Combination of Fluconazole and Alpha-tocopherol in the Treatment of Yellow Nail Syndrome

Yellow nail syndrome (YNS) is an uncommon disorder that is characterized by the slow nail growth, marked thickening, and yellow to yellow-green discoloration of the fingernails or toenails. Although the etiology of YNS is unknown, a diagnosis is indicated by the concurrent presentation of the nail changes, with lymphedema and respiratory manifestations. Although lymphedema and respiratory manifestations are sometimes manageable with regimens of medical and surgical treatments, YNS treatment options are limited and often unsuccessful. For the patient, YNS can also be cosmetically unacceptable and concealment with nail polish may not always be possible. However, it is now widely accepted that the azole class of antifungals can stimulate linear nail growth. In addition, vitamin E has also been reported in the treatment of YNS with positive results. Herein, the authors report on a promising combination treatment of oral fluconazole pulse therapy and oral alpha-tocopherol (vitamin E) in 13 patients with YNS with clinical successes observed in 2 individuals and clinical cures observed in 11 subjects.