A patient presents with yellow-brownish thickened nail plates with subungual hyperkeratosis, onycholysis, and an absent lunula. The slow nail growth and lymphedema affecting both lower limbs suggest which syndrome?

• A Pachyonychia congenita type 1 — associated with oral leukokeratosis
• B Onychodystrophy secondary to lichen planus — associated with 20-nail dystrophy
• C Yellow nail syndrome (YNS) — associated with lymphedema, pleural effusion, and respiratory disease ✓
• D Nail-patella syndrome — associated with absent patellae and nephropathy

Explanation

Yellow nail syndrome (YNS) is the clinical triad of yellow-discolored nails (slow-growing, thickened, curved excessively, onycholysis), lymphedema, and respiratory manifestations (pleural effusion, bronchiectasis, recurrent infections). The absent lunula is characteristic due to slow nail growth (<0.25 mm/week vs normal 3 mm/week). Pathogenesis involves impaired lymphatic drainage affecting nail matrix vascularization. Vitamin E has been reported to help YNS. Pachyonychia congenita (KRT6/KRT16/KRT17 mutations) causes painful palmoplantar keratoderma and subungual hyperkeratosis from birth, not lymphedema. Nail-patella syndrome (LMX1B mutation) shows triangular lunulae and absent/hypoplastic patellae.

Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.