Ava Monroe
A black toenail can be caused by several factors, including fungal infections, diabetes, vitamin B12 deficiency, and skin conditions like psoriasis. However, one of the most common causes is trauma or injury, resulting in a subungual hematoma, where blood collects under the nail, causing it to turn black. In such cases, the blackened toenail may fall off a few weeks after the injury and can take up to six months to grow back.
| Characteristics | Values |
|---|---|
| Cause of black nail | Trauma/injury, fungal infection, bacterial infection, vitamin B12 deficiency, psoriasis, melanoma |
| Treatment | Drain blood with a needle, antifungal medication, topical steroids, phototherapy, removing the nail |
| Time for nail to fall off | A few weeks |
| Time for new nail to grow | Fingernail: 2 months; Toenail: 4 months to 6 months |
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What You'll Learn
- Black nail causes: trauma, fungal infection, vitamin deficiency, or skin conditions
- Treatments: home remedies, antibiotics, or medical procedures
- Recovery time: a few weeks to several months
- Prevention: wear properly-sized shoes and keep nails trimmed
- Complications: infection, permanent cosmetic changes, or nerve damage
Black nail causes: trauma, fungal infection, vitamin deficiency, or skin conditions
A black nail is usually caused by trauma to the nails. This can occur as a sudden, sharp injury to the toe or by repetitive harm to the nail over time. The injury causes the area under the nail to bleed and swell, resulting in a dark colour. In some cases, the blood pools under the nail and exerts painful pressure on the toe, which may need to be drained by a doctor.
Black nails can also be caused by fungal infections, which usually cause white or yellowish discolouration. However, debris can build up near the infection, causing the nail to appear black. Toenails are particularly prone to fungal infections due to the warm and moist environment created by socks and shoes. Most fungal infections can be treated at home with over-the-counter creams and ointments, but if the infection persists, it is important to consult a doctor.
Vitamin deficiencies can also cause nail discolouration. For example, spoon-shaped nails, or koilonychia, can be a sign of iron deficiency or a lack of vitamin C. All-white or mostly white nails could indicate a selenium deficiency, while white lines or streaks may be due to deficiencies in zinc, calcium, or B-complex vitamins.
In some cases, black nails can be indicative of more serious underlying health conditions, such as skin cancer or melanoma. Melanonychia, a brown or black colour in the nail, can be caused by inflammatory skin diseases, malnutrition, trauma, systemic disease, or certain medications. It is always best to consult a doctor if you notice any dark streaks or discolouration in your nails, as it could indicate a more serious condition.
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Treatments: home remedies, antibiotics, or medical procedures
Black toenails are usually the result of trauma or injury, and in mild cases, they will grow out naturally over time without treatment. However, there are several treatment options available depending on the cause, ranging from home remedies to medical procedures.
Home Remedies
If the black toenail is caused by a fungal infection, there are various over-the-counter (OTC) treatments available, including ointments, soaks, and creams. These can be applied topically to the nail, and some sources recommend filing or cutting off any white markings on the nails and soaking them in water before drying and applying the cream. While these treatments are readily available, they may take months to work and are not strong enough for moderate or severe cases.
Antibiotics
If a fungal infection is more severe or does not respond to initial treatment, a doctor may prescribe additional medication. Antifungal pills, such as itraconazole (Sporanox) and terbinafine (Lamisil), are more effective than creams and gels but must be closely monitored due to potential side effects and interactions with other medications. Antifungal nail polish containing drugs like ciclopirox can also be prescribed, but studies show this is much less effective than taking pills. Doctors may also recommend pairing pills with other treatments for better results.
Medical Procedures
In cases of blunt force trauma, a doctor may use a needle or a special instrument to make a small hole in the nail to relieve pressure and drain the blood. This must be done within two days of the injury. If the nail is severely injured, infected, or beginning to separate, a healthcare provider may recommend removing the nail. The area will be numbed to ensure the procedure is painless. For deep and persistent infections, a doctor may surgically or nonsurgically remove all or part of the nail. Nonsurgical treatment involves applying urea ointment to the nail and wrapping it in plastic and tape.
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Recovery time: a few weeks to several months
The time it takes for a black nail to fall off and recover varies depending on the cause and treatment method. In the case of a subungual hematoma, which is a collection of blood under the nail due to trauma or injury, the nail may fall off a few weeks after the initial injury and can take up to six months to grow back completely. During this time, it is important to protect the sensitive skin of the nail bed, known as the nail plate, and keep it clean and covered with a bandage.
If the black nail is caused by a fungal infection, the recovery time will depend on the severity of the infection and the treatment method. Mild cases may clear up on their own or with over-the-counter antifungal creams and ointments, while more severe infections may require oral or topical antifungal medications prescribed by a doctor. Fungal infections can be challenging to treat, and nails may take several months to grow back completely.
In some cases, a black nail may be caused by an underlying medical condition such as psoriasis, anemia, or even melanoma (a rare form of skin cancer). Treating the underlying condition will help the nail regain its original colour, and recovery times will vary depending on the condition and its severity. For example, nail psoriasis may be treated with topical steroids or phototherapy, while melanoma will require immediate medical attention and may involve more invasive treatments.
It is important to note that if a black nail is not causing any pain and less than half of the nail is discoloured, it may not require any treatment at all. In these cases, the nail will eventually grow out, and the discolouration will disappear over time. However, if more than half of the nail is black or if there are signs of infection, it is recommended to seek medical advice to determine the best course of action and promote faster recovery.
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Prevention: wear properly-sized shoes and keep nails trimmed
While it is not always possible to prevent black toenails, wearing properly-sized shoes and keeping your nails trimmed are two important ways to reduce your risk.
Wearing properly-sized shoes is essential for foot health. Ill-fitting shoes are a common cause of black toenails, as they can pinch and jam the nail, causing bleeding underneath. This can happen with both tight shoes and those that are too loose, allowing your foot to slide forward with each step and repeatedly bumping your toes. Shoes that are too small can also cause other foot problems, such as ingrown toenails and deformities in the nails.
To ensure your shoes fit correctly, make sure there is enough room for your toes to move and that your foot does not slide forward when you walk. If you are a runner or walk a lot, be mindful of the swelling that can occur during exercise, which can create more pressure on your toes.
Keeping your nails trimmed is another important way to prevent black toenails. Long nails are more prone to injury, such as stubbing your toe or dropping something on your foot, which can cause bleeding and bruising underneath the nail. Trimming your nails also reduces the risk of ingrown toenails, which can lead to bacterial infections and discolouration.
In addition to wearing properly-sized shoes and keeping your nails trimmed, you can also reduce your risk of black toenails by maintaining good foot hygiene and moisturising your nails and feet.
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Complications: infection, permanent cosmetic changes, or nerve damage
A black nail can be caused by several factors, including fungal infections, blunt force trauma, ill-fitting shoes, or, in rare cases, melanoma—the most aggressive form of skin cancer. While mild cases may resolve without treatment, severe cases may require medical intervention.
Leaving a black nail untreated can lead to several complications, including infection, permanent cosmetic changes, or nerve damage. Here are some details on each of these potential issues:
- Infection: Fungal infections are a common cause of black nails. Toenails are particularly susceptible to fungal infections due to the warm and moist environment created by socks and shoes. In some cases, a fungal infection may resolve with over-the-counter creams and ointments. However, if the infection persists, it is essential to consult a doctor. Fungal infections can be challenging to treat, and oral antifungal medications or even surgical removal of the nail may be necessary in severe cases.
- Permanent cosmetic changes: Repeated trauma to the toenails, such as wearing ill-fitting shoes, can lead to permanent deformities in the nails. These deformities may include thickening, discolouration, or lifting away from the nail bed. In some cases, these cosmetic changes may be irreversible.
- Nerve damage: While less common, nerve damage can occur if the injury extends to the nail bed or the tissue underneath the nail. Lack of sensation or unusual colours in the fingertip may indicate nerve damage. It is crucial to seek medical attention if you experience any of these symptoms.
It is important to monitor your black nail and seek medical advice if you are concerned about any of these potential complications. Leaving a black nail untreated can lead to more severe issues, and early intervention is always advisable.
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Frequently asked questions
It can take several weeks for a black nail to fall off.
A black nail is usually caused by a subungual hematoma, which is a collection of blood under the injured nail. This can be caused by a blunt force injury or trauma, such as stubbing your toe or dropping something on it.
If the black nail is not causing you pain and less than half of the nail is black, there is no need to treat it. The nail will grow out over time and the discoloration will go away. However, if more than half of the nail is black or if the injury is severe, you should see a healthcare provider for evaluation and treatment.
If the black nail is due to a fungal infection, you can try using over-the-counter creams and ointments to clear the fungus and allow the nail to heal. You can also try home remedies such as soaking your nails in warm water and keeping them moisturized. However, if the infection does not go away after a few days, you should consult a doctor.
