THERAPEUTICAL NOTES   

Giornale Italiano di Dermatologia e Venereologia 2002 February;137(1):57-60

Copyright © 2002 EDIZIONI MINERVA MEDICA

language: Italian

Therapeutic effects of a-tocopherol on the Yellow Nail Syndrome: further observation

Bianchi L., Marulli G. C., Campione E., Chimenti S.

Ospedale «S. Eugenio» - Roma Clinica Dermatologica

Yellow nail syndrome is a rare condition: less than 190 cases have been described in the literature so far. The complete syndrome is characterized by the association of dystrophic nails, yellowish color of lamina, idiopathic lymphedema of the extremities and different disorders of the respiratory system. However, a unique ungueal involvement has been described so defining the incomplete form. The case of a 47-year-old man suffering from a 1 year history of thick, opaque and yellow nails is reported. Loss of the cuticles, transversely and longitudinally increased curvature of the laminae completed the clinical picture. Furthermore, the nail growth speed was substantially reduced during the last year. All fingernails and toenails were involved. Nail cultures for bacteria and fungi were repeatedly negative. Routine tests and cranial and chest X-rays did not display any anomalies. According to the literature, oral a-tocopherol at the dosage of 900 UI daily was prescribed. After 6 months of therapy, a pronounced clinical improvement of both finger and toenails was observed. Even though a spontaneous remission cannot be excluded, the time relationship between starting of treatment and nail clearing is impressive. This result seems to confirm the therapeutic effects of antioxidant substances such as a-tocopherol acting either on the abnormal keratinization and the arrested nail growth or on the blocking of pigment formation developed by products of free-radical-mediated oxidations, all considered as possible mechanisms involved in the pathogenesis of this syndrome.