What is your approach to treating these yellow fingernails?
A 54-year-old male presented for evaluation of his fingernails and toenails, which have been turning yellow over the past 6 months, but are currently asymptomatic. The nail changes were preceded by recurrent chronic sinusitis, which had been treated with a variety of antibacterial antibiotics, but an infection still persists. The patient is otherwise healthy.
The patient’s doctor did not think a fungal infection was the cause, but referred the patient for further evaluation.
What is your approach?
A. Clip nails for fungal culture
B. Clip nails for histopathology with fungal stains
C. Start a course of oral terbinafine
D. Refer to ear, nose, and throat specialist or allergist to treat the sinusitis
E. Obtain a chest x-ray
(Answer and discussion on next page)
Answer: Refer to a specialist to treat the sinusitis
Yellow nail syndrome1 is a rare condition of yellow nails associated with respiratory disease and lymphedema. The etiology remains obscure and the condition is benign. Most patients improve when the underlying respiratory condition is successfully treated. Nail clippings and culture will be negative. Oral antifungal therapy will not help the nails unless the sinus infection is fungal. A chest x-ray is not unreasonable given the association.
Reference:
1. Maldonado F, Ryu JH. Yellow nail syndrome. Curr Opin Pulm Med. 2009;15(4):371-375.