Yellow Nail Syndrome

Yellow nail syndrome (YNS) is a rare condition characterized by the clinical presentation of discolored, hypoplastic nails, recurring pleural effusions, and lymphedema. While no precise etiology for YNS has been determined, strong evidence suggests that it may be the result of underdeveloped or dysfunctional lymphatic drainage channels.

Individuals with YNS are prone to repeated respiratory and rhinosinusitis infections, with the consequent development of obstructive and/or restrictive lung disease.

Airway clearance indications associated with yellow nail syndrome include:

  • Restrictive lung disease: Restrictive lung disease is characterized by static or diminished lung volume and vital capacity. The ability to take a big breath, to generate expiratory force, and to cough effectively may be affected, contributing to inadequate clearance of pulmonary secretions.

  • Retained secretions: Ineffective clearance of pulmonary secretions can lead to secretion retention and pooling. Retained secretions are an ideal growth medium for bacterial pathogens. Consequent infections produce still more mucus, initiating a vicious cycle of mucus obstruction, recurrent bouts with pneumonia, bacterial colonization, and progressive pulmonary compromise.

In addition to placing patients at risk for pulmonary infection, retained secretions may result in impaired gas exchange. This is particularly significant for people with restrictive disorders because their pulmonary function is already compromised.

Aggressive bronchial hygiene, including daily Airway Clearance Therapy, is an essential component in the management of patients with pulmonary complications from yellow nail syndrome. Conscientious attention to daily secretion clearance may prevent or minimize the pulmonary complications associated with this disorder.

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Sources

:
1. Cordasco EM, Beder S, Bavbek S, Gurses H, Mehta AC. Clinical Features of the Yellow Nail Syndrome. Cleveland Clinic Journal of Medicine 1990. 57 (5):472-476.
2. Hershko A, Hirshberg B, Nahir M, Friedman G. Yellow Nail Syndrome. Postgraduate Medical Journal 1997. 73: 466-468.

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