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Subungual Hematoma: Symptoms, Causes, Treatments
Subungual hematoma — commonly referred to as black toenail, runner’s toe and tennis toe when it affects the nails on the feet — is when a pool of blood collects underneath a nail and leaves it discolored or black.
In addition to a toenail or fingernail that appears black or burgundy in color, subungual hematoma can also cause intense, throbbing pain if the thickened blood builds pressure against the nail. Other symptoms of black toenail or fingernail include redness, swelling, ingrown toenails and possibly an odorous discharge.
There are many causes of black toenails, but trauma or a crush injury is the most common. Runners are more susceptible to developing subungual hematoma, as their feet sometimes repeatedly strike the tip of their shoes. The discoloration that develops is essentially a bruise.
Usually black toenails either grow out or fall off and then regenerate on their own, a process that can take about six months to complete. Sometimes medical attention is necessary, especially in cases where the black toenail is causing excruciating pain or if the discoloration covers more than 25% of your nail. The latter could be a sign that the nail bed is severely lacerated or that there is exposed bone underneath the nail — both of which can lead to a bone infection (osteomyelitis) that could result in loss of the toe.
If medical treatment is sought, you can expect a couple of different decompression methods that will help drain the blood, including using a needle to perforate the nail, using a heated wire or carbon laser to burn a hole in the nail or complete nail removal.
In some cases, toenail discoloration can be caused by a fungus, so it’s important to get any discoloration of nails inspected by a podiatrist. Since a fungal infection can spread and be difficult to treat, it’s best to have a podiatrist help you stop the fungus in its tracks early on.
What Is A Subungual Haematoma?
A subungual haematoma is a collection of blood (haematoma) underneath a toenail or fingernail (black toenail). It can often be extremely painful despite its relatively small size. However, it is not considered a serious medical condition. It is sometimes known as runner’s toe, tennis toe, or skier’s toe.
Subungual haematomas are common nail bed injuries caused by blunt or sharp trauma to the fingers or toes. Bleeding from the rich vascular nail bed results in increased pressure under the nail and can cause significant discomfort. Subungual haematoma drainage, also known as nail bed trephination, can be performed to relieve this discomfort should it be required. This can be performed in a consultation room and generally does not require the use of anaesthesia.
Ouch! So how does this happen?
The condition results from a traumatic injury, such as slamming a finger in a door, blunt force trauma from a dropped heavy object or from sports activities, such as climbing or hiking rugged terrain.
The bleeding comes from the (vascular) nail bed underlying the (avascular) nail plate. A laceration of the nail bed causes bleeding into the constricted area underneath the hard nail plate. Throbbing pain is common. The nail develops a black discoloration overlying the nail bed but under the nail plate.
Subungual haematomas are also very common in runners and are caused by downward pressure or horizontal separation of nail plate from the nail bed. This repetitive trauma leads to bleeding and pooling of blood beneath the nail plate.
Symptoms of a Subungual Haematoma
The most common symptom of a subungual haematoma is severe, throbbing pain generated by the pressure of blood collecting between the nail and the nail bed. Other symptoms include:
- A dark-coloured discoloration (red, maroon, or purple-black) under all or part of the affected nail.
- Tenderness and swelling of the tip of the affected toe.
Diagnosis of a Subungual Haematoma
If a subungual hematoma was caused by a severe blow to a finger or toe, you should either seek medical attention from your Podiatrist or hospital emergency room. In addition to the hematoma, you may have broken bones or serious damage to the nail bed and/or surrounding tissues.
Depending on the mechanism of injury, you may have a broken bone or suffered serious damage to the nail bed and surrounding soft tissues and structure. Your Podiatrist will examine your nail and may require you to undergo an X-ray to either confirm or rule out a bone fracture or other injury.
Clinically, it is characterized by reddish-black discoloration of the toe nail. The nail plate may also become thicker and more brittle as a result of the injury (onychochauxis). Infrequently, the toe may become painful and require surgical drainage
Runner’s toe is often associated with poor or tight-fitting shoes. The key to prevention of runner’s toe is to purchase properly fitted shoes!
Treatment of an Uncomplicated Subungual Haematoma
A painless and small subungual hematoma usually requires no treatment. However, the pressure caused by the pooled blood under the nail can be extremely painful and limit the function of your walking. To relieve the pain, your Podiatrist may perform a decompression (also called trephination) procedure to allow the underlying blood to drain, relieving pressure and pain to the area.
After numbing the affected finger or toe with a nerve block, your Podiatrist may use one of the decompression methods to drain the subungual hematoma:
- Cautery. A heated wire (electrocautery device) or carbon laser is used to burn the hole or holes. This is a quick and painless procedure.
During the cautery procedure, the heated tip is cooled by contact with the hematoma, which prevents injury to the nail bed.
Resolution of a Subungual Haematoma
Unless a subungual hematoma is very small, an affected nail will usually fall off on its own after several weeks because the pooled blood has separated it from its bed. A new fingernail can regrow in as little as eight weeks while a new toenail may not fully regrow until about six months. If there has been injury to the nail bed and/or surrounding tissues, regrowth may be delayed.
Even with the best repair, there is still a possibility that the new nail may grow back with an abnormal appearance. See your Podiatrist if you notice any problems with the nail as it heals and regrows.
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Treatment for Blood Under Your Nail
Your fingers and toes serve as the first contact with the world. Thus, your fingernails and toenails are especially prone to injury whether it be a stubbed toe or power-tool injury.
Sometimes such injury results in a bleed under the nail, a condition called subungual hematoma. These bleeds can result in darkened discoloration (i.e., black nail), pressure, and pain. In addition to being painful, nail discoloration can also be unsightly, which is another reason to seek medical help for this condition.
Subungual Hematoma Explained
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With subungual hematoma, injury to the nail results in bleeding (hematoma) at the level of the nail bed (under the nail plate) or nail matrix. The nail matrix is a rapidly dividing layer of cells at the base of the nail lying toward the cuticle. Rapidly dividing cells of the nail matrix fill with keratin and thus become a hardened nail.
More extensive damage to the nail can not only result in bleeding under the nail (i.e., simple subungual hematoma) but also more extensive damage to the nail fold or digit itself.
If left untreated, a simple subungual hematoma typically grows out with the lengthening nail plate and resolves on its own, although sometimes subungual hematomas can result in your nail falling off (onycholysis).
Until the nail grows out, however, you can expect weeks to months of blue-black discoloration. Interestingly, fingernails grow faster than toenails so it takes longer for your toenails to grow out.
In addition to discoloration, blood under the nail can result in pressure and pain, which can be relieved by a primary care physician or podiatrist (i.e., “foot doctor”). Delayed treatment can result in nail deformity or infection.
When to See Your Doctor
If you experience a bleed under your nail, your doctor or urgent care physician can drain the excess fluid to and relieve the pressure. The procedure, called a nail trephination, is useful when performed within the first 48 hours.
If your subungual hematoma happened due to a severe injury, you should also see a healthcare provider because there may be a toe or finger fracture.
Based on the history and physical exam, most cases of subungual hematoma can be readily diagnosed (and treated) by your healthcare provider. When a fracture is expected, an X-ray is needed.
Rarely, what appears to be a subungual hematoma can be something else such as:
- Nail bed nevus (a mole or birthmark that grows slowly or not at all)
- Splinter hemorrhage (indicative of psoriasis or endocarditis)
- Longitudinal melanonychia (pigmented bands)
All these listed conditions are painless, and, unlike subungual hematomas, these lesions don’t change or change slowly.
Some differential diagnoses are serious, like endocarditis (i.e., heart infection) or melanoma (i.e, skin cancer), so it’s a good idea to have your nails checked out by your physician if you can’t pinpoint the cause.
It takes about 48 hours for blood at the level of the nail bed to clot. During this time, this blood can be drained by a physician, a process called nail trephination. If you wait to have the blood drained, nail trephination may not be able to be performed.
Nail trephination uses hot metal wire, electrocautery device, or spinning, large-bore needle to pierce the nail bed. Fortunately, the nail bed lacks innervation so nail trephination doesn’t hurt.
The hole created by piercing should be large enough to let the blood drain which takes about a day or two. During this time, the hole through which the blood oozes should be covered with sterile gauze.
After nail trephination, you won’t need antibiotics although a pain reliever like ibuprofen may help with residual pain. Your physician will advise you on effective pain relief. Make sure to follow all your physician’s instructions (including instructions to soak the affected area and apply clean dressing) and follow up with your physician as prescribed.
If the affected area reaccumulates blood or appears infected, contact your physician.
When the hematoma covers more than half the nail, your physician may choose to remove the nail completely. Moreover, if the nail injury is deep, the nail may also be removed. Before removing the nail, your physician will perform a digital block in order to anesthetize the area.
Finally, keep in mind that it can take several months for a nail to grow back.
RUNNER’S TOE (SUBUNGUAL HEMATOMA) | Sports Medicine Today
Subungual hematoma refers to a painful condition caused by a buildup of blood (hematoma) or “blood blister” underneath the fingernail or toenail. It may occur after trauma to the nail, either acute or repetitive. Runners and dancers are commonly affected due to repetitive down-striking forces to the toes, but the injury is seen in tennis players and rock climbers as well.
The main symptoms are pain underneath the nail as well as a dark or black coloration. The pain is caused by the pressure from the blood, whereas the color is due to the breakdown of the pigments in the collecting blood and will resolve over time (usually several months) as the toes grow out.
Sports Medicine Evaluation & Treatment
The diagnosis is made by the nail’s appearance and x-rays are usually not obtained unless a fracture is suspected. It is important to provide an accurate history to your physician, as a melanoma (type of skin cancer) of the nail unit can appear very similar and requires urgent attention.
Although the condition is not considered serious and will resolve with time, the pain can prevent continued activity and may not be able to be treated with ice and over-the-counter pain medications alone. For these cases, a physician or medical professional will need to create holes through the top of the nail (a procedure known as trephining), commonly with a heated needle or similar tool, in order to relieve the pressure and prevent the nail from falling off. Anesthesia (such as numbing medication) is not usually required for this procedure as it is quick and well-tolerated by most individuals.
Using proper fitting footwear decreases the chance of occurrence. The most common footwear changes are to have a less constrictive toe box in the shoe or to pad the toes.
Return to Play
Return to sport or activity can be immediate if symptoms permit.
AMSSM Member Authors
Jason Brucker, MD and Craig Young, MD
Tully AS, Trayes KP, Studdiford JS. Evaluation of nail abnormalities. Am Fam Physician. 2012 Apr 15; 85(8):779-787.7.
Meek S, White M. Subungual haematomas: is simple trephining enough? J Accid Emerg Med. 1998 July; 15(4): 269271.
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Injury or Poisoning
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Podnehtový hematom, Subunguální hematom
Black Fingernail – Symptoms, Causes & Treatment
A black fingernail is known as a subungual hematoma. It is caused by a build-up of blood under the fingernail. This usually results from an impact or trauma to the finger which can cause considerable pain. In most cases, ice and ibuprofen are sufficient to treat it. Here we explain the symptoms and treatment of a black fingernail, as well as when to seek medical advice.
Signs & symptoms
- A black fingernail usually follows direct trauma to the finger.
- You will have felt pain from the initial trauma. Blood quickly bleeds and gathers underneath the fingernail increasing a feeling of pressure under the nail.
- Later, your fingernail will appear black and will most likely continue to be painful.
- Pain from a black fingernail is often described as a throbbing pain. This is because your blood pressure varies as your heart beats.
Treatment for a black fingernail
Most subungual hematomas do not require medical attention and are treatable at home. If the total area of blood is no more than 25% of the nail then the following guidelines may apply.
- Apply ice (wrapped in a cloth) or cold therapy for 10 minutes at a time, every hour to reduce bleeding and swelling. Elevate the hand to reduce bleeding and swelling. This aids the tissue fluids to flow away from the site of injury using gravity to assist.
- Your doctor may prescribe Anti-inflammatory medication such as Ibuprofen to ease pain and inflammation. The pain and pressure will ease over a couple of days and the blood will drain on its own.
- If the bleeding covers more than 25% of the nail then seek medical attention as the blood under the nail may need draining.
- Local anaesthetic injected into the finger will numb the nail. Then your doctor will make a hole in your nail to allow blood to drain through. As a result, pressure under the nail reduces.
- A cautery, needle or even a sterilized paperclip is used drill or burn the hole in your nail.
- No follow-up treatment is usually necessary. However, occasionally, the whole nail imight need to be removed.
This article has been written with reference to the bibliography.
Subungual hematoma: Symptoms, causes, and treatment
A subungual hematoma occurs when an injury breaks open blood vessels under the nail, causing blood to collect and become trapped in one spot.
Poorly fitting shoes can also cause subungal hematomas, especially if the person is very active. Shoes that are too tight or narrow can put pressure on the toenail, breaking blood vessels and leading to a pool of blood under the nail.
Running or hiking down steep hills or stopping and starting suddenly, such as while playing soccer or basketball, can also cause a type of subungual hematoma. This is often called runner’s toe.
If a subungual hematoma is small and the pain is mild, it will usually resolve without treatment or complications.
However, if there is severe damage to the nail bed, or if the pain is unmanageable, a person should seek medical treatment.
A person may have a subungual hematoma if they have injured their finger or toe and:
- there appears to be blood under the nail
- the nail feels sore or tender
- it feels like there is pressure under the nail
- the nail is discolored
People with artificial nails may not be able to see a subungual hematoma. If a person feels intense pain and pressure, they should remove the artificial nail and examine the nail bed.
A minor subungual hematoma does not cause serious health problems. Home remedies can help to manage pain while the injury heals.
Over-the-counter pain relievers can reduce discomfort and swelling. In addition, the RICE method can be useful for minor subungual hematomas. RICE stands for:
- Rest: Limit use of the affected finger or toe.
- Ice: Use an ice pack, to reduce swelling and pain.
- Compression: Apply pressure such as a wrap to the area immediately, to reduce the amount of blood that can pool.
- Elevation: Keep the affected hand or foot elevated, to reduce swelling.
For more serious injuries, this may not be enough. Any significant injury to the nail can damage or break the bone underneath. A person should seek medical attention if:
- the pain is unbearable
- the injury happened to a baby or child
- the bleeding is uncontrollable
- there is a cut or laceration
- the base of the nail is damaged
- without injury, any nail turns dark or discolored
A doctor may need to remove a severely injured nail or use stitches for deep cuts.
Sometimes the damaged nail is not removed but used as a cover to protect the nail bed while it heals. The damaged nail may need to be removed at a later date.
When the damaged nail bed heals, the bleeding will stop and a new nail will grow.
If a doctor suspects that the bone is broken, they may order an X-ray. Broken fingertips may be covered with a hard splint for several weeks to promote healing and to protect the area from further injury.
A doctor may perform a procedure called nail trephination to drain the blood from under the nail. This can help to relieve pain and pressure.
The doctor will make a small hole in the nail with a laser or needle. Afterward, the area may be wrapped with a bandage and may continue to drain for up to 3 days.
This procedure should not be attempted at home, as it can cause infections or further injury to the nail bed.
Possible signs of an infection include:
- fluid or pus draining from under the nail
- increased swelling or pain
- red streaks in the skin
- a fever
- a feeling of heat or throbbing in the finger or toe
- excessive redness around the area of injury
If any of these symptoms appear, see a doctor right away.
A minor subungual hematoma usually heals over time without treatment. The trapped blood will eventually be reabsorbed, and the dark mark will disappear.
This can take 2–3 months for a fingernail, and up to 9 months for a toenail.
If there is severe damage to the nail bed, the nail may be malformed or cracked when it grows back. Or, it may fail to regrow. This is uncommon, however, and may be prevented by seeing a doctor for treatment when an injury occurs.
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90,000 Subungual hematoma – causes, symptoms, diagnosis and treatment
Subungual hematoma is a consequence of mechanical trauma to the nail phalanx of the upper or lower extremity, in which hemorrhage occurs in the soft tissues of the nail bed. The damage is characterized by pain of varying degrees of intensity, a local increase in temperature, edema, the appearance of red, and then bluish and black staining of the nail plate. Diagnosis is based on history and clinical presentation.In most cases, no treatment is required. Detachment of the nail plate, a laceration of soft tissues is an indication for surgical treatment of the damaged area, suturing and dressing.
Synonymous names are used to denote pathology: bruise under the nail, “blue nail”. Throughout life, each person receives such bodily harm, sometimes more than once. More often, injuries are recorded in males of working age.The peak of injuries occurs during the warm season and the vacation period, when the majority is engaged in construction and repairs, work on personal plots, and actively resting in nature. The overwhelming majority of cases of subungual hemorrhage remain outside the field of vision of doctors, since patients often consider the damage to be insignificant and simply ignore it.
In the development of subungual hematomas, physical impact and a number of predisposing factors play a role.Thus, the risk of bleeding in response to minor trauma increases in patients taking anticoagulants. Patients with diabetes mellitus and other diseases in which polyneuropathy develops, tactile and pain sensitivity are impaired late, notice damage. The main reasons for the appearance of subungual hematomas are:
- Sharp directional impact. A contusion of the terminal phalanx, depending on the strength of the impact, can lead to damage to the vessels of the skin, crushing of tissues, the appearance of a laceration, and bone fracture.Each of these injuries is characterized by an accumulation of blood under the nail. Therefore, any injury requires medical attention.
- Prolonged mechanical stress. Wearing shoes of the wrong size and fullness leads to injury to the nail plates and the skin beneath them. In fact, a callus develops, which fills with serous fluid or blood. In this case, the nail plate may peel off completely or partially.
The development of a subungual hematoma is based on a violation of the integrity of the vessels. The spilled blood soaks the tissues, including the nail plate. If the volume of blood is small, the structure of the soft tissues is preserved. If the volume and rate of bleeding are significant, then under the pressure of the blood, soft tissues exfoliate with the formation of a cavity. A hematoma that has formed under the skin at the hole or in the area of the nail bed, as the nail grows, moves in the distal direction.Blood pressure in the area of the hematoma irritates the nerve endings, which provokes pain. A sharp increase in hematoma volume leads to the formation of a subungual space or a breakthrough of blood near the nail folds.
The blood soaked in soft tissues is gradually absorbed. The staining of the nail plate is irreversible. Over time, the blood clot loses moisture, becomes at first dark blue, then turns black. In both cases, a spot is formed, which moves to the free edge of the nail plate.
Often the terms “hematoma” and “bruising” are used interchangeably, but this is not entirely true. The differences between these two conditions relate to the mechanisms of injury, the clinical picture of the disease, the duration of forced temporary disability due to limb injury, and medical approaches to treatment.
- Subungual bruise. It develops as a result of the impregnation of the skin and subcutaneous tissue with blood from damaged vessels.As a rule, it is formed with an insignificant effect and is characterized by unexpressed symptoms. The patient’s condition is quickly normalized, the functioning of the limb is restored.
- Subungual hematoma. Differs from bruising by dissection of tissues with the formation of a cavity filled with blood. Hemorrhagic impregnation also takes place, however, the volume of blood poured out is much greater than with bruising, which increases the likelihood of nail detachment and the development of other complications.
Symptoms of the subungual hematoma
The characteristic signs of hemorrhage in the subungual region that developed after trauma are local hyperemia, fever, edema, pulsating or bursting pain. The peak of the local temperature rise occurs 2-3 hours after the injury. On the 2-3rd day, the pain subsides, the swelling begins to subside.
Immediately after injury, the nail acquires a deep red or cherry-purple color. On the second or third day, the affected area turns blue, after another week or two it acquires an intense black color.The blood-soaked portion of the nail is gradually moved towards the nail edge and cut off. Thus, the black spot can persist for 2-3 months.
In cases where uncomfortable shoes are the cause of injury, slight soreness or discomfort may occur. But more often a change in the color of the nail plate becomes an accidental finding during the implementation of foot care. Simultaneously with the color change, exfoliated fragments of the plate, calluses on the skin of the fingers in the area of the nail ridges are often revealed.
Damage to the skin and base of the nail leads to its deformation. The severity and duration of the deformation is determined by whether the growth zone was affected. Normally, the deformed areas are cut off with scissors during the manicure. Trauma to the base of the nail plate leads to persistent deformity that does not disappear over time. The appearance of a crack or chip of the nail as a result of mechanical action creates conditions for the penetration of infection and the development of purulent inflammation of the damaged tissues.Microorganisms multiply especially actively in the hematoma cavity. Insufficient care of the bruised phalanx can cause the development of felon.
In appearance, subungual hematomas have similar features to onychopathies in psoriasis, melanoma. The extent of finger injury from impact is not always obvious. In this regard, it is better to consult a surgeon, even if the injury seems frivolous. Comprehensive examination of a patient with phalanx injury includes:
- General examination .A hematoma is indicated by the presence of a previous mechanical effect, an acute course with a rapid increase in symptoms. Palpation of the damaged area is painful. Drainage, which can be performed directly during the outpatient appointment, has a quick effect.
- X-ray examination . An X-ray of a finger is performed to detect a violation of the integrity of the bones and joints of the limb. According to the X-ray data, it is possible to judge the presence of a fracture, but it is impossible to draw unambiguous conclusions about the degree of damage to soft tissues (skin, tendons, muscles), the volume of the hematoma.
Treatment of subungual hematoma
Medical tactics are determined by the severity of the injury. Indications for seeking medical help are intense, unbearable pain in the area of the injured phalanx and the size of the hematoma over ¼ of the nail area. The scope of medical care is determined by the surgeon on the basis of examination and X-ray data:
- First aid. Proper care of the damaged phalanx allows you to quickly relieve pain, stop or slow down bleeding, and prevent detachment of the nail plate.Immediately after the injury, you must immerse your finger in a container of cold water for 15-20 minutes. Then, if there is an open wound, treat the damaged area with an antiseptic solution and apply a bandage.
- Drainage of hematoma. The nail plate over the hematoma is punctured with a needle or burned out with a thermocoupler. The outflow of blood through a small hole leads to a decrease in pressure on the tissues, a decrease in the intensity of pain. A drained subungual hematoma dissolves faster, which is important for patients who need not have cosmetic defects on their hands.
- Removal of the nail plate. The nail plate is removed partially or completely when it is detached from the nail bed. Attempts to save the nail can lead to unfavorable consequences: detached fragments disrupt the normal functioning of the finger, and can cause additional injury in case of accidental separation.
- Surgical debridement. Crushing injury of tissues, laceration, bone fracture require PST, which includes removal of non-viable fragments, suturing, drainage.The purpose of medical manipulations is to create optimal conditions for healing, prevention of dysfunction of the foot or hand, and purulent-septic complications.
- Whitening damaged nail. The blood-soaked nail plate grows back within a few months. To eliminate a cosmetic defect in one procedure, the injection subungual injection of special bleaches allows. In this case, the black spot is completely discolored. Topically applied whitening drugs do not give a noticeable effect.
Forecast and prevention
In the overwhelming majority of cases, the subungual hematoma goes away on its own without treatment. Within a month or two, only a cosmetic defect in the form of a dark spot on the nail reminds of the injury. As a preventive measure, it is recommended to observe safety precautions and accuracy when performing work, closing doors, moving goods. Properly selected sports and casual shoes allow you to maintain the health of your feet. To protect the fingers, it is recommended to use special work gloves and various devices that reduce the likelihood of damage to the upper limbs (grips, clamps, manipulators).
90,000 diagnostics and treatment – DNA health
If you at least once accidentally received a blow on the nail or pinched your finger with a door, most likely you are familiar with the consequence – a bruise under the nail, or, in scientific terms, a subungual hematoma. As a rule, such an injury is not dangerous, but you need to know how to deal with the consequences in order to keep the nail healthy.
Our nails are protected with rollers. The posterior layer (proximal) is connected to the nail by a thin film.She is responsible for the growth of the nail on the surface. At the base of the nail there is a bed with capillaries. Damage to them leads to bleeding of the nail matrix. When the blood has no outlet, it accumulates under the nail, and outwardly we see a bruise that must be treated.
As mentioned above, a hematoma under the nail arises from a strong mechanical shock or pinching. But beyond that, there are a number of other reasons:
- object dropped,
- tight, uncomfortable shoes (oversized),
- deformation of the nail (too long),
- medication intake.
If pigmentation appears on the nail just like that, without any blows, this is a reason to go to a therapist who will diagnose and find out the cause. Perhaps the hematoma was provoked by medications or some internal processes in the body. For example, stripes along the vertical axis of the nail can be caused by a condition such as psoriasis. Fungus can also pigment the nail.
What it looks like
One of the obvious clinical manifestations of a subungual hematoma is a dark blue color.Sometimes the nail begins to blacken and comes off over time. After injury, the nail and finger pulsate with pain, the tissues around them redden and swell. The healing process takes several months. At first, the bruising becomes less intense, then begins to follow the growth of a healthy nail in the distal direction.
If the nail plate is cracked, the wound must be treated with an antiseptic. Alcohol or, if absent, hydrogen peroxide will do. To stop the bleeding, you can press a sterile bandage over the wound for a couple of minutes.
If the impact site remains closed, you need to attach a piece of ice or something cold. In this case, the future bruise will be slightly less or not appear at all. It all depends on the strength of the blow.
If the blow was very strong and you feel that the pain intensifies during movement, it is better to go to the emergency room for the help of a specialist in order to avoid potential complications (detachment or infection) in the future. It is also best to see a doctor right away if a child is injured. The impact may have led to a fracture or fracture, and it is better to exclude this possibility by radiography.
In addition, the doctor can make a painless puncture with a thin sterile needle at the site of the bruise. This removes the blood clot and heals faster. In extreme cases, the doctor performs trephination of the nail – removal of the nail plate or its fragment.
How to get rid of a hematoma under the nail
At home, you can and should help the healing process of the bruise under the nail. There are proven methods for this.
Potassium permanganate (potassium permanganate)
The injured finger is immersed in a weak solution of potassium permanganate.This procedure will allow you to rinse your finger and disinfect, because potassium permanganate is an excellent antiseptic!
Analgin or ibuprofen will relieve throbbing pain. This will allow you to wear shoes and walk if your foot is injured.
This ointment improves blood circulation. For the best effect, it should be applied three times a day. The course of treatment lasts until the color of the nail changes to a healthy one.
Anti-inflammatory, antibacterial and analgesic effects have:
- tetracycline ointment,
- Vishnevsky ointment.
They can be used for pain relief and antibacterial effects.
To accelerate healing, you can make infusions of the following herbs:
These plants are very effective as they have an analgesic and disinfecting effect.
In general, a subungual hematoma is not as dangerous as it seems. The main thing is to provide the necessary assistance on time and not to bring it to a deplorable state.If a large hematoma under the nail remains after a week and the bruise does not even think to decrease, it is better to visit a doctor. The specialist will carefully examine the injury and give the necessary recommendations. A careless attitude towards injury can lead to deformation of the nail plate and other complications. Therefore, in severe cases, it is best to see a doctor.
How to treat a black or purple nail for irregularities and bruises
Do you have a black nail ? A bruised or bruised nail will turn black like after hitting .This is the same when we accidentally hit some part of the body, and a small bruise appears.
In this article, we will look at which of the best Treatment to cure a black or purple nail, which symptoms are the most common and what to do if a nail falls off.
What is the best treatment for purple or black nails?
Prevention is the best solution to avoid toenail and hand nail problems. While there is no preventive system as such to avoid black nails, the following guidelines should ideally be followed to achieve rapid improvement after we have been injured.
Treatment of nail contusions without complications
Having a purple nail in your hands that has been hit quite often. However, we have to differentiate the degree of impact, since sometimes the root can be damaged and its growth will change.
In addition, it can cause internal bleeding, which makes it aesthetically rather ugly.
This bruise on the nail or bump, also known as subungual hematoma , may be painless and may not require treatment.However, the pressure created by the blood that has accumulated under the black nail can be very painful. To avoid pain, your doctor may perform decompression, also called trepanation, which allows the blood to drain, relieving pressure and pain in the area.
After anesthetizing the affected finger or toe, the doctor may use the following decompression methods to drain the blood:
- Cauterization . This can be done with a medical hot wire or carbon laser, which is used to burn the wound.This is usually not painful and fast.
- With a needle. A large bore medical needle can also be used to pierce a black nail. During the procedure, the heated tip is cooled by contact with the hematoma, thus avoiding injury.
After some of these procedures, your nail will be bandaged and your fingers will be bandaged, and you may need to use cold compresses for the first 12 hours. If you need to add something, your doctor will need to tell you what to do and how to do it.The only possible complication is that you will become infected.
If the blow was too strong and you were seriously injured, in these cases it may be necessary for a doctor to perform stitches. But usually, if the bruise is not very small and the nail is affected, after a few weeks the nail may come off on its own due to accumulation of blood. A new nail will grow in about 8 weeks if it comes out of the hand, if it is a toenail it can take up to 6 months. The neoplasm of the nail may have an abnormal appearance, in no case or in doubt, do not think about it and consult a doctor.
You shouldn’t worry, though, because if your nail happens, it doesn’t necessarily stay that way forever, as the black or purple color may fade as the nail grows. If the blow you received on the nail was very strong, you should be aware that if the root is damaged, the nail may come off. . In this case, the nail will grow back.
Simple home remedies for uneven nails
Next, I offer you a treatment so that your black nail heals quickly and in a healthy way without losing detail!
- After you have damaged your nail, you should soak the broken finger in chamomile tea. This infusion should be hot, but not hot enough to burn. Chamomile is a natural sedative and tranquilizer that can help reduce inflammation and pain from a stroke.
- Try putting your finger in and out of the chamomile glass. If you are unable to move or bend your finger, you may have had a fracture and you should see your doctor as soon as possible.
- You can stick nail in a glass of warm water with plenty of salt to reduce inflammation and prevent the nail from turning purple or black.
How to cure a nail
What is a subungual hematoma?
On purple or black nails from bump , bleeding occurs under the nail (hands or feet) and is called subungual hematoma . This is usually caused by crushing and severe stabbing pain when blood collects under the nail.
In the absence of bone fractures or more serious damage, the presence of such a hematoma should rarely be a cause for concern.
Causes of purple nails or subungual hematoma
Very often, a subungual hematoma is a direct consequence of a finger injury involving the tip of the finger. For example, this can be after hitting a door with your finger, a heavy object, or a hammer. It can also happen after dropping a heavy object, such as a dumbbell, onto your toe.
In some cases of injury under the nail will cause dark areas of black or purple, But you have nothing to worry about, although it is always a good idea to go to the doctor to check this and make sure that the nail root is not damaged.
Subject of the article:
Why do nails turn yellow?
Purple nail symptoms
The most common symptom of a bruised nail: Severe throbbing pain This is caused by the pressure of blood that collects between the nail and the toe. There may also be discoloration that is darker than black, such as red, brown, or purple (it can be on part of the nail or completely).
Should I diagnose a nail with a bump?
If you have subungual hematoma and it was caused by a hard blow to either the nail or the foot, you will need to see a doctor as soon as possible so that he can assess the damage you have done to your finger and nail.You need to know if you have fractures or serious damage to the tissues of your nails or fingers.
Your doctor will examine your toe and purple nail. and you may need to have x-rays to confirm or rule out a bone fracture or other type of injury.
What to do if a nail falls off?
Nails can fall out due to various factors, most often due to a very severe impact due to the fact that has had a nail infection, unsuitable shoes or playing sports for many hours.
Toenail loss can happen to both fingernails and toenails, but we don’t have to worry as fingernails grow in two months and toenails in four.
We advise you to see a specialist doctor if you have any abnormalities in the affected toe so that he or she can find the best treatment for you.
Flesh grows under my nail, is that bad?
If you see flesh growing under the nail it is best to go to dermatologist .It might just be a benign problem, but it could also be something more serious. Also, if you notice that this nail is blackish, it is probably a vein problem.
What if my toenail comes off?
First of all, you need to be patient. We know it is very painful when the nail flakes off, but don’t worry because it usually heals within a few days. Trim or file your nail, rinse well with saline, and then cover with adhesive tape.
In any case, you should be aware that depending on what caused your detachment, you will be advised to see a doctor. And this could be due to a fungal infection, injury, or even due to taking certain medications, for example, those given to cancer patients. If in doubt, consult a professional.
How do I remove flaky nails?
If the nail has come off, rinse your finger with serum, and then use nail clippers to cut whatever you can .Then take a file to clean up those shorter, more stubborn parts. Do this with caution as it can be annoying and even painful.
Best tips if a nail falls off
- First you must clean the area : as soon as the nail has fallen off, rinse the affected area thoroughly with warm water and mild soap.
- Find out the reason : It is important to know the reason why the nail fell off. If it was due to a shock, it does not mean anything serious, although if an infected area is visible, you should see a specialist doctor.
- Maintain a Protected Area: After your nail has fallen, you must be careful not to rub in this area so as not to infect your nail. If it does not fall completely, it must be cut to avoid more serious pain and injury. You must keep this area dry and you can apply the bandage not too tightly so as not to interfere with circulation.
- Take medication: Medication can be taken to relieve pain, ideally pain relievers, although if the pain is due to fungus, be sure to treat it with an antiseptic.
Latest recommendations for consideration
Finally, we will give you the following guidelines that you can follow to avoid this problem in the future:
- Wear comfortable shoes where the foot can breathe and not be tight.
- Use the sandalias or flip flops when you are in the public shower of the gym or sports facility.
- Wash your feet every day and dry them well.
- use talcum powder for feet, you can buy it here).
- Disinfect all your pedicure tools clean them with a cotton pad and a little rubbing alcohol each time.
Subungual hematoma: treatment | Competently about health on iLive
If there was a minor injury to the nail, as a result of which there was a small hemorrhage under it, the treatment will only consist in reducing the intensity of the pain syndrome.You can use ice cubes or packaged frozen foods for this purpose. The cold is applied to the injury site, thereby relieving pain and swelling. It is advisable to apply ice every half hour for 3-5 minutes until the pain subsides.
If the pain is severe enough, you can take pain relievers: analgesics or non-steroidal anti-inflammatory drugs, which are in your home medicine cabinet. It can be “Analgin”, “Tempalgin”, “Ibuprofen”, “Nimid”, and in case of severe pain, “Ketorolac” or “Ketanov”.
In addition, a decoction made from the herb and flowers of St. John’s wort can be taken as an absolutely safe analgesic and anti-inflammatory agent. It is recommended to drink the medicinal composition several times a day, little by little, at intervals of 3 hours. You should not expect a quick result from a natural medicine, but after a couple of days you can observe a noticeable decrease in pain.
Alternatively, it is suggested to apply a fresh leaf or white cabbage gruel to the sore finger.It must be said that the effectiveness of this recipe remains in doubt. An uncomplicated subungual hematoma, though, is a great time to get it checked.
The same can be said about softening the nail plate in order to remove caked blood with a hot solution of potassium permanganate, which should have a rich cherry color. It is assumed that the desired effect can be achieved by dipping the injured finger into hot (as long as you can endure so as not to get burned) water for a quarter of an hour.
This recipe is recommended only if the injury was earlier, the pain has passed, leaving only a bruise under the nail.
Usually, first aid is sufficient to relieve pain and inflammation. If the discomfort does not go away during the day, there is pressure and discomfort in the nail area, indicating a severe bruise, you should definitely consult a specialist doctor for help. The help of a specialist may also be needed if the nail plate is detached from the skin as a result of an injury or a break occurs in it.The doctor will examine the wound and prescribe appropriate treatment.
If blood accumulation is observed under an intact nail plate, the doctor will perform a drainage operation to remove it. The essence of the operation is to pierce the nail and remove the accumulated blood from under it, which brings noticeable relief to the patients and prevents the nail from peeling off.
Puncture of a subungual hematoma is not a painful procedure, because the nail plate itself does not have nerve endings, and the removal of blood does not require a violation of the integrity of soft tissues.Nevertheless, some people psychologically adjust themselves to pain, begin to worry, and make sudden movements. To avoid this, your doctor may suggest local anesthesia with lidocaine. In other cases, the puncture site is irrigated with an anesthetic solution.
After pretreating the nail plate with an antiseptic, drainage is started. The procedure for extracting blood from under the nail can be carried out in two ways:
- a puncture is made using a sufficiently thick medical needle, screwing it into the nail plate as in the case of a drill,
- the nail plate at the site of the hematoma is burned with a special device – a thermal scooter.
Blood begins to flow out through the hole. To speed up this process slightly, lightly press on the nail plate. Next, an antiseptic-soaked napkin is applied to the finger, which is fixed with a bandage. Since blood can ooze from the hole in the nail for a day or more, the dressing should be changed periodically (at least once a day).
A prerequisite for the success of this procedure is sterility, because infection in the puncture site will provoke the development of a purulent process under the nail plate, the treatment of which may require its removal.It is customary to use a hydrogen peroxide solution as an antiseptic. In its absence, you can use other excellent antiseptics: an alcoholic solution of iodine, an aqueous solution of potassium permanganate or furacilin. The use of the drug “Chlorhexidine” with a pronounced antibacterial effect is indicative. It is customary to treat not only wounds, but also hands and surgical instruments before and after surgery.
On the Internet, you can find a description of nail drainage at home using a paper clip that needs to be heated over a fire in order to then pierce the nail with it to draw blood out.Before the procedure, it is recommended to lubricate the surface of the nail with iodine, and after removing the drainage and blood – with hydrogen peroxide with the application of a bandage soaked in the same solution.
In theory, if the operation is carried out under conditions of good disinfection of the clip and nail, infection should not occur. However, often such self-medication has unfortunate results. Patients have to consult a doctor for a suppuration of the nail.
In the case of very voluminous hematomas that cover most of the nail, as well as when spontaneous detachment of the nail plate is observed, doctors often resort to surgical treatment – removal of the nail followed by treatment of the tissues under it.
Treatment is understood to mean removing accumulated blood, treating the cavity with an antiseptic and applying an aseptic dressing to prevent infection from entering an open wound.
In some cases, not the entire nail is to be excised, but only a deformed, exfoliated part of it, which may subsequently be subject to repeated injury.
Surgical removal of the nail may also be necessary if a purulent-inflammatory process has begun under the nail plate.In this case, the wound is washed, treated with an antiseptic, and then one of the effective antibacterial ointments (tetracycline, synthomycin, erythromycin, etc.) is applied on top. Aseptic bandage must be applied on top. The wound needs to be treated and bandaged daily.
In severe injuries, if the nail peeled off on its own and had to be removed, doctors at the site of tissue damage can suture using self-absorbable materials.Reappointment with examination of the stitches can be assigned 3-4 days after the injury.
At the request of the doctor at home, the seams will have to be washed with soap and water and applied to them with antibiotic ointments, after all, any wound is the path of least resistance for the penetration of pathogenic microorganisms that cause purulent-inflammatory processes.
Removal of subungual hematoma
1.With a fresh injury
finger with subnoggeous hematoma
they carry out anesthesia according to Lukashevich –
I will protect (see above).
or with a needle perforate the nail
plate directly above the formed
hematoma. With adequate drainage
the hematoma is easily removed through
hole when pressing on the nail
the plate around it.
3 the old subungual
the hematoma is removed without anesthesia,
burning a hole in the nail plate
red-hot end of the stationery
paper clips or a needle.
bandage with antiseptic ointment.
Ingrown nail removal
the field is widely treated with 5% alcohol
tincture of iodine and alcohol, fenced off
conduction anesthesia of the finger by
Lukashevich — Oberst.
sharp-pointed scissors are inserted under the nail
thumb, backing 0.5 cm from
ingrown edge of it, advance it to
the root of the nail and dissect it all over
capture the subject as deeply as possible
remove part of the nail and twist in
direction away from the cutting line.
5.Under the periungual
the roller is inserted flat with the scalpel,
raise the roller with it and excise the tissue,
lying at the root of the nail. Instead of excision
root scraping can be done
removed part of the nail.
extensive granulations they are excised
arcuate cut together with a roller
and keratinized tissues.
7 the wound is loose
tampon, if there are favorable
conditions are stitched.
ingrowth of the nail and relapses of the disease
perform a more radical operation.
The posterior nail fold is dissected in two
cuts 1 cm long along the continuation
the lines of the lateral edges of the nail plate.
A skin flap with a posterior ridge is removed
from the nail and turn away. Clamp
dislocate and remove the plate. Longitudinally
the affected lateral ridge is excised with
part of the adjacent matrix and
the corresponding part of the germ
areas of the nail. The edge of the skin wound after
excision of the lateral periungual
the roller is mobilized and several
skin sutures, covering the area of the removed
emulsion, removal of stitches in 8-9 days.
Removal of benign tumors of the skin and subcutaneous fatty tissue
the field is treated with a solution
antiseptic, fenced off with sterile
material. The skin along the incision line and
the surrounding tissue
infiltrated with 0.5% novocaine solution.
Cut through the skin and stupidly excrete a tumor,
spreading hemostatic jaws
clamping Billroth and bypassing everything
spurs of lipoma penetrating into interfascial
cracks.To facilitate tumor isolation
you can sew it with stitching stitches.
Hemostasis, layered wound suture. Large
cavities after lipoma removal are drained
tube through a separate puncture. Large
by the size of the lipomas located
deep or in hazardous areas, removed in
surgical hospital. Everything
surgically removed tumor
education is sent to histological
the field is treated with a solution
antiseptic, fenced off with sterile
material.The skin along the incision line and
surrounding tissues infiltrate 0.5%
solution of novocaine. Cut through the skin and
subcutaneous tissue, expose the tumor,
put a stitch on it,
pulling up for which they allocate
fibroids in a blunt and acute way. Bleeding
vessels are ligated, capillary
bleeding is stopped by pressing
gauze swabs. Layer-by-layer suturing
cavity after removal of fibroids from
rubber graduate for 1-2 days. Tumor
sent for histological
research. The stitches are removed on the 7th-8th
removal is performed in the absence
signs of suppuration of atheroma in the “cold”
period. Under the local infiltration
with anesthesia, cut the skin over the atheroma.
If it is significantly thinned and welded
with a cyst, produce two semi-oval
cut to remove the modified
the area of skin above it, trying not to open
her, i.e. do not damage the capsule. If
the latter is damaged, it is removed
total weight or in parts after
emptying the cyst from its mushy
the cavity is treated with alcohol and sutured,
leaving a rubber graduate for a day.
The atheroma is opened and drained by the operative
by under local anesthesia without removing
its shell in conditions of purulent inflammation
due to the danger of its spread to
Hemorrhage under the toenail treatment
Traditional medicine With the help of traditional medicine recipes, you can cure a bruise and relieve pain at home.When an impact has occurred, then from the damaged vascular tissues, blood accumulates under the nail plate. Simultaneously with the color change, exfoliated fragments of the plate, calluses on the skin of the fingers in the area of the nail ridges are often revealed.
Even if there is no fracture, the swelling and soreness at the injury site may remain from several weeks to several months.If there are no medicinal herbs available, then take any dark green plant, rub it with your hands until juice forms and apply it to the hematoma. Prognosis After a large hematoma under the nail drains, the pressure under the nail will decrease and the pain will decrease significantly. If the methods of traditional and folk treatment have not had an effect, then it is better to seek qualified medical help. One of the possible risks and long-term complications of a subungual hematoma is nail loosening. Alternative methods if there are contraindications to the use of medicines, with a bruised nail, you can use folk recipes: a mixture of dried leaves of yarrow and plantain (1 tbsp.
Subungual hematoma treatment Competently about health on iLive
Twice a day, soak with antibacterial soap and water for 10-15 minutes after the procedure, apply a dry, sterile dressing. Immediately after injury to the finger, a purple spot appears, which gradually turns purple-black. In the first stages of the disease, ointments such as triacort, prednisolone ointment, triamcinolone are prescribed.If the hematoma under the nail is large, hurts a lot, or bruises are formed without injuring the limbs, it is imperative to consult a doctor.
Actions of the victim after a bruise: as already mentioned, something cold should be applied to the bruised area and kept for five minutes. On impact, not only a hematoma may form under the nail, but the nail plate itself may burst, and the nail is deformed. The careless attitude to domestic injuries, which is observed everywhere, alas, can have its unpleasant consequences.This recipe is recommended only if the injury was previously, the pain has passed, leaving only a bruise under the nail. Compresses can be made with this plant to relieve inflammation and swelling; with the help of fresh wormwood, you can relieve pain from a bruised big toe.
Subungual hematoma nail trauma Diagnosis and treatment
When hemorrhages appear under the nails caused by the development of psoriasis, alternative methods can also be used.Means for active growth of nails – all kinds of baths with essential oils, sea salt and other useful elements. In most patients, pain stops immediately after simple trephination (removal of a fragment) of the nail. At this time, the puncture site should be covered with a sterile gauze bandage, which must be changed daily.
To do this, perforation of the nail or surgical removal of the entire nail plate is performed using a medical drill.The operated finger is tied with a sterile bandage, after a certain period the nail plate will slide off. To get rid of the hematoma as soon as possible, use gels venitan, troxevasin, venoruton or ointments of a similar action. The same can be said about softening the nail plate in order to remove caked blood with a hot solution of potassium permanganate, which should have a rich cherry color.
Hammer | Dermatology in Russia
II light Life history
He had no contact with known allergens and skin irritants, adverse physical, chemical and biological environmental factors.
No bad habits Anamnesis of the disease
There is no indication of the inherited nature of the disease
Duration of the disease:
Debut at the age:
At the age of 32-60 years
No contacts with infectious patients had.
The nature of the course of the disease:
Episodes of the disease (exacerbations):
This is the only episode of the disease
This is the initial treatment
Previous treatment and its effectiveness:
Patient treatment (incl.h. self-medication) did not receive.
Description of the rash:
The pathological process is localized on the nail phalanx of the first finger of the left hand. A dark spot (black and dark brown), irregular in shape, with clear boundaries is visible through the nail plate. The proximal border corresponds to the shape of the lunula. Stripe-like or peaked hemorrhages in the form of “splinters” extend from the spot in the distal direction. The nail itself with post-traumatic onychomadesis – the entire nail plate is separated from the bed from the proximal edge.Proximal to the separation line, a new, healthy (of usual color and shape) nail plate grows, the size of which makes it possible to judge the duration of the injury (more than a month). Hutchinson’s (Hutchinson’s) symptom is negative – there is no pigmentation of the skin surrounding the nail plate (nail folds and fingertip).
Primary elements of the rash:
Additional categories of elements:
Localization of the rash:
Distribution of rash:
Localized rash (one focus)
Nature of the location of the rash:
Changes in nails:
Clinical changes in nails data
Complaints when applying:
On a rash on the first finger of the left hand.
Categories of complaints:
Categories of complaints:
Changes in nails
Examination of the patient:
The patient is of normosthenic constitution. The general condition is satisfactory. Body temperature 36.6 * C. Zev is clean. On the arms and lateral surfaces of the body, there are foci of vitiligo. Hair without features. Peripheral lymph nodes are not enlarged. Physiotherapy is normal.
L60.3 Post-traumatic onychomadesis of the first finger of the left hand.Hemorrhage of the subungual first finger of the left hand.
subungual melanoma, onychomycosis, nevus of the nail bed, glomus tumor, subungual felon
Subungual hematoma is a blood clot that has formed under the nail after bleeding from the nail matrix and nail bed or toe caused by a mechanical foot projection of the nail plate. A subungual hematoma can form as a result of an acute injury – a blow (for example, a blow from a hammer, a car door), infringement, squeezing; and as a result of a chronic traumatic effect on the nail (when wearing uncomfortable shoes; in the latter case, the 1st toe most often suffers.Trauma to the nail causes bleeding in the subungual space – from minor bleeding, manifested by the formation of thin threadlike stripes along the nail plate, to a total tense hematoma that requires surgical treatment, and often the removal of the nail plate. The blood in the subungual space initially has a reddish-purple hue, over time it acquires a brownish-brown or even black color; while maintaining the nail plate, the subungual hematoma resolves within a few months.Spontaneous separation of the nail plate from the nail bed is possible (post-traumatic onycholysis). Due to the accumulation of blood, detritus inhabited by pathogenic or conditionally pathogenic microflora, most often fungal (dermatophytes, candida), can form in the subungual space, the formation of secondary (post-traumatic) onychomycosis or bacterial (most often pseudomonas) onycholysis is possible. In this case, surgical removal of the nail plate and external treatment of the nail bed with antibacterial and antifungal drugs are indicated.In all other cases, treatment of a subungual hematoma is usually not required. Potential complications of a subungual hematoma include onycholysis, nail deformity (especially splitting), and infection. Complications are most likely with a late visit to the doctor, as well as with a fracture of the underlying bone. In view of the similarity of the clinical picture, it is necessary to differentiate the subungual hematoma from the subungual form of acral lentiginous melanoma. The key to success in such cases is a thorough history taking and dermatoscopy.Subungual hematoma: As the nail grows, the dark area gradually shifts towards the free edge. Melanoma is characterized by a symptom of Hutchinson (Hutchinson) – pigmentation of the skin surrounding the nail plate, with the involvement of the nail folds and fingertips. In the phase of radial growth, it is a dark brown, black-blue or black spot, almost uniformly colored, with blurred borders. Age: half of the patients are over 65 years old. Subungual form of acral lentiginous melanoma: usually affects the big toes and toes, occurs on the nail bed and spreads to the nail matrix, eponychium and nail plate within 1-2 years.In the phase of vertical growth, nodes appear, ulceration, and deformation of the nail is possible. The gold standard in the diagnosis of this skin cancer pathology is a biopsy of the affected area. Hutchinson’s pseudo-trait is characterized by dark pigment around the proximal nail fold and is secondary to benign conditions such as racial melanosis. Other causes of Hutchinson’s pseudo-sign is a transparent cuticle, below which the pigment of longitudinal melanonychia is noticeable. With drug-induced trauma and pigmentation, pseudo Hutchinson’s sign can also be observed.A subungual hematoma can be mistaken for subungual melanonychia, however, the pigmentation zone shifts as the nail plate grows, while its proximal border is visible, repeating the shape of the lunula. The hole in the nail plate allows you to see the underlying nail bed and to verify the reason for the discoloration. http://lifenail.ru/zdorove-i-uxod/osobennosti-podnogtevyx-gematom.html http://dermatoscopy.in.ua/gemorragiya_podnogtevaya http://dermline.