Isla Bennett
Blood under the nail, known as subungual hematoma, can be a painful and unsightly problem. It is caused by a direct injury to the nail, which causes blood vessels to break and bleed. As the blood has nowhere to go, it gets trapped underneath the nail, causing pain and discolouration. In some cases, the nail may even fall off. While small hematomas may not require any treatment, larger ones can be extremely painful and may require medical attention. It is important not to try to drain a hematoma at home, as this can lead to infection and permanent damage. Instead, seek medical care, where a professional can perform a procedure called nail trephination to drain the blood and relieve pressure and pain.
| Characteristics | Values |
|---|---|
| Medical term | Subungual hematoma |
| Cause | Bleeding under the nail due to injury |
| Symptoms | Darkened discolouration, black spots, pressure, pain, throbbing pain, swelling, inability to move the finger or toe |
| Treatment | Drainage (trephination) within 48 hours, soaking in warm solution with Epsom salts, bandaging, elevation, ice, anti-inflammatories, removal of the nail |
| Home remedies | Vaseline, non-stick bandage, elevation, cold compress, compression |
| Prevention | Keep the area clean and dry |
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What You'll Learn
When to see a doctor
Subungual hematoma, or bleeding under the nail, can cause severe throbbing pain and should be treated by a healthcare professional. If you notice any of the following, it is recommended that you see a doctor as soon as possible:
- Intense pain and throbbing as blood collects under the nail.
- The affected area continues to collect blood.
- Extreme pain or swelling.
- Inability to move the finger or toe.
- Deformity of the finger or toe.
- The injury is at the base of the nail.
- Discoloration without a known cause.
- The nail bed or surrounding tissues are injured.
- You have broken bones or serious damage to the nail bed.
If you experience any of the above symptoms, it is important to seek medical attention to prevent further complications and ensure proper healing. Do not attempt to drain the blood yourself, as this can lead to infection and other issues. A healthcare provider can perform a simple drainage procedure to relieve the pressure and pain.
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Drainage methods
If you have a subungual hematoma, you should seek medical attention. A healthcare professional will be able to perform a simple drainage procedure to relieve pain and support healing. This procedure is called nail trephination. During trephination, a digit block—a local anaesthetic—is administered so that pain is not felt during the procedure. Then, a small hole is created in the nail using one of the following methods:
- Cautery: A heated wire (electrocautery device) or carbon laser is used to burn a hole in the nail. The heated tip of the wire is cooled by contact with the hematoma, preventing injury to the nail bed.
- Needle: A needle is used to make a hole in the nail.
After the procedure, the nail is usually bandaged, and the finger or toe bandaged and elevated. Cold compresses may also be used during the first 12 hours after decompression.
It is important to note that you should never attempt to drain a subungual hematoma at home. Doing so can lead to serious infection and permanent damage to your nail or finger.
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Home remedies
If you have dried blood under your nail, it is important to first assess the severity of the injury. Blood under the nail is usually caused by an injury that breaks open the blood vessels under the nail, causing blood to collect and become trapped under the nail. This is called a subungual hematoma. Most cases of subungual hematoma will heal on their own within a few months. However, if you are experiencing severe pain, bleeding that does not stop, signs of infection, or a subungual hematoma that does not go away, it is important to contact a doctor.
If the injury is minor, there are several home remedies that can help encourage healing and relieve pain and pressure:
- Rest: Avoid using the affected finger or toe where possible.
- Ice: Apply an ice pack or cold compress to the area to help reduce swelling, pain, and bleeding under the nail.
- Compression: Apply pressure to the area, such as with a wrap, to reduce the amount of blood that can pool under the nail.
- Elevation: Keep the affected hand or foot elevated above your heart to reduce swelling and slow the bleeding.
Over-the-counter pain relievers can also be used to reduce discomfort and swelling. It is important to note that you should not attempt to drain a hematoma at home, as it may cause infection. If home measures do not provide relief, contact a doctor for further advice and treatment options.
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Nail falling off
A nail falling off is often the result of an injury or infection. If you have injured your nail, it may turn black or purple as blood collects underneath it, a condition known as a subungual hematoma. This can cause the nail to separate from the nail bed and fall off after several weeks. If the hematoma covers more than a quarter of the nail, or if you are in pain, you should seek medical attention. A doctor may be able to relieve the pressure by creating a small hole with a heated needle or wire, allowing the blood to drain.
If your nail has fallen off, it is important to protect the sensitive skin underneath. Cover the area with a bandage or plaster to keep it protected and clean. You can also apply an antibiotic ointment to prevent infection. If your entire nail has fallen off, you should seek immediate medical attention.
If only part of your nail has fallen off, do not try to remove the rest of it. Instead, use nail clippers to carefully trim off any parts that are still attached to your toe, to prevent them from catching on clothing or bed sheets. You can then use a nail file to smooth any sharp or jagged edges.
Nails typically grow back within 18 months, but it is important to take care of your nail and ensure any underlying causes are treated. This could include treating any fungal infections or psoriasis.
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Preventing reoccurrence
To prevent dried blood from collecting under your nail, take precautions to avoid injuries to your fingers and toes. Subungual haematomas are usually caused by sudden trauma to the nail, such as stubbing your toe, hitting your finger with a hammer, or dropping something heavy on your finger or toe.
To prevent such injuries, be mindful of your surroundings and take extra care when handling heavy objects. Wear protective footwear when engaging in activities that may pose a risk to your toes, such as playing sports or working in a hazardous environment. For your fingers, consider wearing protective gloves when performing tasks that could cause trauma to your nails, such as gardening or carpentry.
Additionally, maintain well-trimmed nails as longer nails are more prone to injury. Keep your nails moisturised to prevent them from becoming brittle and prone to breakage. Avoid wearing tight shoes, as this can also cause trauma and increase the risk of subungual haematomas.
If you notice any signs of injury or trauma to your nails, seek medical attention promptly. Early intervention can help prevent further complications and promote proper healing. Follow your healthcare provider's instructions for caring for your injured nail, including keeping the area clean and dry, and taking any prescribed medications or treatments.
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Frequently asked questions
It is called a subungual hematoma.
If the affected area continues to collect blood, you experience extreme pain, or the injury is at the base of the nail, it is best to see a healthcare provider. You should not attempt to drain your hematoma at home.
Doctors may perform a procedure called nail trephination, which involves creating a small hole in the nail to allow the blood to escape and relieve pressure and pain.
