Ava Monroe
A black nail is often the result of trauma or injury, causing bleeding underneath the nail. This is known as a subungual haematoma, where blood is trapped under the nail and darkens, turning the nail black. In mild cases, the black nail will grow out naturally over time without treatment. However, if more than half of the nail is black, it is painful, or there are signs of infection, it is recommended to seek medical advice. The time it takes for a black nail to grow out or heal will depend on the severity of the injury and the treatment required.
| Characteristics | Values |
|---|---|
| Cause | Trauma or injury, fungal infection, skin cancer, medication side effects, diabetes, vitamin B12 deficiency, ingrown toenail, psoriasis, anemia, or vascular disease |
| Treatment | Draining excess fluid, relieving pressure, medication, home treatments, removing the nail, stitches, bandaging, elevation, ice, anti-inflammatories, splint, rest, different shoes |
| Time to heal | Varies depending on the cause and treatment; can take several weeks to months for a nail to grow back |
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What You'll Learn
Draining blood from under the nail
A black nail is usually caused by a subungual hematoma, or bleeding under the nail. This is often the result of a crushing or stubbing injury, such as dropping a heavy object on your foot or toes, which causes blood to pool under the nail. The injury can cause extreme pain and pressure, and the blood may turn dark over time.
If you experience bleeding under your nail, it is recommended to see a healthcare provider as soon as possible. A small subungual hematoma may not require medical treatment, and you can treat it at home by icing and elevating the area to reduce swelling, and taking over-the-counter anti-inflammatories for minor pain. However, if the affected area continues to collect blood, you experience extreme pain, or the injury is at the base of the nail, it is important to seek medical attention.
If you seek medical treatment, the doctor will first examine your nail and may take an X-ray to check for any fractures or other injuries. To drain the blood from under the nail, the doctor will first clean the area and administer a digital block to numb the area. They will then use a heated 18-gauge needle or cautery device to make a small hole in the nail, allowing the blood to drain out. Some clinics may even use specialized lasers for this procedure. The hole should be 3 to 4 millimeters thick to allow for continuous drainage. After the drainage, the doctor will cover the area with a dry bandage and you will need to keep the wound clean and dry while it heals.
It is important to note that attempting to drain the blood at home using methods such as a heated pin or paper clip can cause infection. Therefore, it is always best to seek professional medical help for proper treatment.
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Treatment for fungal infections
A black nail can be caused by several factors, including fungal infections, trauma or injury, and, in rare cases, melanoma. The treatment for a black nail will depend on the underlying cause.
Fungal nail infections cause the nail to become discoloured, thickened, and distorted. Toenails are particularly susceptible to fungal infections, as socks and shoes provide a warm and moist environment for the fungus to thrive.
If you suspect a fungal nail infection, you can consult a pharmacist or a doctor for advice. Treatment for mild infections may involve applying antifungal medicine to the nail regularly for several months. For more severe infections, your doctor may prescribe antifungal tablets, which need to be taken for up to six months. It is important to follow the treatment plan as directed and continue until advised to stop, as stopping early may lead to the infection returning.
In some cases, if the infection fails to clear or the nail becomes badly infected, your doctor may recommend nail removal. This procedure is typically performed under local anaesthesia, and the nail can regrow, although it may take about six months.
Additionally, researchers are exploring new treatment options for nail fungus, including the use of lasers and light treatments, as well as patches, nail lacquers, and gels.
Treatment for Trauma or Injury
Trauma or injury to the nail can cause bleeding underneath, known as subungual hematoma, resulting in black discolouration. In mild cases, the nail may grow out naturally over time without treatment. However, if there is intense pain, swelling, or continuing bleeding, it is important to seek medical attention.
For small hematomas, home care measures such as icing, elevation, and over-the-counter anti-inflammatory medications can help reduce swelling and pain. In more severe cases, a doctor may drain the excess fluid with a needle to relieve pressure. If the nail bed or surrounding tissues are injured, the nail may need to be removed, and stitches may be required to repair the area. A new fingernail can regrow in as little as eight weeks, while a toenail may take up to six months.
Treatment for Melanoma
Melanoma is a rare cause of black toenails, and it is the most aggressive form of skin cancer. If melanoma is suspected, a doctor will review treatment options, which may include managing the underlying condition and allowing the nail to regain its original colour.
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Blunt force trauma
A black nail is typically caused by a subungual hematoma, which is a bruise that forms under the nail after trauma. This can be the result of blunt force trauma, such as hitting your finger with a hammer, dropping a heavy object on your toe, or even from repeated trauma, such as long-distance running or dancing. Subungual hematomas can cause severe, throbbing pain and nail discolouration, with the nail appearing black-and-blue, black-and-purple, or brown and black.
If you experience a nail injury, it is important to ensure that your tetanus vaccination is up to date. For more serious injuries, such as a broken bone or deep cut, it is recommended to seek medical attention at an urgent care centre or emergency room. Treatment for a subungual hematoma typically involves relieving pressure by draining the blood trapped under the nail. This can be done by creating a small hole in the nail, allowing the blood and fluid to drain out. In some cases, the nail may need to be removed and the nail bed repaired.
The bruise will usually grow out over several weeks or months as your nail grows back. During this time, the discolouration may change from red or purple to dark brown or black. It can take up to six to nine months for the nail to completely grow out and return to its normal colour. In some cases, the nail may fall off on its own and a new nail will grow in to replace it. This process can take about four to six months for a fingernail and up to twelve months for a toenail.
While subungual hematomas usually heal well, there is a risk for complications such as nail loss, infection, and deformities. It is important to watch for signs of infection, such as redness, swelling, or pus, and seek medical attention if needed. Additionally, if the trauma has caused damage to the nail matrix, a ridge or split may develop, which will eventually disappear as the nail regrows.
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Managing underlying medical conditions
Black nails are often caused by injuries or trauma, such as a heavy object falling on the toes, or tight shoes pinching and jamming the toenail, causing bleeding underneath the nail. In mild cases, the black nail will grow out naturally over time without treatment. In more severe cases, such as when the nail begins to detach from the nail bed, a person should seek medical treatment.
However, black nails can also be indicative of underlying medical conditions, such as:
Fungal Infections
Fungal infections are a common cause of black nails, particularly toenails, as socks and shoes provide a warm and moist environment for fungi to thrive. Treatment for fungal infections typically involves the use of creams and ointments, which are available over the counter or online. In more severe cases, a doctor may prescribe additional medication to help the injury heal.
Melanoma
Melanoma, the most aggressive form of skin cancer, can cause black or brown bands on the nail, often appearing on the dominant thumb or big toe. It can also cause dark patches of skin to develop beneath the nail bed. Melanoma is a serious condition that requires prompt medical attention.
Medication Side Effects
Certain medications can cause melanonychia, resulting in black or brown pigmentation of the nail plate. These include chemotherapy drugs, antimalarials, biologics for inflammatory conditions, seizure medications, and antifungals. If medication is the cause of black nails, a healthcare provider may consider adjusting or changing the prescription. However, it is important to never stop or alter medications without medical advice.
Other Conditions
Other underlying medical conditions that can cause black nails include psoriasis, lichen planus, endocarditis, and glomus tumour, among others. Treating and managing these underlying conditions is crucial to help the nails regain their original colour.
It is important to consult a healthcare professional if you experience black nails without an apparent cause, as they can perform a thorough examination, order diagnostic tests, and provide appropriate treatment or referrals.
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Toenail regrowth
A black toenail is often the result of trauma or injury to the toe, such as dropping a heavy object on it or wearing ill-fitting shoes. In some cases, it can also be caused by a fungal infection or, rarely, melanoma. The treatment for a black toenail depends on the underlying cause.
If the black toenail is due to trauma or injury, the discoloured part of the nail will disappear as the nail grows out. This can take several months, with a new toenail typically taking about six months to fully regrow. In the case of a severe injury, such as when the nail detaches from the nail bed, it is important to seek medical treatment. A doctor may need to remove the nail and repair the nail bed with stitches. To aid the healing process, it is recommended to keep the toe bandaged and elevated during the first 12 hours, and to use cold compresses. In some cases, a splint may be necessary for a few days until the tenderness subsides.
For mild cases of a black toenail caused by trauma, the nail will typically grow out naturally over time without treatment. However, if the black toenail is causing pain or swelling, a doctor can treat the condition by draining the blood with a needle. This procedure must be done within 48 hours of the injury, as after this time, the blood will start to clot, making drainage difficult. After the procedure, it is important to follow the doctor's instructions for caring for the injured nail.
If the black toenail is due to a fungal infection, it can often be treated at home with over-the-counter creams and ointments. However, if the infection does not clear up after a few days, it is recommended to consult a doctor. They may take a sample of nail clippings to send for lab analysis and determine the recommended treatment.
In rare cases, a black toenail may be indicative of melanoma, the most aggressive form of skin cancer. Melanoma causes the skin to develop dark, irregular patches, which can also grow beneath the nail bed. As melanoma develops slowly and without other symptoms, it often goes unnoticed in the early stages, especially if it originates under the toenail. Therefore, it is important to consult a doctor if you experience a sudden, unexplained black toenail or if it does not heal with time and at-home treatments.
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Frequently asked questions
It depends on the cause. If it is due to a fungal infection, it may go away with over-the-counter treatments. If it is due to trauma, the discolouration may disappear as the nail grows out, which can take up to six months for toenails.
Black nails can be caused by trauma, such as dropping something heavy on your foot. They can also be caused by fungal infections, which are common in toenails due to the warm and moist environment created by socks and shoes.
You should see a doctor if the black nail is painful, if there are signs of infection, or if more than half of the nail is black. You should also seek medical attention if you experience sudden, unexplained black nails, or if the discolouration appeared slowly.
In rare cases, black nails can be a sign of melanoma, the most aggressive form of skin cancer. It is important to see a healthcare professional if you are concerned about this possibility.
Yes, several medical conditions can cause black nails, including diabetes, vascular disease, kidney disease, heart infection, psoriasis, and anemia. Certain medications can also lead to nail discolouration.
