Introduction:
Yellow nail syndrome affects the nails present in the fingers and toes. It also affects the lungs and airways. Excess fluid formation rich in proteins is observed in the various parts of the body, soft tissues, skin, and lymph. This syndrome is commonly seen in older individuals. The exact origin of yellow nail syndrome is still in the research process. The first case of yellow nail syndrome was observed in 1964.
What Are the Different Signs and Symptoms Shown in Patients With Yellow Nail Syndrome?
-
Appearance - The nails appear curved due to excess thickening of the layers during development.
-
Growth - The growth of nails is diminished due to the disorder.
-
Damage - The hard skin beneath the nails gets damaged and separates itself from the nail. This condition is known as onycholysis. The nail falls off the nail bed after a few weeks. It is commonly seen in toenails.
-
Infection - Some patients develop infections in the nail bed. It affects the soft tissue present in the corner of the nails. This condition is known as paronychia and affects both toes and fingernails.
-
Translucent - The nails affected due to other disorders appear rough and transparent. They are highly opaque. But patients with yellow nail syndrome have clear and translucent nails.
-
Respiratory Illness - Yellow nail syndrome is related to respiratory illness. Fluid is collected around the chest. It leads to breathing difficulty and pain near the chest. This condition is known as pleural effusion.
-
Cough - Persistent infection in the airways causes inflammation called bronchitis. It affects small air passages and destroys them. This is known as bronchiectasis. It produces a cough.
-
Sinusitis - Inflammation of the sinus lining causes sinusitis. However, a chronic infection can provoke recurrent pneumonia. The symptoms related to respiratory illness appear initially in the yellow nail syndrome even before clinical findings on the nails.
-
Swollen Legs - Legs are more commonly affected than hands in yellow nail syndrome. The collection of lymph or fluid in the legs induces swelling. This condition is known as peripheral lymphedema. It occurs during puberty.
-
Tightness On the Legs - Peripheral portion of the legs with fluid feels heavy to lift or walk. It appears stiff.
-
Decreased Flexibility - The flexibility reduces in hands, wrists, and ankles and they become rigid.
-
Hard Skin - The skin present in peripheral portions of the legs becomes hard and thick.
What Are the Various Causes That Induce Yellow Nail Syndrome in Elderly Patients?
There is no exact cause for yellow nail syndrome. It occurs randomly and has no reason.
-
Genetic Disorder - Few types of research suggest that yellow nail syndrome is an acquired condition. It is sporadic and hence known as a genetic disorder primarily. The affected gene passed through families causes this disorder.
-
Autosomal Dominant - A single abnormal gene is responsible for yellow nail syndrome. It is an autosomal dominant condition. The abnormal gene occurs due to transmission from parent to child or through mutations. FOXC2 is the most commonly mutated gene in yellow nail syndrome.
-
Gender and Age - A study says 50 % of the chance for yellow nail syndrome is acquired through pregnancy. It involves both males and females equally. Patients above 50 years of age commonly present with yellow nail syndrome. The condition can also affect children rarely.
-
Immunodeficiency Syndrome - Yellow nail syndrome commonly occurs in elderly patients with cancer and autoimmune disorders.
-
Kidney Disorders - Patients with nephrotic syndrome are usually reported with yellow nail syndrome.
-
Drugs - 'Thiol' group of drugs are used to treat rheumatoid arthritis. These drugs induce the development of yellow nail syndrome.
-
Implants - The dental prosthesis is supported in the gum tissue using titanium implants. Titanium toxicity is the major cause of yellow nail syndrome. Some researchers observed that the symptoms of yellow nail syndrome did not improve even after the removal of titanium implants.
-
Circulation - Malfunction of lymph results in lymphedema. Obstruction of lymphatic vessels or rupture of tiny blood vessels causes leakage of fluid into the blood cells. This is known as microvascular permeability. The fluid gets accumulated in the soft tissue present under the nails and eventually leads to yellow nails.
How Is Yellow Nail Syndrome Diagnosed?
-
History - The medical professional makes a clinical evaluation and asks for family history to identify the genetic disorder.
-
Physical Examination - The characteristic finding of yellow nail syndrome is nail changes. It is carefully examined.
-
Blood Test - The fluid present in the peripheral extremities is collected using a needle and a sample of blood is obtained. It is examined in the laboratory for the presence of abnormal proteins. Advancements in the medical field are useful to identify the FOXC2 gene.
What Are the Standard Treatment Methods Available for Treating Yellow Nail Syndrome?
The type of treatment for yellow nail syndrome depends on the symptoms present in the patient.
-
Vitamin E - Mild changes in the yellow nails recover within a few months without any treatment. However, inducing vitamin E helps in nail formation after falling off due to onycholysis.
-
Medication - Recurrent infections and respiratory problems are treated with antibiotics. Antibiotic therapy helps to prevent further complications. Corticosteroids are prescribed for the improvement of symptoms yellow nail syndrome. The patient should choose alternative medicine for treating rheumatoid arthritis.
-
Drainage - The fluid present in the legs and chest lining in case of pleural effusion is removed. Drainage is done with the help of a catheter. Bandages can be used to improve circulation and reduce lymph fluids.
-
Genetic Counseling - The genetic counselor modifies the mutated gene to prevent further familial disorder. This has proved to be an effective method for the management of yellow nail syndrome.
What Is the Difference Between Yellow Nail Syndrome and Lymphedema-Distichiasis Syndrome?
FOXC2 gene is also mutated in a condition called lymphedema-distichiasis syndrome. The symptoms like swelling and lymph accumulation in lymphedema-distichiasis are similar to yellow nail syndrome. Hence, careful examination is necessary to differentiate these conditions. Patients with distichiasis have extra eyelashes. The symptoms of lymphedema are related to eyes like drooping of eyelids and fibrous tissue formation over the eyeball. They are sensitive to sunlight. These patients have cleft palate and abnormal cysts in the spinal cord. Using all these criteria, the medical professional diagnoses lymphedema distichiasis. Two to three diagnostic tests are necessary for confirmation of yellow nail syndrome.
Conclusion:
Consult a dermatologist for examination of discolored, bleeding, and swollen nails. They can interpret the best treatment plan according to the symptoms. Avoid trimming the nails and picking the encircling tissue from a nail technician because trimming can make the nails thicker and make them painful. If the yellow nails are left untreated, fungal infections provoke the accumulation of dead skin cells under the nails.
