Sophia Delgado
Blood under the fingernails, known medically as a subungual hematoma, is usually caused by a traumatic injury. This could be from stubbing a toe, hitting a finger with a hammer, or even wearing shoes that are too tight. The injury causes bleeding under the nail, resulting in darkened discoloration and pressure and pain. Unless the area of bleeding is very small, the nail will usually fall off on its own after several weeks as the pooled blood has separated it from its bed.
| Characteristics | Values |
|---|---|
| Medical term | Subungual hematoma |
| Cause | Blood vessels under the nail break open due to injury or physical trauma |
| Symptoms | Darkened discolouration, black spots, severe throbbing pain, swelling, inability to move the finger or toe |
| Treatment | Home remedies (rest, ice, compression, elevation), medical treatments (decompression, drainage, removal of the nail) |
| Healing time | Varies from weeks to months or years; fingernails regrow in 8 weeks, toenails in 6 months |
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Subungual hematoma
If you have a subungual hematoma, you should see a healthcare provider as soon as possible. If it has been less than 48 hours, your doctor can drain the excess fluid to relieve the pressure. They may also recommend that you ice and elevate the area, and take over-the-counter anti-inflammatories for minor pain. If the injury is severe or there is a risk of infection, your doctor may need to remove the entire nail and use stitches to repair the nail bed. In most cases, however, the nail will fall off on its own after several weeks. A new fingernail can regrow in as little as 8 weeks, but a new toenail may take up to 6 months.
If you have not had any injury but still notice a darkened area under your nail, you should see your doctor to rule out other possible causes, such as a tumour or melanoma.
There are several methods that your doctor may use to drain a subungual hematoma. They may perform cautery, using a heated wire or carbon laser to burn a hole in the nail. Alternatively, they may use a needle to make a hole and allow the blood to drain. After this procedure, your doctor will bandage your nail, and you will need to keep the finger or toe bandaged and elevated for the first 12 hours.
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Traumatic injury
Blood under the fingernails, or subungual haematoma, is usually caused by a traumatic injury. This could be something falling on the nail, stubbing your toe, hitting your finger with a hammer, or slamming your finger in a car trunk. It can also be caused by wearing tight shoes.
Subungual haematomas can result in darkened discolouration, such as black spots, and pressure and pain. The blood collects and becomes trapped under the nail, causing intense pain and throbbing. Unless you have broken bones or damage to the nail bed and/or surrounding tissues, this injury is usually not serious. However, it is important to seek medical attention if you experience extreme pain, swelling, or an inability to move the finger or toe, as this could indicate a fracture.
If the injury is minor, a subungual haematoma will usually heal over time without treatment. The trapped blood will eventually be reabsorbed, and the dark mark will disappear. This can take a number of months or even years. In the meantime, there are home remedies that can help manage the pain and swelling, such as resting the affected area, using a cool pack, keeping the hand or foot elevated, and applying compression.
For more serious injuries, medical treatment may be necessary. A doctor may perform a procedure called nail trephination to drain the blood from under the nail and relieve the pressure and pain. This involves making a small hole in the nail with a laser or needle. The area may then be wrapped with a bandage and will continue to drain for up to 3 days. It is important not to attempt this procedure at home, as it can cause infections or further injury to the nail bed.
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Melanoma
Blood under the fingernails is called a subungual hematoma, which is usually caused by a traumatic injury. Examples include stubbing your toe, hitting your finger with a hammer, or slamming your finger in a car trunk. It can also occur if you wear shoes that are too tight.
Now, onto the details about melanoma.
Symptoms of Subungual Melanoma
The most common symptom of subungual melanoma is a dark streak on the nail, which may look like a brown or black band. This can appear on any nail but is most often seen on the thumb or big toe of the dominant hand or foot. This dark streak is known as "Hutchinson's sign" and is indicative of the cancer spreading to the surrounding skin. Additionally, subungual melanoma can cause nail lifting, nail splitting, and changes to the nail itself, such as thickening or other types of damage.
Other symptoms that may indicate subungual melanoma include:
- A bump or nodule under the nail
- A band of colour on the nail, which can be wide and irregular or dark and narrow
- Changes to the nail, such as thickening, splitting, or other types of damage
- Pain at the nail bed
- Bleeding
It is important to note that subungual melanoma can occasionally occur without the distinctive pigmented streaks. In such cases, individuals may experience other symptoms associated with subungual infections.
Diagnosis and Treatment of Subungual Melanoma
To diagnose subungual melanoma, a doctor will first conduct a physical examination of the affected area and review the patient's medical history, including medications and family history. They may also perform a dermatoscopy, a non-invasive procedure to assess the severity of the condition. If melanoma is suspected, a biopsy of the nail matrix and nail bed will be performed to confirm the diagnosis.
Treatment options for subungual melanoma include:
- Surgical removal of the affected area, which may include removing a portion of the nail or digit
- Removal of only the abnormal tissue
- Radiotherapy, using X-rays
- Immunotherapy, in cases of metastatic melanoma, to help the body's immune system fight the cancer
- Targeted therapy, using drugs to stop the action of molecules crucial to cancer cell growth
Prevention and Early Detection
While melanoma under the nails is rare, it is important to be vigilant and check your nails for any changes. Early detection of subungual melanoma can lead to successful treatment and survival. If you notice any of the above symptoms or signs, it is recommended to make an appointment with a board-certified dermatologist as soon as possible.
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Home remedies
Blood under the fingernail, or subungual haematoma, is usually caused by a traumatic injury, such as slamming your finger in a car trunk or stubbing your toe. The injury breaks open blood vessels under the nail, causing blood to collect and become trapped under the nail. This can result in darkened discolouration, such as black spots, and pressure and pain.
If the affected area continues to collect blood, you are experiencing extreme pain, or the injury is at the base of the nail, it is best to seek medical treatment. If the subungual haematoma is small and the pain is mild, it will usually resolve without treatment.
If the haematoma covers more than half the nail or the nail injury is deep, your healthcare provider may remove the nail completely. They will numb the area first so that it doesn't hurt when the nail is taken off. It can take several months for a nail to grow back, and the new nail may not look normal.
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Medical treatments
Blood under the fingernails, also known as subungual hematoma, can be caused by a traumatic injury or an underlying health condition. If you notice blood under your fingernails, it is important to seek medical attention, especially if you are experiencing symptoms such as severe pain, swelling, or an inability to move the affected finger or toe. Here are some medical treatments for subungual hematoma:
- Drainage and decompression: If you seek medical care within 48 hours, a healthcare provider can drain the excess fluid and relieve the pressure. This procedure involves creating a hole in the nail for the blood to drain out. The hole can be made using a heated wire (electrocautery device), a carbon laser, or a needle. The area will then be bandaged, and you will be instructed to keep the finger or toe elevated and use cold compresses for the first 12 hours.
- Nail removal: If the hematoma covers a large area of the nail or the injury is deep, your doctor may need to remove the entire nail. This is done to repair the nail bed and prevent further complications. The area will be numbed before the nail is removed to minimize pain.
- Stitches: In cases where the nail bed is injured, your doctor may use stitches to repair the damage. This can help promote proper healing and reduce the risk of infection.
- Pain management: Subungual hematoma can be extremely painful due to the pressure of the pooled blood. Over-the-counter anti-inflammatories, such as aspirin or ibuprofen, can help manage minor pain. For more severe pain, your doctor may recommend or prescribe stronger pain medications.
- Soaking: Your healthcare provider may recommend soaking the affected finger or toe in a warm solution with Epsom salts. This can help to further drain fluid and alleviate discomfort.
- Follow-up care: After any medical procedure, it is important to follow all instructions from your healthcare provider. This includes recommendations for pain relief, caring for the treated area, and follow-up appointments to monitor healing and watch for potential complications.
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Frequently asked questions
Blood under the fingernails or toenails is called a subungual hematoma.
A subungual hematoma is usually caused by a traumatic injury, such as stubbing your toe, hitting your finger with a hammer, or slamming your finger in a car trunk. It can also be caused by wearing tight shoes or repetitive stress from movements such as running.
Minor subungual hematomas usually heal over time without treatment. Home remedies such as resting, icing, applying compression, and elevation can help encourage healing. For more serious injuries, medical treatments may be necessary. Doctors can perform a procedure called nail trephination to drain the blood from under the nail and relieve pain and pressure.
