Ava Monroe
A black fingernail, or subungual hematoma, is caused by a build-up of blood under the nail, usually resulting from an injury or trauma to the finger. This can be caused by a blow to the nail, or by closing the finger in a door or drawer, and can cause considerable pain. The blood under the nail may need to be drained by a doctor, especially if it covers more than 25% of the nail.
| Characteristics | Values |
|---|---|
| Cause | Trauma or injury to the finger |
| Vitamin B12, B9 (folate), or vitamin D deficiency | |
| Protein deficiency | |
| Antifungal or chemotherapy medications | |
| Fungal infection | |
| Melanoma | |
| Bacterial infection | |
| Tendon injury | |
| Bone fracture | |
| Treatment | Ice |
| Anti-inflammatory medication | |
| Drainage of blood | |
| Antibiotics |
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What You'll Learn
Drain blood from under the nail
A black fingernail, or subungual hematoma, is usually the result of an injury to the finger. This can be very painful, and the pain is often described as throbbing. This is because the blood pressure varies as your heart beats. In most cases, the pain can be managed with ice and anti-inflammatory medication.
If the pain is particularly severe, a doctor may recommend draining the blood from under the nail. This procedure involves numbing the finger with a local anaesthetic, then using a cautery, needle, or sterilised paper clip to make a hole in the nail and allow the blood to drain out. This reduces the pressure under the nail and relieves pain.
If you wish to drain the blood at home, you can do so by straightening a paper clip and heating the tip in a flame until it is red-hot. Place the tip of the paper clip on the nail and let it melt through. Go slowly and reheat the clip as needed. Do not push or apply pressure on the paper clip, as this could accidentally burn the skin under the nail. As soon as the hole is complete, blood will escape and the pain will be relieved. Soak the finger in warm, soapy water for 10 minutes, 3 times a day for 2 to 3 days.
Clear or bloody fluid may continue to drain from the nail for 2 to 3 days. You may repeat the procedure using the same hole if the pain returns. If the pain does not go away after draining the blood, you may have a more serious injury, so be sure to contact your doctor. Keep an eye out for signs of infection, which may include increased pain, swelling, redness, warmth, red streaks, or pus.
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Treat with ice and anti-inflammatory medication
A black fingernail, or subungual hematoma, is usually the result of an injury or trauma to the finger. This can cause a build-up of blood under the fingernail, which can be very painful. The pain from a black fingernail is often described as throbbing pain, caused by varying blood pressure with each heartbeat.
To treat a black fingernail, the first step is to manage the pain and reduce any swelling. This can be done by applying ice wrapped in a cloth for 10-15 minutes at a time, a few times an hour. Elevating the hand above the level of the heart can also help to slow down the bleeding and reduce throbbing pain.
Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) can be taken to help reduce pain and swelling. Examples of these include ibuprofen and naproxen. In some cases, your doctor may prescribe anti-inflammatory medication.
If the pain is severe and the blood covers more than 25% of the nail, seek medical attention as the blood under the nail may need to be drained by a medical professional. This will involve numbing the finger with a local anaesthetic and then making a small hole in the nail to allow the blood to drain.
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Identify the cause
A black fingernail can be caused by a number of factors, some more serious than others. It is important to identify the cause to determine whether medical attention is required.
Trauma or Injury
A black fingernail is often the result of direct trauma or injury to the finger. This can cause a build-up of blood under the fingernail, known as a subungual hematoma, which can be painful and may require medical attention. The blood appears black and can cause throbbing pain due to increased pressure under the nail.
Melanonychia
Melanonychia is a common condition characterised by black or brown lines or stripes on the nail, usually starting at the bottom of the nail bed and continuing to the top. It can affect one or multiple nails and is caused by increased deposits of melanin, the pigment that gives skin its colour. Melanonychia can be benign or malignant and may be a sign of nail cancer, so it is important to consult a doctor for diagnosis and treatment.
Nutritional Deficiency
Dark lines on the nails can also be a sign of nutritional deficiencies, specifically a lack of vitamin B12, vitamin D, or protein. Addressing these deficiencies through dietary changes or supplements may help resolve the issue.
Infections
Fungal infections, such as onychomycosis or tinea unguium, can cause the nails to discolour and turn black. Bacterial infections, such as cellulitis or paronychia, can also lead to black fingernails. Infections can usually be treated with antibiotics or antifungal medications, but it is important to seek medical advice to prevent the infection from worsening.
Other Factors
Other factors that can contribute to black fingernails include wearing tight shoes or gloves, habits like nail-biting or picking, and the use of certain medications, such as antifungals or chemotherapy drugs. In some cases, dark nails may be a sign of a more serious underlying health condition, so it is always advisable to consult a healthcare professional for an accurate diagnosis and appropriate treatment.
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Consult a dermatologist
A black fingernail is usually caused by a build-up of blood under the fingernail, resulting from an impact or trauma to the finger. This is called a subungual hematoma and can cause considerable pain. In most cases, ice and anti-inflammatory medication are sufficient to treat it. However, if the pain is severe, a doctor may drain the blood from under the nail.
If you experience a black fingernail, it is important to monitor the situation and seek medical attention if necessary. While a black fingernail is often caused by trauma, it can also be a sign of something more serious. Here are some reasons why you should consult a dermatologist regarding your black fingernail:
Infection
In some cases, a black fingernail can be caused by a bacterial or fungal infection. If you notice redness, swelling, or soreness around the nail, it is important to seek medical advice. Early diagnosis and treatment with antibiotics or antifungal medication can help clear up the infection and prevent further complications.
Melanoma
A black or dark streak under the fingernail could be a sign of melanoma, the most serious type of skin cancer. While not all dark streaks are melanoma, it is crucial to have any suspicious marks examined by a dermatologist as soon as possible. Caught early, melanoma can often be treated successfully. However, if left untreated, the condition may worsen, and treatment may become more difficult.
Nutrient Deficiency
Dark lines on the nails can sometimes indicate a deficiency in certain nutrients, such as vitamin B12, B9 (folate), or vitamin D or an iron deficiency. A dermatologist can help determine if your black fingernail is related to nutrient deficiency and provide guidance on improving your diet or taking appropriate supplements.
Chronic Conditions
In some instances, a black fingernail can be a symptom of an underlying chronic condition. For example, multiple Beau lines (horizontal lines on the nail) can indicate conditions such as endocarditis, which may present with additional symptoms like fatigue, fever, and joint pain. A dermatologist can help evaluate your overall health and determine if any underlying conditions are contributing to your nail changes.
Persistent Pain or Discomfort
If your black fingernail is accompanied by persistent pain or discomfort, it is important to consult a dermatologist. They can assess the severity of the condition and provide appropriate pain management options or refer you to a specialist if needed.
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Determine if it's melanonychia
Melanonychia is a condition that causes brown or black lines on your fingernails or toenails. It can appear in one nail or several and can affect individuals of all sexes and ages. The lines usually look like stripes that begin at the bottom of the nail bed and continue to the top. These lines can occur naturally if you have a dark complexion.
Melanonychia occurs when there is an increase in the number of pigment cells, called melanocytes, in the nail plate, or when there is an increase in melanin production. Melanin is the brown-coloured pigment that gives skin its colour. The condition can develop due to several factors, including nail trauma, nutritional deficiencies (such as low vitamin B12, vitamin D, or protein), medication, and other health conditions.
If you suspect that you have melanonychia, it is important to seek medical advice to ensure an accurate diagnosis and rule out any potential complications. A doctor can perform a dermatoscopic exam using a microscope to closely examine the discoloured areas and determine if the condition is benign or malignant. They may also perform a nail biopsy to confirm the diagnosis.
It is worth noting that melanonychia can sometimes be a sign of a more serious health issue, such as nail cancer or melanoma. Therefore, it is always advisable to have a doctor examine any dark streaks or discolouration in your nails.
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Frequently asked questions
A black fingernail is usually caused by a build-up of blood under the nail, known as a subungual hematoma. This is often the result of trauma to the finger, such as a crush injury or a blow to the nail.
If you have a black fingernail, you should assess the severity of the injury. If the pain is mild and the hematoma is small, it will usually heal without treatment. You can encourage healing by resting the finger, icing it, and elevating your hand to reduce throbbing and swelling. For pain relief, you can take over-the-counter anti-inflammatory medication, such as ibuprofen.
If you experience severe pain, bleeding that won't stop, signs of infection, or if the hematoma doesn't go away on its own, you should seek medical attention. Additionally, if the bleeding covers more than 25% to 50% of the nail, a doctor should evaluate it, as it could indicate a more serious issue.
A doctor may recommend draining the blood from under the nail to relieve the pressure and pain. This procedure, called trephination, involves creating a small hole in the nail to allow blood to drain out. In some cases, local anaesthetic may be administered, and the whole nail might need to be removed.
It typically takes about 4 to 6 months for a new fingernail to grow back completely. During this time, the nail bed will heal, and you may notice ridges or other abnormalities in the new nail.
