Yellow nail syndrome - Nail and Distal Digit
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Synopsis
The classic triad occurs only in about one-third of patients, and involvement of the nails only is observed in about 10% of cases. Lymphedema and respiratory tract involvement may develop before, during, or after the nail dystrophy.
YNS affects men and women equally. It usually presents in the fourth to sixth decade of life.
The pathophysiology is not well understood, but microangiopathy and titanium have both been implicated as being responsible for the disease.
- Microangiopathy as the cause of the nail changes is proposed because dermoscopy of the nail fold capillaries in some patients with YNS showed dilated and tortuous capillary loops.
- Reports have implicated titanium in the development of YNS. Elevated levels of titanium have been found in patients with YNS, and this exposure may be from medications and dental implants. It is thought that the interaction between amalgam and gold leads to the yellow nail color.
Codes
ICD10CM:L60.5 – Yellow nail syndrome
SNOMEDCT:
45342007 – Yellow nails
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Onychomycosis
- Chronic paronychia
- Pseudomonas nail infection
- Drug-induced yellow pigmentation (5-fluorouracil, tetracycline)
- Tobacco staining of the nails
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:02/19/2017
Last Updated:01/18/2022
Last Updated:01/18/2022
Yellow nail syndrome - Nail and Distal Digit