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Yellow nail syndrome.

S D DeCoste1, M J Imber, H P Baden

  • 1Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston 02114.

Journal of the American Academy of Dermatology
|April 1, 1990
PubMed
Summary
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Yellow nail syndrome (YNS) may not stem from systemic issues, as nail changes can resolve independently. Histopathology reveals primary stromal sclerosis, suggesting a novel cause for YNS manifestations.

Area of Science:

  • Dermatology
  • Pulmonology
  • Pathology

Background:

  • Yellow nail syndrome (YNS) is a rare disorder typically presenting with characteristic nail abnormalities, lymphedema, and respiratory issues like bronchiectasis and sinusitis.
  • The exact etiology of YNS remains unclear, with previous theories suggesting a link to systemic manifestations.

Observation:

  • Two cases of YNS are presented where the distinct yellow nail changes resolved spontaneously.
  • Crucially, the resolution of nail changes occurred independently of the ongoing respiratory symptoms in these patients.

Findings:

  • Histopathologic examination of the nail matrix and bed revealed dense, fibrous tissue replacing the subungual stroma.
  • Numerous ectatic, endothelium-lined vessels were observed, mirroring findings in pleural tissue from YNS patients.

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  • These findings suggest primary stromal sclerosis in the nail bed.

    • Implications:

    • The independent resolution of nail changes challenges the notion that they are solely a consequence of systemic disease in YNS.
    • The histopathologic findings propose primary stromal sclerosis as a potential underlying mechanism for YNS.
    • This hypothesis suggests that lymphatic obstruction due to stromal sclerosis may drive the diverse clinical manifestations of YNS.