Yellow Nail Syndrome: Analysis of 23 Consecutive Patients and Effect of Combined Fluconazole-Vitamin-E Treatment

Abstract

Background. Yellow nail syndrome (YNS), a very rare disorder of unknown etiology, is characterized by a triad associating yellow nails, respiratory manifestations and lymphedema. YNS treatment remains non-codified. Methods. This retrospective study was conducted from January 2008 to December 2022 in a single tertiary department exclusively dedicated to lymphatic diseases. All consecutive patients with YNS were included. Results. Thirteen men and 10 women were included in the study. Three patients had yellow nails at birth or during childhood. For the other 20 patients, median (Q1–Q3) age at first sign was 50.8 (43–61) years. Median (Q1–Q3) first-YNS-sign-to-diagnosis interval was 17 (10–56) months. For 4 patients, YNS was associated with primary intestinal lymphangiectasia. The first YNS sign was chronic cough (45.5%), followed by yellow nails (27.3%), chronic sinusitis (18.2%) and lymphedema (9.1%). At first consultation, among these 23 patients, 69.6% had the complete triad, all had yellow nails and cough, 82.6% chronic sinusitis and 69.6% lymphedema. Lymphedema involved only the lower limb (n=12), lower and upper limbs (n=2), the lower and upper limb and face (n=2). Nineteen (82.6%) patients were treated with fluconazole (100 mg/d, (n=8) or 300 mg/wk, (n=11)) combined with vitamin E (1000 mg/d) for a median of 13 months. Responses were complete for 4 (21.1%) patients, partial for 8 (42.1%) and therapeutic failures for 7 (36.8%). Conclusion. YNS is a rare disease that almost always starts with a chronic cough. Despite inconstant efficacy, fluconazole–vitamin E in combination can be prescribed to treat yellow nails.