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Taguchi M, Masuko H, Kawashima K, Yamagishi T, Kitaoka Y, Shigemasa R, Yoshida K, Tsurushige C, Satoh H, Hizawa N. Control of pleural effusion with prednisolone in a patient with yellow nail syndrome: A case report. Exp Ther Med 2024; 27:224. [PMID: 38596656 PMCID: PMC11002817 DOI: 10.3892/etm.2024.12512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 03/05/2024] [Indexed: 04/11/2024] Open
Abstract
Yellow nail syndrome (YNS) can induce bilateral exudative pleural effusion; however, to the best of our knowledge, no standard treatment for YNS has been established. The present study describes a patient with YNS for whom the pleural effusion was controlled by prednisolone. A 73-year-old man was referred to the University of Tsukuba Hospital (Ibaraki, Japan) complaining of shortness of breath, which was diagnosed as being due to bilateral pleural effusion. Based on the presence of yellowing and growth retardation of the toenails, lymphedema, bilateral exudative pleural fluid of unknown etiology, and lymphatic congestion on lymphoscintigraphy, the patient was diagnosed with YNS. The pleural fluid was predominantly lymphocytic and responded to systemic steroid administration [prednisolone 30 mg/day (0.5 mg/kg) for 2 weeks, with subsequent weekly tapering]. The general condition of the patient and their dyspnea also improved with treatment. These findings indicated that systemic steroid administration should be considered as one of the treatment options for patients with YNS who are reluctant to undergo chest drainage or pleurodesis due to the potential for a decrease in their ability to perform daily activities and respiratory function.
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Affiliation(s)
- Manato Taguchi
- Department of Pulmonary Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan
| | - Hironori Masuko
- Department of Pulmonary Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan
| | - Kai Kawashima
- Department of Pulmonary Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan
| | - Tetsuya Yamagishi
- Department of Pulmonary Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan
| | - Yuka Kitaoka
- Department of Pulmonary Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan
| | - Rie Shigemasa
- Department of Pulmonary Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan
| | - Kazufumi Yoshida
- Department of Pulmonary Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan
| | - Chikako Tsurushige
- Department of Respiratory Medicine, Moriya Daiichi General Hospital, Moriya, Ibaraki 302-0102, Japan
| | - Hiroaki Satoh
- Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba-Mito Kyodo General Hospital, Mito, Ibaraki 310-0015, Japan
| | - Nobuyuki Hizawa
- Department of Pulmonary Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan
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Algain M. Yellow Nail Syndrome Successfully Treated with Oral Terbinafine and Topical Minoxidil. Clin Cosmet Investig Dermatol 2021; 14:249-252. [PMID: 33746514 PMCID: PMC7967026 DOI: 10.2147/ccid.s301197] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/23/2021] [Indexed: 01/22/2023]
Abstract
Yellow nail syndrome (YNS) is a rare disease of unknown etiology that is characterized by varying degrees of pulmonary manifestations, lymphedema, and yellow discoloration of the nails. Herein, we report the efficacy of oral terbinafine and topical minoxidil in treating the associated nail abnormalities of YNS in a 66-year-old woman. The patient presented with yellow, brittle, slow-growing nails, which had developed progressively over the past 8 months; left ankle edema; a chronic, purulent, productive cough; and exertional dyspnea. Based on these symptoms, she was diagnosed with YNS. She failed to respond to treatment with fluconazole and vitamin E; however, she was successfully treated with oral terbinafine and topical minoxidil. The treatment was well tolerated, and we speculate that its mode of action includes promoting lymphatic formation and barrier enhancement, thereby improving the distal lymphedema, in addition to distal vasodilation that accelerates the nail growth. To our knowledge, this is the first report of successful treatment of YNS using these agents.
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Affiliation(s)
- Maysoon Algain
- Department of Dermatology, King Abdulaziz University, Jeddah, Saudi Arabia
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Vollono L, Chessa MA, Bruno A, Starace M, Alessandrini A, Piraccini BM. Nails: The Window to the Nose? Update on Yellow Nail Syndrome. Dermatol Pract Concept 2020; 10:e2020031. [PMID: 32363094 DOI: 10.5826/dpc.1002a31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2019] [Indexed: 12/29/2022] Open
Abstract
Background Yellow nail syndrome is a rare condition characterized by typical nail alterations and variable presence of lymphedema and respiratory disease. The pathogenesis is still obscure, with most of the literature deriving from case reports and few investigations. The most reported respiratory conditions associated with yellow nail syndrome are pleural effusion and bronchiectasis, whereas association with rhinosinusitis is rarer. Objectives To describe a case of yellow nail syndrome and to provide a literature review regarding this disorder, discussing pathogenetic hypothesis, associated conditions, and therapeutic options. Patients/Methods A 49-year-old man presented with arrested growth and alterations of his nails, without any history of previous trauma or inflammation but with a severe nasal septum deviation and a history of chronic rhinosinusitis. A diagnosis of yellow nail syndrome was made. Results Six months after undergoing rhinoseptoplasty and treatment with oral vitamin E, the patient's nails were cured. Conclusions This case emphasizes the role of the dermatologist in detecting systemic conditions. The correct diagnosis led to complete resolution of both nail alterations and associated respiratory disorders.
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Affiliation(s)
- Laura Vollono
- Dermatology Unit, Department of Medicina dei Sistemi, Tor Vergata University, Rome, Italy
| | - Marco Adriano Chessa
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Antonio Bruno
- Radiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Michela Starace
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Aurora Alessandrini
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Bianca Maria Piraccini
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
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Itagaki H, Katuhiko S. Yellow nail syndrome following multiple orthopedic surgeries: a case report. J Med Case Rep 2019; 13:200. [PMID: 31256758 PMCID: PMC6600893 DOI: 10.1186/s13256-019-2136-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/29/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Yellow nail syndrome is a rare condition associated with a triad of symptoms: yellow nails, lung lesions, and lymphedema. We report a case of yellow nail syndrome caused by titanium exposure from multiple artificial joint replacements. CASE PRESENTATION A 78-year-old Asian woman presented to our outpatient department with chief complaints of cough, fever, and nausea. The patient was hospitalized for observation because of the presence of hypoxemia and bilateral pleural effusion. Her medical history included knee joint replacement and two spinal fusion surgeries. Her physical examination conducted following hospitalization revealed yellow nails on both hands and feet. This finding, combined with the observation of bilateral pleural effusion, raised suspicion for yellow nail syndrome. Blood analysis yielded negative results, as did the tests for sputum culture, interferon liberation, pleural effusion culture, and pleural effusion cytology. Pleural histopathological analysis and imaging yielded negative results. Considering the possibility of titanium exposure from artificial joints based on the patient's medical history, we examined a chest radiograph obtained before the second spinal fusion surgery; however, no pleural effusion was observed. Pleural effusion was observed, however, following the surgery. On the basis of these findings, the patient was diagnosed with yellow nail syndrome due to titanium exposure. CONCLUSIONS Clinicians should examine the nails of patients with unexplained pleural effusion. Moreover, they should inquire about titanium exposure when obtaining the patient's medical history.
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Affiliation(s)
- Hideya Itagaki
- Department of General Surgery, Honjoudaiichi Hospital, 110, Iwabuchishita, Yurihonnjou, Akita, 015-8567, Japan.
| | - Suzuki Katuhiko
- Department of General Surgery, Honjoudaiichi Hospital, 110, Iwabuchishita, Yurihonnjou, Akita, 015-8567, Japan
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Matsubayashi S, Suzuki M, Suzuki T, Shiozawa A, Kobayashi K, Ishii S, Iikura M, Izumi S, Kudo K, Sugiyama H. Effectiveness of clarithromycin in patients with yellow nail syndrome. BMC Pulm Med 2018; 18:138. [PMID: 30111321 PMCID: PMC6094584 DOI: 10.1186/s12890-018-0707-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 08/09/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Yellow nail syndrome (YNS) is a rare disease characterized by the triad of thickened, slow-growing yellow nails, lymphedema, and chronic respiratory manifestations. The cause of YNS is not known; however, it is suggested to be due to a congenital lymph abnormality. Since YNS is accompanied by chronic bronchial infection in more than half of patients, we hypothesized that treatment with clarithromycin (CAM) could be effective. We therefore evaluated the effectiveness of CAM against nail discoloration and respiratory manifestation in patients with YNS. METHODS We conducted an observational study involving 5 patients with YNS who were treated at our institution between January 2005 and January 2016. CAM was prescribed for every patient. Patient demographic information, comorbidities, medications, chest radiographs, and clinical data such as nail color were extracted to evaluate clinical outcome. RESULTS Mean patient age was 71.6 years, and 2 patients (40%) were male. Four patients had sinusitis, and 2 had rheumatoid arthritis. Regarding respiratory manifestations, 4 patients had sinobronchial syndrome and 2 had pleural effusion. Nail discoloration improved in every patient after CAM treatment. Four patients also experienced improvement in their respiratory manifestations. CONCLUSIONS In patients with YNS, the anti-inflammatory activity of macrolides might improve their systemic inflammation. This improvement could help to reduce lymphedema and promote nail growth. TRIAL REGISTRATION Ethical approval was provided by the institutional review board of the National Center of Global Health and Medicine (NCGM-G-002143-00), in January 2017. This study is retrospectively registered for UMIN Clinical Trial Registry ( UMIN000028514 ) in August 4th, 2017.
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Affiliation(s)
- Sachi Matsubayashi
- Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Manabu Suzuki
- Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo, 162-8655, Japan.
| | - Tomoyuki Suzuki
- Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Ayako Shiozawa
- Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Konomi Kobayashi
- Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Satoru Ishii
- Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Motoyasu Iikura
- Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Shinyu Izumi
- Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Koichiro Kudo
- Waseda University Organization for Regional and Inter-regional Studies, 2-1-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo, 169-0051, Japan
| | - Haruhito Sugiyama
- Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo, 162-8655, Japan
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Abstract
Yellow nail syndrome (YNS; OMIM 153300, ORPHA662) is a very rare disorder that almost always occurs after 50 years of age but a juvenile or familial form has also been observed. YNS is diagnosed based on a triad associating yellow nail discoloration, pulmonary manifestations (chronic cough, bronchiectasia, pleural effusion) and lower limb lymphedema. Chronic sinusitis is frequently associated with the triad. YNS etiology remains unknown but a role of lymphatic impairment is usually evoked. YNS is more frequently isolated but may be associated in rare cases with autoimmune diseases, other clinical manifestations implicating lymphatic functions or cancer and, hence, is also considered a paraneoplastic syndrome. YNS management is symptomatic and not codified. YNS can resolve spontaneously. Oral vitamin E alone or even better when associated with triazole antifungals may achieve partial or total disappearance of nail discoloration. Pleural effusion can be treated surgically, with decortication/pleurectomy or pleurodesis. Antibiotic prophylaxis is prescribed for bronchiectasia with chronic sputum production. Lymphedema treatment is based on low-stretch bandages and the wearing of elastic compression garments combined with skin care, exercises and, as needed, manual lymph drainage.
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Affiliation(s)
- Stéphane Vignes
- Department of Lymphology, Centre National de Référence des Maladies Vasculaires Rares (Lymphœdèmes primaires), Hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015, Paris, France.
| | - Robert Baran
- Nail Disease Centre, 42, rue des Serbes, 06400, Cannes, France
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Woodfield G, Nisbet M, Jacob J, Mok W, Loebinger MR, Hansell DM, Wells AU, Wilson R. Bronchiectasis in yellow nail syndrome. Respirology 2016; 22:101-107. [PMID: 27551950 DOI: 10.1111/resp.12866] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 05/23/2016] [Accepted: 06/09/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Yellow nail syndrome (YNS) is a rare and poorly described disease process. In this case-control study, clinical features and findings on HRCT were compared with idiopathic bronchiectasis (IBx). METHODS A review of all patients attending an adult bronchiectasis clinic between 2007 and 2013 identified 25 YNS patients. IBx patients were matched in a 2:1 ratio for age, duration of symptoms and gender. RESULTS Median age of onset was 53 years. There were 12 male and 23 Caucasian YNS patients. Respiratory manifestations included chronic productive cough (100%), chronic rhinosinusitis (88%), pleural effusions (20%) and lymphoedema (12%). Chest symptoms preceded yellow nails in the majority (68%). Abnormal nails persisted at follow-up in 23 of 25 patients but improved in 14. In both disorders, there was symmetrical, predominantly lower lobe bronchiectasis on HRCT. Extent (P = 0.04), severity (P = 0.03) and bronchial wall thickness (P = 0.05) scores were lower in YNS, with less upper and middle lobe disease. Multivariate analysis showed an independent association with increased mucus plugging in YNS. There was a similar prevalence of Pseudomonas aeruginosa infection and mild lung function abnormalities. CONCLUSION Bronchiectasis in YNS is less severe than IBx but is associated with increased mucus plugging, onset is in middle age and there is no female predominance. Treatment targeted at improved secretion clearance may improve both chest and nail symptoms, with consideration of long-term macrolide antibiotics.
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Affiliation(s)
| | - Mitzi Nisbet
- Host Defence Unit, Royal Brompton Hospital, London, UK
| | - Joe Jacob
- Radiology Department, Royal Brompton Hospital, London, UK
| | - Wing Mok
- Radiology Department, Royal Brompton Hospital, London, UK
| | | | | | - Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | - Robert Wilson
- Host Defence Unit, Royal Brompton Hospital, London, UK
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Ro S, Ishii S, Hayashi Y, Kobayashi K, Masaki H, Miyoshi S, Takeda Y, Hojo M, Sugiyama H. Thoracoscopy under Local Anesthesia was Useful for Diagnosing Yellow Nail Syndrome. Intern Med 2016; 55:975-80. [PMID: 27086815 DOI: 10.2169/internalmedicine.55.5247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
An 80-year-old woman with rheumatoid arthritis and a past history of tuberculosis presented with exertional dyspnea and edema of both legs. Chest X-ray performed on admission showed bilateral pleural effusion. Thoracoscopy under local anesthesia was performed, and vasodilation and non-specific yellowish inflammatory changes were noted in the pleura. A pathological examination showed chronic fibrosing pleuritis in addition to chronic pleural inflammatory changes with lymphoid aggregates. The nails on all fingers and toes were thickened and displayed yellow discoloration, and the edema was resistant to diuretics. Lymphoscintigraphy was conducted, which showed lymphatic drainage abnormalities. The patient was ultimately diagnosed as having yellow nail syndrome.
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Affiliation(s)
- Shoki Ro
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
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9
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Morimoto K, Saraya T, Kurosaki A, Yano R, Sasaki Y, Osawa T, Kudoh S, Goto H. Relapse of Yellow Nail Syndrome with Pulmonary Lymphedema. Intern Med 2016; 55:169-72. [PMID: 26781018 DOI: 10.2169/internalmedicine.55.4849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Yellow nail syndrome (YNS) is a rare disorder characterized by the triad of yellow, thickened nails, lymphedema, and respiratory manifestations such as pleural effusions, bronchiectasis, and recurrent lower respiratory tract infections. We report a case of YNS showing pulmonary interlobular septal thickening on thoracic computed tomography, implying the presence of lymphatic edema. The patient showed both the remission and relapse of yellow nail with different lung treatments over a long clinical course.
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Affiliation(s)
- Kozo Morimoto
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Japan
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10
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Kurin M, Wiesen J, Mehta AC. Yellow nail syndrome: a case report and review of treatment options. CLINICAL RESPIRATORY JOURNAL 2015; 11:405-410. [PMID: 26257383 DOI: 10.1111/crj.12354] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 06/23/2015] [Accepted: 08/03/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS Yellow nail syndrome is a rare disorder involving characteristic nail changes, lymphedema and chronic respiratory symptoms. Currently there is no definitive treatment and there have been no prospective randomised controlled trials evaluating the available options. In order to strengthen the literature on this topic, we present the case of a 67-year-old man with YNS and a detailed review of current treatment options. METHODS We included 40 articles for the final review according to their relevance with the subject. RESULTS Data for use of the commonly chosen therapies for YNS remains inconclusive, with small studies and case reports showing mixed results of efficacy. CONCLUSION Although the date indicates that it is reasonable to recommend a trial of conservative therapy including vitamin E, antibiotics and compression stockings before pursuing more aggressive or invasive modalities, larger scale studies are required to determine the true efficacy of all treatment options.
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Affiliation(s)
- Michael Kurin
- Department of Internal Medicine, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
| | - Jonathan Wiesen
- Department of Pulmonary and Critical Care, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Atul C Mehta
- Department of Pulmonary and Critical Care, Cleveland Clinic Foundation, Cleveland, OH, USA
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Imadojemu S, Rubin A. Dramatic improvement of yellow nail syndrome with a combination of intralesional triamcinolone, fluconazole, and sinusitis management. Int J Dermatol 2015; 54:e497-9. [PMID: 26226835 DOI: 10.1111/ijd.12916] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Sotonye Imadojemu
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA. .,Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Adam Rubin
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
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12
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Annan M, Delaplace M, Carre P, Hommet C, Mondon K. Case report of chronic cough and legs edema of an 84-year-old man: when the solution is found in the nails. Geriatr Gerontol Int 2015; 15:515-6. [PMID: 25828789 DOI: 10.1111/ggi.12383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Mariam Annan
- Department of Geriatric Medicine, University Hospital Center of Tours, Tours, France; François Rabelais University of Tours, Tours, France
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13
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Lotfollahi L, Abedini A, Alavi Darazam I, Kiani A, Fadaii A. Yellow Nail Syndrome: Report of a Case Successfully Treated with Octreotide. TANAFFOS 2015. [PMID: 26221155 PMCID: PMC4515333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Yellow nail syndrome (YNS) is an uncommon condition characterized by a triad of yellow nail coloration, lymphedema and respiratory tract involvement. This syndrome typically affects middle-aged persons. Although several etiologies have been described, to date; the exact etiology remains unclear. Different treatment plans have been suggested, but all data available emphasize the fact that treatment is mainly symptomatic and the underlying disease is not targeted. The most reported treatment protocol is chemical pleurodesis combined with alpha-tocopherol (vitamin E). Hereby, we describe a case of YNS in a 34 year-old woman with the onset of symptoms in childhood. The symptoms improved dramatically after treatment with octreotide.
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Affiliation(s)
- Legha Lotfollahi
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefeh Abedini
- Tracheal Diseases Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ilad Alavi Darazam
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arda Kiani
- Tracheal Diseases Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Correspondence to: Kiani A, Address: NRITLD, Masih Daneshvari Hospital, Shahid Bahonar Ave, Darabad, Tehran 19569, P.O:19575/154, IRAN, Email address:
| | - Abbas Fadaii
- Pulmonology Department, Labbafi Nejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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14
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Anolunula in Fingernails among Patients Infected with HIV. ISRN DERMATOLOGY 2014; 2014:271230. [PMID: 24701356 PMCID: PMC3950909 DOI: 10.1155/2014/271230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 12/17/2013] [Indexed: 11/26/2022]
Abstract
Lunula is the white, half-moon shaped area seen in proximal ends of some nails. Though a few studies have described the nail changes that can occur in association with HIV infection, none of these paid much attention to lunula. Aims and Objectives. To study the lunula in fingernails among HIV infected patients. Materials and Methods. An observational, cross-sectional study to record presence of lunula in 168 HIV-positive patients and compare it with age and sex matched 168 healthy HIV-negative control. Anolunula (absence of lunula) in HIV-positive patients was correlated with CD4 counts, stages of HIV infection, time since patient was diagnosed as HIV-positive, and status of antiretroviral therapy. Results. Anolunula was present in significantly more fingernails in HIV-positive patients compared to HIV-negative controls. There was a highly significant difference for total anolunula (anolunula in all fingernails) in study and control group. Incidence of total anolunula was directly proportional to the stage of HIV infection, increasing progressively as the HIV infection advances from stage 1 to stage 4. Conclusion. Absence of lunula is related to not only HIV infection per se but also the stages of HIV infection.
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