Yellow nail syndrome (YNS) is a rare disease that can cause nail changes and swelling, along with respiratory (breathing) problems. Some symptoms of yellow nail syndrome overlap with those of lung cancer, such as chronic cough and recurrent respiratory infections. The exact cause of yellow nail syndrome and the connection to lung cancer is not well known, though research shows it affects people with certain types of cancer at higher rates.

Read on to learn more about yellow nail syndrome, including its variety of symptoms, potential causes and related conditions, and how it’s treated.

What Is Yellow Nail Syndrome?

Yellow nail syndrome is a rare disorder that usually affects older adults. Despite the name, yellow nail syndrome isn’t just a nail disorder — it affects the lungs and limbs too.

Yellow nail syndrome is defined as having at least two of the following health issues:

• Lymphedema (swelling in parts of the body)
• A respiratory tract condition
• Yellow, hard, deformed nails

Researchers aren’t sure how prevalent (common) yellow nail syndrome is. However, it’s known as an extremely rare condition, estimated to affect only 1 in every 1 million people. About 100 cases of yellow nail syndrome have been reported in medical journals, usually in people over 50 years of age.

Though case reports have shown higher rates of yellow nail syndrome among people with cancer, more research is needed on how common it is in people with lung cancer and whether it tells health care providers anything about prognosis.

Symptoms of Yellow Nail Syndrome

The symptoms of yellow nail syndrome are thought to be a result of dysfunction in the lymphatic system, causing lymph (a bodily fluid high in protein) to not drain properly. Notably, yellow nail syndrome and lung cancer have some symptoms in common.

Nail Changes

Both the fingernails and toenails can be affected by yellow nail syndrome. Nail changes from yellow nail syndrome include:

• Discoloration (pale yellow or greenish-yellow)
• Slow growth or apparent cessation of growth
• Thickening
• Smoothness but with some ridges
• Humps excessively curved in shape
• Absence of cuticles (the strip of hard skin at the base of the nail)
• Onycholysis (separation of the nail from the nail bed), which may cause nails to fall off

Excessively curved nails are also a symptom of finger clubbing, which can be a symptom of lung cancer.

You can develop yellow nail syndrome without having the characteristic yellow nails — some people have respiratory problems first before they notice any nail changes.

Respiratory Problems

Yellow nail syndrome also affects the pulmonary system (lungs) and is associated with certain respiratory problems, some of which are also associated with lung cancer.

For example, a chronic cough is the most common respiratory problem associated with yellow nail syndrome. Yellow nail syndrome is also associated with pleural effusions (fluid in the lungs) Fluid in the lungs can cause the following respiratory symptoms:

• A lingering cough
• Shortness of breath
• Chest pain

Pleural effusions are fairly common in people with yellow nail syndrome — approximately 2 out of 5 people with yellow nail syndrome have buildup of fluid in their lungs.

Other respiratory problems associated with yellow nail syndrome include:

• Chronic sinusitis — Ongoing inflammation of the sinuses
• Recurrent pneumonia — Ongoing infection/inflammation of the lungs
• Bronchitis — Ongoing infection and/or inflammation of the main tubes coming out of the lungs
• Bronchiectasis — Damage and widening of the small tubes coming out of the lungs

Lymphedema

Yellow nail syndrome is often accompanied by lymphedema — when parts of the body swell due to the lymphatic system not working properly. When lymph doesn’t drain well, it collects under the skin, causing noticeable swelling and puffiness. For example, people with yellow nail syndrome frequently have swollen ankles and legs.

Swelling caused by lymphedema is very common in yellow nail syndrome — approximately 80 percent of people with yellow nail syndrome experience swelling in their body, usually in the lower limbs, and less frequently in the face, hands, and genital area. (Face swelling also sometimes occurs with lung cancer.)

Swelling may cause the swollen areas to feel heavy, tight, and less flexible. Lymphedema also affects the skin, causing it to become harder and thicker. (Some symptoms of lung cancer also can affect the skin.)

Lymphedema associated with yellow nail syndrome usually shows up later than nail changes, sometimes not until months afterward.

Causes of Yellow Nail Syndrome

The exact cause of yellow nail syndrome is unknown. Some health experts say abnormalities in the lymphatic system may be a cause since the symptoms of yellow nail syndrome are often associated with lymphatic system dysfunction. The accumulation of lymph fluid under the skin can cause the nails to turn yellow.

Still others say it’s an inherited condition based on certain genetic factors. For example, some research has shown a link between yellow nail syndrome and mutations (changes) in the FOXC2 gene, which leads to a condition called lymphedema-distichiasis syndrome. However, some researchers argue that mutation of the FOXC2 gene is only related to lymphedema-distichiasis syndrome and that yellow nail syndrome diagnosed based on this genetic mutation may be a misdiagnosis.

Finally, some experts believe yellow nail syndrome occurs for no apparent reason.

Related Conditions Associated With Yellow Nail Syndrome

Although there isn’t a known cause of yellow nail syndrome, it affects people with the following health conditions at higher rates:

• Certain types of cancer
• Thyroid disease
• Immunodeficiency disorders
• Rheumatoid arthritis (RA)
• Nephrotic syndrome (a kidney disorder)

More research is needed as to whether lung cancer is one of the types of cancer that frequently occur with yellow nail syndrome. Similarly, more research is needed to determine if lung cancer and yellow nail syndrome share underlying causes or risk factors.

Talk to your doctor if you notice symptoms of yellow nail syndrome or have questions about whether a diagnosis of yellow nail syndrome is related to living with lung cancer.

Treatment

There is no cure for yellow nail syndrome, but it can be managed by treating the symptoms, including with corticosteroids, vitamin E supplementation, and antibiotics. Some symptoms may need more in-depth care, while others may be managed at home.

Your doctor might also recommend treatment based on the suspected underlying cause. For example, if they think you may have pleural effusion — which can be caused by lung cancer spreading — they may do a procedure to drain the excess pleural fluid.

Corticosteroids

Corticosteroids may be used to treat nail changes and inflammation. However, more evidence is needed on using corticosteroids to treat nail symptoms. Current evidence suggests they’re not effective enough to justify their use for nail changes.

Vitamin E

Nail changes from yellow nail syndrome are usually permanent, though sometimes nails can go back to normal or improve without treatment. Treatment may include vitamin E to slow or stop nail changes. You may be prescribed a vitamin E topical ointment you apply to your nails or oral vitamin E you take by mouth.

Sometimes, antifungal medications are prescribed with vitamin E or on their own to help with nail growth.

Antibiotics

Antibiotics may be prescribed to treat chronic respiratory infections, such as bronchitis, associated with yellow nail syndrome. Antibiotics work by killing the bacteria causing the repeat infections.

Surgical and At-Home Management

Some respiratory problems require surgical treatment, such as for pleural effusions, which may require a tube to be inserted into the tissue around the lungs to drain excess fluid.

Lymphedema, on the other hand, may be able to be managed from home with compression garments (like compression stockings) and exercises designed to improve lymph flow.

Yellow nail syndrome symptoms can improve or even go away, but it takes staying in touch with your doctor to help keep symptoms from coming back. Talk to your doctor about treatment options targeted at your yellow nail syndrome symptoms and what you can do to manage symptoms from home.

Talk With Others Who Understand

MyLungCancerTeam is the social network for people with lung cancer and their loved ones. On MyLungCancerTeam, more than 12,000 members come together to ask questions, give advice, and share their stories with others who understand life with lung cancer.

Do you have yellow nail syndrome? What symptoms do you have and how are they treated? Share your experience in the comments below, or start a conversation by posting on your Activities page.