{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T14:14:04Z","timestamp":1787062444550,"version":"build-2736575974"},"reference-count":39,"publisher":"American Academy of Pediatrics (AAP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,1,1]]},"abstract":"<jats:p>Yellow nail syndrome (YNS) is an uncommon disorder, the classic triad of which consists of yellow nails, lymphedema, and respiratory symptoms. Few pediatric cases have been reported. We report a 9-year-old girl with yellowish nail discoloration for 1 year accompanied by respiratory symptoms, including chronic cough, recurrent pneumonia, bronchiectasis, and chronic sinusitis. The patient was diagnosed with YNS. Knowing that a relationship between YNS and titanium has been reported, we collected her nail clippings and detected titanium in them by energy dispersive radiograph fluorescence. This patient\u2019s titanium exposure may have come from her habit of swallowing children\u2019s toothpaste. With meticulous avoidance of swallowing toothpaste, she had amelioration of her yellow nail discoloration as well as diminution of her respiratory symptoms. We reevaluated her nail clippings for titanium 3 years later, and no titanium was detected. This observation suggests that avoiding titanium exposure could alleviate the symptoms of YNS. This is the first report of YNS in a pediatric patient that demonstrates a relationship between YNS and titanium. We review the previous reports of pediatric patients with YNS.<\/jats:p>","DOI":"10.1542\/peds.2016-0546","type":"journal-article","created":{"date-parts":[[2016,12,8]],"date-time":"2016-12-08T05:10:21Z","timestamp":1481173821000},"source":"Crossref","is-referenced-by-count":12,"title":["Titanium Dioxide in Toothpaste Causing Yellow Nail Syndrome"],"prefix":"10.1542","volume":"139","author":[{"given":"Ting-Yuan","family":"Hsu","sequence":"first","affiliation":[{"name":"Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Chen","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan;"},{"name":"Department of Medicine, MacKay Medical College, Taipei, Taiwan;"},{"name":"MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming-Dar","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan;"},{"name":"Department of Medicine, MacKay Medical College, Taipei, Taiwan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian Pin-Hsuan","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan;"},{"name":"Department of Medicine, MacKay Medical College, Taipei, Taiwan;"},{"name":"Department of Pediatrics, Taipei Medical University Hospital, Taipei, Taiwan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeng-Daw","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan;"},{"name":"Department of Medicine, MacKay Medical College, Taipei, Taiwan;"},{"name":"Department of Pediatrics, Taipei Medical University Hospital, Taipei, Taiwan; and"},{"name":"Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2017,1,1]]},"reference":[{"key":"2021120904274923600_B1","first-page":"132","article-title":"The yellow nail syndrome: dystrophic nails associated with lymphoedema.","volume":"50","author":"Samman","year":"1964","journal-title":"Trans St Johns Hosp Dermatol Soc"},{"issue":"2","key":"2021120904274923600_B2","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1378\/chest.08-0137","article-title":"Yellow nail syndrome: analysis of 41 consecutive patients.","volume":"134","author":"Maldonado","year":"2008","journal-title":"Chest"},{"issue":"1","key":"2021120904274923600_B3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s12011-010-8828-5","article-title":"Titanium, sinusitis, and the yellow nail syndrome.","volume":"143","author":"Berglund","year":"2011","journal-title":"Biol Trace Elem Res"},{"issue":"3","key":"2021120904274923600_B4","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1136\/thx.21.3.247","article-title":"Yellow nails, lymphoedema, and pleural effusions.","volume":"21","author":"Emerson","year":"1966","journal-title":"Thorax"},{"issue":"5","key":"2021120904274923600_B5","first-page":"821","article-title":"Pleural-fluid kinetics in a patient with primary lymphedema, pleural effusions, and yellow nails.","volume":"119","author":"Runyon","year":"1979","journal-title":"Am Rev Respir Dis"},{"issue":"5","key":"2021120904274923600_B6","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1378\/chest.61.5.452","article-title":"Pulmonary manifestations of the yellow nail syndrome.","volume":"61","author":"Hiller","year":"1972","journal-title":"Chest"},{"key":"2021120904274923600_B7","first-page":"223","article-title":"The nail in systemic diseases and drug-induced changes","author":"Tosti","year":"1994"},{"issue":"4","key":"2021120904274923600_B8","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1097\/MCP.0b013e32832ad45a","article-title":"Yellow nail syndrome.","volume":"15","author":"Maldonado","year":"2009","journal-title":"Curr Opin Pulm Med"},{"issue":"2","key":"2021120904274923600_B9","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1111\/j.0954-6820.1986.tb03302.x","article-title":"Yellow nail syndrome--the triad of yellow nails, lymphedema and pleural effusions. 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