Titanium, sinusitis, and the yellow nail syndrome

Fredrik Berglund, Björn Carlmark, Fredrik Berglund, Björn Carlmark

Abstract

Yellow nail syndrome is characterized by nail changes, respiratory disorders, and lymphedema. In a yellow nail patient with a skeletal titanium implant and with gold in her teeth, we found high levels of titanium in nail clippings. This study aims to examine the possible role of titanium in the genesis of the yellow nail syndrome. Nail clippings from patients with one or more features of the yellow nail syndrome were analyzed by energy dispersive X-ray fluorescence. Titanium was regularly found in finger nails in patients but not in control subjects. Visible nail changes were present in only half of the patients. Sinusitis with postnasal drip and cough was the most common complaint. The dominant source of titanium ions was titanium implants in the teeth or elsewhere. The titanium ions were released through the galvanic action of dental gold or amalgam or through the oxidative action of fluorides. In other patients the titanium was derived from titanium dioxide in drugs and confectionary. Stopping galvanic release of titanium ions or canceling exposure to titanium dioxide led to recovery. In one patient with a titanium implant, the symptoms recurred after renewed exposure to titanium. Yellow nail syndrome is caused by titanium.

Conflict of interest statement

None.

References

    1. Samman PD, White WF. The “yellow nail” syndrome. Br J Dermatol. 1964;76:153–157. doi: 10.1111/j.1365-2133.1964.tb14499.x.
    1. Berglund F, Carlmark B. Yellow nail syndrome in patients with titanium and gold implants [Abstract] Toxicol Lett. 1999;109(suppl 1):53.
    1. Forsell M, Marcusson JA, Carlmark B, et al. Analysis of the metal content of in vivo fixed dental alloys by means of a simple office procedure. Swed Dent J. 1997;21:161–168.
    1. Emerson PA. Yellow nails, lymphoedema, and pleural effusions. Thorax. 1966;21:247–253. doi: 10.1136/thx.21.3.247.
    1. Zerfas AJ. Yellow nail syndrome with bilateral bronchiectasis. Proc Royal Soc Med. 1966;59:448.
    1. Nakielna EM, Wilson J, Ballon HS. Yellow nail syndrome: report of three cases. Can Med Assoc J. 1976;115:46–48.
    1. Hassard AD, Martin J, Ross JB. Yellow nail syndrome and chronic sinusitis. J Otolaryngol. 1984;13:318–320.
    1. Camilleri AE. Chronic sinusitis and the yellow nail syndrome. J Laryngol Otol. 1990;104:811–813. doi: 10.1017/S0022215100112460.
    1. Varney VA, Cumberworth V, Sudderick R, et al. Rhinitis, sinusitis and the yellow nail syndrome: a review of symptoms and response to treatment in 17 patients. Clin Otolaryngol Allied Sci. 1994;19:237–240. doi: 10.1111/j.1365-2273.1994.tb01222.x.
    1. Cebeci F, Celebi M, Onsun N. Nonclassical yellow nail syndrome in six-year-old girl: a case report. Case J. 2009;2:165–169. doi: 10.1186/1757-1626-2-165.
    1. Somorin AO, Adesugba AJ. The yellow nail syndrome associated with sinusitis, bronchiectasis and transitory lymphoedema in a Nigerian patient. Clin Exp Dermatol. 1978;3:31–33. doi: 10.1111/j.1365-2230.1978.tb01455.x.
    1. Hunsberger JF. Electrochemical series Table I. In: Weast RC, editor. Handbook of chemistry and physics. 57. Boca Raton: CRC Press; 1976. pp. D141–D143.
    1. Reclaru L, Meyer J-M. Effects of fluoride on titanium and other dental alloys in dentistry. Biomaterials. 1998;19:85–92. doi: 10.1016/S0142-9612(97)00179-8.
    1. Strietzel R, Hösch A, Kalbfleisch H, et al. In vitro corrosion of titanium. Biomaterials. 1998;19:1495–1499. doi: 10.1016/S0142-9612(98)00065-9.
    1. Schiff N, Grosgogeat B, Lissac M, et al. Influence of fluoride content and pH on the corrosion resistance of titanium and its alloys. Biomaterials. 2002;23:1995–2002. doi: 10.1016/S0142-9612(01)00328-3.
    1. Ben-Yehuda A, Ben-Chetrit E, Eliakim M. Yellow nail syndrome: case report and review of the literature. Isr J Med Sci. 1986;22:117–119.
    1. Ishizaki C, Sueki H, Kohsokabe S, Nishida H. Yellow nail induced by bucillamine. Int J Dermatol. 1995;34:493–494. doi: 10.1111/j.1365-4362.1995.tb00621.x.
    1. David-Vaudey E, Jamard B, Hermant C, et al. Yellow nail syndrome in rheumatoid arthritis: a drug-induced disease? Clin Rheumatol. 2004;23:376–378. doi: 10.1007/s10067-004-0862-2.

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