. Characteristically, the nail symptoms in the context of yellow nail syndrome are not present as an isolated phenomenon, but only correspond to one of three typical symptoms.

The characteristic triad of symptoms includes nail growth disorders, pleural effusions and primary lymphedema. In addition to the accumulation of fluid in the chest area, the bronchi can expand. Recurring sinus infections are also a common symptom.

The bronchial changes often lead to bronchitis or bronchiectasis. In individual cases, these symptoms are associated with α-1 antitrypsin deficiency and other changes in the lymphatic vessels.

Diagnosis & course of disease

The first suspicion of yellow nail syndrome overtakes the doctor after a detailed anamnesis based on the clinical picture. Imaging of the lymphatic system as well as the bronchi and pleura can confirm the first suspicion, as can the laboratory diagnostic determination of α-1-antitrypsin. The prognosis for patients with yellow nail syndrome depends on various factors.

The degree of bronchial involvement is just as important for the prognosis as the possible presence of an overriding disease. If the syndrome is due to a primary disease, its treatability is decisive for the prognosis. In the case of malignant tumors in particular, the time at which the diagnosis is made plays an important role in determining whether the disease can be treated and cured.


In general, yellow nail syndrome leads to various nail disorders. These complaints primarily lead to a significantly reduced aesthetics in the person concerned and thus in many cases to inferiority complexes or reduced self-esteem. This in turn can lead to bullying or teasing and can have a very negative impact on the sufferer’s quality of life.

It is not uncommon for patients to suffer from psychological problems as well. Growth disorders can also occur on the nails and make everyday life more difficult. In addition to the problems with the nails, yellow nail syndrome also leads to inflammation of the nose or bronchitis in many cases. Patients often suffer from breathing difficulties and swollen lymph nodes. This can also lead to water accumulation in the chest area, which can make breathing difficult.

Yellow nail syndrome is usually treated with surgery. There are no further complications. The symptoms are thus significantly alleviated and limited. Furthermore, the patients are dependent on different therapies in order to avoid further complaints. With early treatment, the patient’s life expectancy is not negatively affected by yellow nail syndrome.

When should you go to the doctor?

If there are changes in the nails on the fingers or toes, the observations should be discussed with a doctor. If growth is disturbed or if there is discoloration, there is cause for concern. Medical examinations are necessary so that the cause can be clarified and a diagnosis can be made. Unusual thickening of the nails should be understood as a warning signal from the organism. They indicate internal disorders that require medical care.

If the nails come loose from the nail bed, you should see a doctor immediately. If no accident or violence has caused the symptoms and visual changes, an assessment by a doctor is advisable. Special care is also required in the case of breathing disorders, breathing noises and swelling of the lymph. These are complaints that need further investigation. If there is an increase in health irregularities over the course of several days or weeks, you must consult a doctor immediately.

Symptoms in the chest area, a feeling of tightness or general malaise should also be presented to a doctor. There is also a need for action in the event of repeated inflammation of the paranasal sinuses.

Treatment & Therapy

If the yellow nail syndrome occurs in the larger context of an underlying disease, full attention is paid to the triggering disease. Ideally, a causal treatment of the primary disease takes place. Curing the cause also reverses the symptoms of the syndrome. Many cases of yellow nail syndrome have unclear causes.

In these cases, causal therapy is not possible. In this context, treatment is purely symptomatic. Local and systemic therapy with vitamin E is used as a symptomatic form of therapy. Existing pleural effusions always require minimally invasive treatment.

This also applies to larger primary diseases. This minimally invasive symptomatic treatment usually corresponds to a pleural puncture. During this therapeutic puncture of the pleura, the area of ​​the pleura is relieved in order to restore the patient’s ability to ventilate. The doctor punctures the gap in the pleura between the ribs and the lungs.

Beforehand, the extent of the effusion is estimated sonographically. Based on this imaging, the doctor marks the puncture site. In order not to injure the liver and spleen, the puncture site should not be below the sixth or seventh intercostal space. The puncture cannula is placed perpendicular to the skin at the upper edge of the rib.

The patient engages in constant aspiration while the doctor inserts the cannula. After aspirating the pleural fluid, the doctor removes the steel mandrel and repositions the cannula. The pleural effusion is drained using a connected three-way stopcock.


Yellow nail syndrome can only be prevented to the extent that the primary causative diseases can be prevented. Since the syndrome in many cases cannot be traced back to an obvious primary disease, there are few promising preventive steps available.


Affected people with Yellow Nail Syndrome usually only have very few and only very limited measures of direct follow-up care available, so that those affected by this disease should ideally consult a doctor very early and initiate treatment. It cannot heal on its own. Since this is a genetic disease, a complete cure is usually not possible.

If there is another desire to have children, genetic testing and counseling may be advisable to find out whether yellow nail syndrome can reappear in the offspring. Most of those affected are dependent on surgical interventions with yellow nail syndrome, which can alleviate and limit the symptoms.

Those affected should definitely rest and rest after the procedure. Stress or physical activities should be avoided in order not to unnecessarily burden the body. Furthermore, with this disease, the support and help of one’s own family is very important. This can also prevent depression and other mental illnesses. It cannot generally be predicted whether the life expectancy of those affected will be reduced.

You can do that yourself

If there are any abnormalities in the nails, your own lifestyle should be checked. Discoloration of the nails on fingers or toes can indicate improper nutrition. It is important to check whether a balanced and vitamin-rich diet is taking place. Otherwise, changes must be made immediately in order to avoid an increase in symptoms or further illnesses.

In addition, the intake of pollutants should be avoided and should be switched off as soon as possible. The consumption of nicotine, both active and passive, can lead to serious health consequences. For many of those affected, physical contact with cigarettes, cigars or other smoking devices leads to physical irregularities. On the other hand, daily care of the hands and especially the nails is helpful. This includes cleansing, removing skin subunits and supplying the skin with important nutrients. This allows preventive measures to be taken and stabilization of nail growth to be achieved.

Since the disease often indicates an existing cancer, the affected person needs mental strengthening to cope with the health impairments. The immune system must be supported so that the affected person can successfully complete the necessary treatment measures. Stressors are to be reduced overall and sleep hygiene is to be optimized. In many cases against different forms of overloading, which must be changed and reduced immediately.

Yellow Nail Syndrome