The yellow nail syndrome

The yellow nail syndrome is a rare clinical entity which combines three main features: yellow discolouration of the nails, chronic lymphedema, and pleural effusion. Since 1994, chronic rhinosinusitis is associated in this syndrome. A lot of other pathologic conditions are often present. The most frequent are: bronchiectasis, recurrent pneumonia, pericardic effusion, humoral immunity deficiencies. Among the etiopathogeneses advocated, the more credible ones deal with changes of the lymphatic network with hypoplastic vessels leading to inadequate adaptation, after local damage of the tissues. When this syndrome is suspected on the basis of the examination of the nails, an extensive investigation (dermatologic, pneumologic, lymphographic, biologic) has to be launched to exclude underlying neoplasma, or autoimmune disease, frequently associated with this syndrome. The treatment is controversial and poorly effective. Vitamin A and E, Zn sulfate and itraconazole are drugs the most often advised. Spontaneous healing is reported in 30% of the cases. Endoscopic endonasal surgery in such cases, when the sinusal mucosa is involved, is controversial and its outcome is not yet documented.