Caleb Foster
Black toenails can be unsightly and uncomfortable. They are usually caused by trauma or injury, such as dropping something heavy on your toe, or wearing ill-fitting shoes that cause repetitive trauma. In some cases, they can be caused by a fungal infection, or, more rarely, by subungual melanoma, a form of skin cancer. Treatment for black toenails depends on the cause, but it's important to note that removing a toenail yourself can lead to serious complications. If you're unsure about the cause of your black toenail, or if it doesn't respond to home treatments, it's best to consult a doctor for advice and treatment.
| Characteristics | Values |
|---|---|
| Cause | Injury, fungal infection, ingrown toenail, melanoma, anemia, vitamin B12 deficiency |
| Symptoms | Pain, pressure, blood, bacterial infection, nail discoloration, nail sensitivity, nail separation |
| Treatment | Clean the toe with warm soapy water, trim the nail, wrap the toe with an adhesive bandage, apply antibiotic ointment, drain blood with a sterilized pin, antifungal creams, surgery |
| Prevention | Wear properly fitting shoes, keep toes dry and clean, avoid wearing open-toed sandals, avoid exposing feet to the sun, wear sunscreen, cut nails straight across |
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What You'll Learn
Consult a doctor
If you have a black dead nail, it is important to determine the cause before attempting to remove it. In some cases, consulting a doctor may be necessary.
Firstly, a black toenail can be caused by trauma or injury, such as stubbing your toe or dropping something on it. This is known as a subungual hematoma, which is a bruised nail. If the injury is recent, you may be able to care for it at home by applying ice to reduce swelling and pain. However, if the pain worsens or you notice signs of infection, such as redness, swelling, or fever, it is important to seek medical care.
Additionally, if your black toenail is caused by a fungal infection, it is recommended to consult a doctor. They can prescribe suitable antifungal medication, such as topical or oral antifungals, to treat the infection effectively. In some cases, over-the-counter ointments and creams may be sufficient to clear the fungus, but if the infection persists, medical attention is advised.
Moreover, it is crucial to consult a dermatologist or doctor if your black toenail is accompanied by other symptoms or if the cause is unclear. A dark streak on the nail could indicate melanoma, a serious form of skin cancer. Early detection and treatment are essential, so it is always recommended to have any nail discoloration examined by a medical professional.
In cases where the black toenail is severely damaged or detached from the nail bed, it is important to seek medical advice. A doctor can determine the best course of action, which may include draining the blood with a needle to relieve pressure and pain. They can also assess the need for partial or complete removal of the nail and ensure the procedure is performed safely using sanitized instruments in a sterile environment. Attempting to remove the nail at home can lead to complications and increase the risk of infection.
Finally, if you have any underlying health conditions, such as diabetes, circulation problems, or anemia, it is important to consult a doctor before attempting to remove a black dead nail. These conditions can affect the healing process and may require adjustments to your treatment plan.
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Treat fungal infections
While a black toenail can be due to trauma or injury, it can also be caused by a fungal infection. In the rare case of subungual melanoma, the treatment is surgical removal of the growth. If you suspect that your black toenail is due to melanoma, you should consult a healthcare provider immediately.
If your black toenail is caused by a fungal infection, toenail treatments include both topical and oral antifungals. There are some over-the-counter (OTC) remedies and medications available, including ointments and soaks. Topical prescription medications that you can apply to the nail include efinaconazole 10% solution. Your dermatologist may also prescribe a medication that you take in pill form, such as terbinafine. Terbinafine is taken daily for 6 weeks to treat fingernails and 12 weeks for toenails. However, it is important to note that terbinafine passes into breast milk, so it should not be taken while breastfeeding.
If treatments from a pharmacy do not work, your doctor may prescribe antifungal tablets. Before starting treatment, your doctor will take a sample of your nail to test what kind of infection you have. They may also need to do a blood test before and during your treatment.
It is important to be cautious when treating a damaged toenail yourself, as it could lead to serious complications. A doctor will use sanitized instruments in a sanitized environment, lowering the risk of infection. They may also numb the area before treatment.
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Drain blood
A black dead nail is typically caused by a subungual hematoma, which is a bruised nail. This occurs when blood pools below the nail plate, often due to direct trauma such as something crushing or slamming the nail. The pressure generated by the pooled blood can cause severe, throbbing pain.
To drain the blood and relieve the pressure and pain, a healthcare provider can perform a simple procedure called nail trephination or decompression. This procedure involves creating a hole in the nail plate to allow the blood to drain out. The nail plate lacks nerves, so this process is not painful.
There are several methods for creating the hole in the nail plate. A heated wire (electrocautery device) or carbon laser can be used to burn a hole, and the heated tip of the wire is cooled by contact with the hematoma to prevent injury to the nail bed. Alternatively, a needle can be used to make a hole, or in the absence of standard equipment, a heated paper clip can be applied at a 90-degree angle to burn a small hole. The hole should be large enough to allow the blood to drain out, which typically takes about a day or two. During this time, the hole should be covered with sterile gauze to keep the area clean and dry, and the patient should be instructed to elevate the affected finger or toe and may use cold compresses during the first 12 hours.
After the procedure, it is important to follow the healthcare provider's instructions for caring for the injured nail. The bandage should be removed after two days, and the area should be gently washed twice a day, covered with Vaseline, and then covered with a non-stick bandage. It is normal for the nail to still look discolored for several weeks, and the bruise will gradually grow out as the nail grows back. It may take about six months for a toenail to fully regrow, and there is a small chance that the nail may not grow back or may look different.
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Remove the nail
While it may be tempting to remove a black dead nail at home, it is important to exercise caution. Removing a damaged toenail yourself could lead to serious complications. There could be more damage to your toe than is visible, and the introduction of bacteria can lead to infection. It is recommended that you seek medical advice before attempting to remove a toenail.
If you have a subungual hematoma, or a bruised toenail, you may wish to ask your healthcare provider about treatment options. Subungual hematomas are caused by bleeding and bruising under the nail, which may cause severe, throbbing pain. The nail may look black-and-blue or black-and-purple. The injury bleeds, and the blood is trapped under the nail, where it darkens. Subungual hematomas usually occur from blunt force trauma, such as stubbing your toe, or crush injuries, such as dropping a heavy object on your toe. They can also occur from repetitive pressure over time, like running in shoes that are too tight.
In some cases, your healthcare provider may recommend removing the nail. They will first numb the area so that the procedure is not painful. They will then separate the nail from the skin and insert a tool under the nail to lift and remove the nail plate. Antibiotic ointment will be applied to prevent infection, and the wound will be bandaged.
If your black toenail is caused by a fungal infection, your doctor may prescribe antifungal cream. If the infection does not respond to treatment, your doctor may need to perform a surgical procedure to permanently remove the nail.
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Prevent future black nails
To prevent black nails caused by trauma or injury, avoid ill-fitting footwear, especially when running or engaging in aerobic activity. Keep your toenails trimmed and avoid sharp corners, as longer nails are more prone to injury. Protect your toes during sports with appropriate footwear, and avoid going barefoot in places where your toes might get stubbed or stepped on.
To prevent black nails caused by fungal infections, maintain good foot hygiene and keep your toes clean and dry. Antifungal drugs, such as imidazole and ketoconazole, can be used to treat fungal infections.
In rare cases, black nails can be a symptom of melanoma, a dangerous form of skin cancer. If you notice any unusual colour changes, especially a dark streak or line running vertically along the nail, seek medical advice promptly.
Additionally, maintaining a healthy diet rich in vitamins B6 and B12 can contribute to overall nail health and help prevent nail discolouration.
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Frequently asked questions
If your nail has stopped growing and appears to be dead, it is most likely due to an injury or a fungal infection. In case of an injury, there may be a blood blister under the nail, causing it to turn black and painful.
For an injury-related black toenail, you can treat it at home using the RICE method: rest, ice, compression, and elevation. You can also take over-the-counter (OTC) pain relievers to manage discomfort and swelling. If there is a blood blister, it is recommended to seek medical help to drain the blister and relieve pressure.
You can start by trying over-the-counter antifungal creams and ointments. If the infection persists or does not respond to treatment, consult a doctor or dermatologist, as you may require a surgical procedure to remove the nail.
It is advised to seek medical help if your black toenail is accompanied by symptoms such as pain, pressure, blood, pus, increasing discomfort, swelling, or redness around the nail. Additionally, if your black toenail is sudden, persistent, or does not respond to at-home treatments, a doctor can provide a diagnosis and appropriate treatment.
While there are suggestions for at-home removal of dead nails, it is important to exercise caution. Removing a toenail yourself can lead to serious complications and increase the risk of infection. It is recommended to seek advice from a medical professional before attempting any removal procedures. They can provide sanitized instruments and a sterile environment to minimize the risk of infection and ensure proper care.
