Yellow nails are not a rare sighting for nail techs. We see varying degrees: deep yellow with a tint of orange usually means someone chose a dark polish. Treatment: Buff it off. Brownish yellow on nails often indicates we’ve got a smoker. Treatment: Add enhancements as usual. These yellow nails may reveal our clients’ vices, but they don’t signal alarm. However, some yellow nails do raise our curiosity, and we begin to question clients to get more information. Yellow nails that pull away from the nail bed, for example, could indicate an infection, so techs want to learn the history of the condition.

Add one more “yellow nail sighting” that should draw your attention. It’s called yellow nail syndrome (YNS), and, while rare, YNS could reveal a lot more about a client than her vices. Thankfully, techs can look for a few telltale signs of YNS that separate it from your run-of-the-mill discoloration. The nails (including the toenails) of a client with YNS will have some or all of these characteristics: They will be thicker than normal and they may have a dark, greenish edge. They will grow slower than normal. A secondary result of the slow growth will be ridges or lines in the nails. There will be a pronounced, almost exaggerated curve to the nails. All the nails will be affected. Some of the nails may have onycholysis (separation of the nail plate from the nail bed), and the cuticle will be absent.

Yellow nail syndrome is most often associated with health conditions due to lymphedema or respiratory conditions. The Mayo Clinic defines lymphedema as the swelling that occurs “when a blockage in your lymphatic system prevents the lymph fluid in your arm or leg from draining adequately.” Lymphedema in the legs can result from something as harmless as a long airplane ride, or it could be present in clients with conditions that are far more serious. Clients with breast or lung cancer who have had lymph tissue or nodes removed may experience lymphedema.

Yellow nail syndrome may also be present in clients who suffer from pleural effusion. A membrane called the “pleura” lines our chest cavity and surrounds each of our lungs. When fluid accumulates between the layers of that membrane, pleural effusion occurs.

At one time, it was believed that yellow nail syndrome was hereditary. However, a recent study in the British Journal of Dermatology (June 2007), suggests that YNS may not be a genetic disease. More information is needed on YNS to make a solid determination of its cause. In order to receive a medical classification of YNS, two of three conditions must be present: changes to the nails, chronic respiratory disorders, and primary lymphedema. In some cases, all three are present. Because YNS is not considered a distinct condition, no treatment exists for yellow nail syndrome. Under the care of a doctor, conditions such as lymphedema or respiratory problems that are present alongside yellow nail syndrome may have treatment options. These include physical therapy, prescriptions, or even natural alternatives. Yellow nail syndrome can clear up once the other condition has been treated.

What’s a Tech to Do?
If you suspect a client’s yellow nails re sult from yellow nail syndrome instead of the more traditional causes, such as staining from polish or smoking, take a few minutes to discuss the nails with the client. While we want to stress that you shouldn’t ever make a diagnosis based on your client’s nails, you may be able to help your client by alerting her to the possibility of a greater health problem. Be alert to symptoms such as swelling in the legs, hands, or arms. Other symptoms are trouble breathing, shortness of breath, or sharp pain when breathing. Educate the client on the possible relationship between these symptoms and yellow nail syndrome and recommend strongly that she see a doctor.

If a client has been to a doctor and can confirm the presence of yellow nail syndrome, a tech must determine the appropriate beautification option for the client’s nails. Remember, a common result of yellow nail syndrome is onycholysis. If a client’s nails are separated from the nail bed, do not apply an enhancement. If the nails and skin are uncompromised, you can manicure or pedicure the nails and apply polish.

Enhancements can be applied with care, but don’t jump to this option too soon. The nails will already have an exaggerated curve and extra thickness, so if the client isn’t a nail biter, a natural nail manicure may be the best choice for this client. This allows her to keep an eye on the changes in her nails without the barrier of tips, gels, or acrylics.

If a new client comes in and you suspect your client has yellow nail syndrome, tell the client you can only perform a natural nail service (either a manicure or pedicure), and she needs to check with a doctor before you can apply enhancements. If a regular client comes in and you notice the symptoms of yellow nail syndrome developing over the course of many months, alert her to your concerns and suggest she visit her doctor. Yellow nail syndrome is a very rare condition, so more than likely the client will return with a clean bill of health, and you can continue to provide excellent service.