Yellow nail syndrome (YNS) is a rare disorder, and diagnosis is based on the clinical findings and the exclusion of other possible causes; the pathogenesis is poorly understood. YNS can be an isolated condition or associated with other diseases; however, YNS associated with multiple myeloma (MM) is rare. A 53-year-old male patient presented with coughing and shortness of breath, and he was diagnosed with YNS with MM. He underwent chemotherapy and achieved a good response. Although the etiology of YNS remains unknown, treating the underlying disease may help prevent or relieve the clinical signs.

Yellow nail syndrome (YNS) has traditionally been thought of as a triad of exudative pleural effusion, yellow nails, and lymphedema. More recently, in addition to the hallmark yellowish nail discoloration, the diagnostic criteria required an associated lymphedema and/or chronic respiratory manifestations including pleural effusions, bronchiectasis or chronic sinusitis. Etiology remains unknown and treatment is supportive and directed towards patient\'s specific complaints. While described alongside multiple endocrine, lymphatic and autoimmune disorders, its most ominous association is malignancy, raising YNS as a possible paraneoplastic condition. Here we present the case of an 80 years-old female with worsening restrictive airway disease and acquired yellow nails, with development of dyspnea, cough and leg edema. Recurrent exudative lymphocyte predominant pleural effusion was treated definitively with pleurodesis. Her leg edema and yellow nails were treated conservatively. We describe previous case reports and series in the literature, outline therapeutic options and discuss prognosis.

BACKGROUND: Titanium is a commonly used inert bio-implant material within the medical and dental fields. Although the use of titanium is thought to be safe with a high success rate, in some cases, there are rare reports of problems caused by titanium. In most of these problematic reports, only individual reports are dominant and comprehensive reporting has not been performed. This comprehensive article has been prepared to review the toxicity of titanium materials within the medical and dental fields.
METHODS: We used online searching tools including MEDLINE (PubMed), Embase, Cochrane Library, and Google Scholar by combining keywords such as \"titanium implant toxicity,\" \"titanium implant corrosion,\" \"titanium implant allergy,\" and \"yellow nail syndrome.\" Recently updated data has been collected and compiled into one of four categories: \"the toxicity of titanium,\" \"the toxicity of titanium alloys,\" \"the toxicity of titanium implants,\" and \"diseases related to titanium.\"
RESULTS: Recent studies with regard to titanium toxicity have been increasing and have now expanded to the medical field in addition to the fields of environmental research and basic science. Problems that may arise in titanium-based dental implants include the generation of titanium and titanium alloy particles and ions deposited into surrounding tissues due to the corrosion and wear of implants, resulting in bone loss due to inflammatory reactions, which may lead to osseointegration failure of the dental implant. These titanium ions and particles are systemically deposited and can lead to toxic reactions in other tissues such as yellow nail syndrome. Additionally, implant failure and allergic reactions can occur due to hypersensitivity reactions. Zirconia implants can be considered as an alternative; however, limitations still exist due to a lack of long-term clinical data.
CONCLUSIONS: Clinicians should pay attention to the use of titanium dental implants and need to be aware of the problems that may arise from the use of titanium implants and should be able to diagnose them, in spite of very rare occurrence. Within the limitation of this study, it was suggested that we should be aware the rare problems of titanium toxicity.

Objective: To describe the clinical characteristics of respiratory manifestations of yellow nail syndrome. Methods: We conducted a retrospective analysis of 2 patients with respiratory diseases associated with yellow nail syndrome. Their clinical and chest radiological data were collected. We searched PubMed, Wanfang and CNKI databases with the keywords \"yellow nail syndrome, yellow nail and lung\" in Chinese and English. And the relevant literatures, including 6 articles in Chinese and 81 articles in English, were reviewed. Results: Our 2 patients were male, one 60 years old and the other 76. Typical yellow nails were present in their fingers, and one of them also showed toe yellow nails. One patient was admitted for refractory respiratory infection and he was diagnosed with diffuse bronchiectasis. The respiratory symptoms could be relieved with antibiotics according to the results of sputum microbiological analysis. The other patient was admitted for cough and exertional dyspnea, and refractory pleural effusions were revealed bilaterally. He received repeated effusion drainage by thoracentesis, and Octreotide was tried recently. A total of 373 cases were reviewed in Chinese and English literatures. Pleural effusions (152 cases) and diffuse bronchiectasis (121 cases) were the most common reported respiratory manifestations. Lymphoedema was present in almost all cases with pleural effusion associated with yellow nail syndrome, and the effusion was usually exudative and lymphocyte predominant. Pleurodesis and decortication were effective for them. But, somatostatin analogues had been tried effectively for these patients recently. On the other hand, literatures showed that diffuse bronchiectasis in yellow nail syndrome was less severe than idiopathic diffuse bronchiectasis, and might benefit from long-term macrolide antibiotics. Conclusions: Yellow nail syndrome is a very rare disorder. Besides yellow nail, respiratory manifestations are the main clinical presentations. Diffuse bronchiectasis and recurrent pleural effusions are the common manifestations.
目的： 探讨黄甲综合征(YNS)呼吸系统的临床表现，提高该病的诊治水平。 方法： 回顾性分析北京协和医院呼吸内科治疗的2例不同临床亚型的YNS患者的临床及胸部高分辨率CT特点，并以\"黄甲综合征\"为检索词，在\"万方数据库、中国知网和中国期刊全文数据库(CNKI)\"中检索出中文文献6篇；以\"yellow nail syndrome, yellow nail and lung\"为关键词，在\"PubMed数据库\"检索出英文文献81篇，综合复习相关文献后进行分析。 结果： 2例患者均为男性，年龄分别为60和76岁，均有双手\"黄甲\"的表现，1例还出现双足趾\"黄甲\"的表现。1例因反复肺部感染就诊，影像学表现为双下肺分布为主的弥漫性支气管扩张，间断给予针对性抗感染治疗、长期口服大环内酯类抗生素治疗后病情相对稳定；另1例则因咳嗽、活动后气短就诊，影像学表现为难治性双侧胸腔积液、左下肺分布为主的多发支气管扩张、双下肢淋巴水肿，给予间断抽胸腔积液，并尝试奥曲肽皮下注射治疗。从国内外文献来看，半数以上的YNS(共373例)患者均有不同形式的呼吸系统受累，其中以胸腔积液(152例)和弥漫性支气管扩张症(121例)多见。几乎所有胸腔积液的YNS患者都有淋巴水肿，多为双侧渗出液，胸腔积液中以淋巴细胞为主，对胸膜粘连、胸导管结扎等外科手术反应良好，但近年来也尝试用生长抑素或类似物治疗。。 结论： YNS是一种以\"黄甲\"、呼吸系统受累及肢体淋巴水肿为表现的罕见病，除\"黄甲\"外，呼吸系统是最常见受累部位，影像学主要表现为弥漫性支气管扩张、难治性胸腔积液。.

Yellow nail syndrome (YNS) is a constellation of clinical findings including at least 2 of the 3 features of thickened yellow nails, respiratory tract involvement, and lymphedema. We report the case of a middle-aged man presenting with dystrophic, thickened yellow nails; an idiopathic pericardial effusion in the absence of pleural effusion(s); and unilateral apical bronchiectasis found on computed tomography of the chest. This represents a unique presentation of YNS as the first report of a patient with YNS and a pericardial effusion in the absence of pleural effusions and lymphedema and is the 11th case report of YNS with pericardial effusion.

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.

OBJECTIVE: 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.
CONCLUSIONS: 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.

The xanthodermatoses consist of a heterogeneous group of cutaneous disorders characterized by the macroscopic yellow hue seen on examination. This hue is attributable to the chemical structure of the accumulating substances within the skin or surrounding tissues. The most common culprits are lipids (cholesterol and triglycerides), elastin, and bilirubin. Exogenous sources of yellow pigment include yellow dyes (including hennas) and metal salts. This article will focus on recognition of these entities, classified in terms of morphology and the site of initial eruption, in order to support the recognition and diagnosis of these widely variable conditions.

BACKGROUND: There have been a few reported cases of congenital great toenail dystrophy (GTND), described as a congenital malalignment of the great toenails. However, acquired GTDN is rare, and has not been documented extensively. This study aimed to describe the clinical features of 21 patients with acquired GTND.
METHODS: Twenty-one patients with acquired GTND who visited Yeouido St. Mary\'s Hospital between June 2005 and August 2012 were retrospectively reviewed.
RESULTS: The mean patient age was 43.1 years (range, 17 to 88 years), and the cohort predominantly comprised women (18/21). In our experience, all acquired GTND patients presented with yellow or yellow-brownish chromonychia, onychotrophy, and onycholysis. Conservative treatment with tape methods and grinding, as well as nail extraction, was provided and yielded little improvement in any case.
CONCLUSIONS: This study provides initial data on the nail changes affecting the great toenail, such as yellowish chromonychia, onychomadesis, and onycholysis. These data may help physicians to distinguish various nail disorders, including onychomycosis, congenital malalignment of the great toenails, and yellow nail syndrome.

Yellow nail syndrome is an idiopathic condition characterized by a triad consisting of yellow nail, lymphedema, and pulmonary manifestations. Thiol compounds such as D-penicillamine have been reported to be the major cause of drug-induced yellow nail syndrome in patients with rheumatoid arthritis (RA). We recently experienced two Japanese cases with RA who developed yellow nail under treatment with bucillamine, a thiol-containing anti-rheumatic drug developed and approved in Japan. We reviewed the literature for similar cases and identified 36 RA cases with bucillamine-induced yellow nail, mostly in Japanese medical journals. Most of these cases (90.3%) showed improvement of yellow nail after discontinuation of bucillamine, whereas lymphedema and pulmonary manifestations improved only in 30.8 and 35.0% of the patients, respectively.