What are the common causes of subungual hematoma. How can you identify the symptoms of blood pooling under a nail. What are the recommended treatment options for draining blood from under a nail. When should you seek medical attention for a nail injury. How long does it typically take for a subungual hematoma to heal.

Understanding Subungual Hematoma: What Causes Blood Under the Nail?

A subungual hematoma occurs when blood pools underneath a fingernail or toenail, typically due to trauma or injury to the nail bed. This painful condition often results from accidents like slamming a finger in a door, dropping a heavy object on the toe, or repetitive impact from ill-fitting shoes.

Common causes of subungual hematoma include:

• Direct blunt force trauma to the nail
• Crushing injuries to the digit
• Repetitive pressure or friction on the nail
• Sports injuries, particularly in runners and athletes
• Accidents involving tools or heavy objects

The severity of a subungual hematoma can vary greatly, from a small, painless discoloration to a large, throbbing collection of blood that causes significant discomfort and may lead to nail loss if left untreated.

Recognizing the Signs: How to Identify a Subungual Hematoma

Identifying a subungual hematoma is crucial for proper treatment and prevention of complications. The most obvious sign is a visible dark-colored area under the nail, which can range from reddish-brown to deep purple or black. This discoloration is caused by blood accumulating between the nail plate and the nail bed.

Other symptoms of a subungual hematoma may include:

• Intense throbbing pain in the affected digit
• Pressure sensation under the nail
• Tenderness when touching the nail or surrounding area
• Warmth in the affected digit
• Swelling around the nail

In severe cases, the nail may become lifted or separated from the nail bed, a condition known as onycholysis. This can increase the risk of infection and may require medical attention.

Treatment Options: How to Safely Drain Blood from Under a Nail

While minor subungual hematomas may resolve on their own, larger or more painful ones often benefit from drainage. This procedure, known as trephination, can provide immediate relief from pain and pressure. However, it’s crucial to perform this safely to avoid complications.

The Paper Clip Method

One common at-home method for draining blood from under a nail involves using a heated paper clip. Here’s a step-by-step guide:

1. Straighten a paper clip and sterilize it with rubbing alcohol
2. Heat the tip of the paper clip until it’s red-hot
3. Gently place the heated tip on the nail where the blood has pooled
4. Allow the heat to melt through the nail, creating a small hole
5. Do not apply pressure, as this could cause pain or injury
6. Reheat and repeat as necessary until the blood begins to drain

Is this method safe for everyone? While the paper clip method can be effective, it’s not recommended for individuals with diabetes, circulation problems, or weakened immune systems. These individuals should seek professional medical care to avoid potential complications.

Professional Medical Treatment

For more severe cases or when at-home methods are not appropriate, a healthcare professional may perform trephination using specialized tools. This typically involves creating a small hole in the nail using an electrocautery device or a sterile needle.

Aftercare: Ensuring Proper Healing of a Subungual Hematoma

Proper aftercare is essential for preventing infection and promoting healing after draining a subungual hematoma. Follow these guidelines for optimal recovery:

• Keep the affected area clean and dry
• Apply an antibiotic ointment to the nail
• Cover the nail with a sterile bandage
• Change the dressing daily or when it becomes wet or soiled
• Avoid activities that could further injure the nail
• Take over-the-counter pain medication if needed

How long does it take for a subungual hematoma to heal completely? Healing time can vary depending on the severity of the injury, but most subungual hematomas resolve within 2-3 months. During this time, the damaged nail will gradually grow out and be replaced by new, healthy nail tissue.

When to Seek Medical Attention: Red Flags for Nail Injuries

While many subungual hematomas can be managed at home, certain situations warrant professional medical care. Seek immediate medical attention if:

• The injury involves a crush or laceration to the nail or surrounding tissue
• There is persistent severe pain or signs of infection
• The hematoma covers more than 50% of the nail bed
• You have a history of diabetes or circulatory problems
• The nail appears to be separating from the nail bed
• You experience fever or chills following the injury

Can a subungual hematoma lead to long-term nail damage? In most cases, proper treatment and care result in full recovery without lasting effects. However, severe injuries may cause permanent changes to nail growth or appearance.

Prevention Strategies: Minimizing the Risk of Subungual Hematomas

While accidents can happen, there are steps you can take to reduce your risk of developing a subungual hematoma:

• Wear protective gear when working with heavy objects or tools
• Use proper techniques when participating in sports or physical activities
• Ensure shoes fit properly to avoid repetitive trauma to toenails
• Be cautious when closing doors or drawers to avoid trapping fingers
• Keep nails trimmed and healthy to reduce the risk of injury

By implementing these preventive measures, you can significantly decrease the likelihood of experiencing a painful subungual hematoma.

Complications and Long-Term Effects of Subungual Hematomas

While most subungual hematomas heal without incident, some cases may lead to complications or long-term effects. Understanding these potential issues can help you identify when additional medical intervention may be necessary.

Potential Complications

• Infection: If bacteria enter through the damaged nail or surrounding skin, an infection can develop. Signs include increased pain, redness, swelling, and discharge.
• Nail Deformity: Severe injuries may cause permanent changes to the nail’s shape or texture.
• Nail Loss: In some cases, the entire nail may separate and fall off. While a new nail will typically grow back, this process can take several months.
• Chronic Pain: Rarely, nerve damage from the initial injury can lead to ongoing pain or sensitivity in the affected digit.

Long-Term Effects

Do subungual hematomas always result in permanent nail changes? Not necessarily. Most people experience full recovery with proper care. However, some may notice:

• Slight discoloration or unevenness in the healed nail
• Temporary or permanent ridges or grooves in the nail surface
• Increased susceptibility to future nail injuries in the affected area

If you notice persistent changes in your nail’s appearance or function after a subungual hematoma, consult with a dermatologist or podiatrist for evaluation and potential treatment options.

Alternative Treatments and Home Remedies for Subungual Hematomas

While draining is often the most effective treatment for subungual hematomas, there are alternative approaches and home remedies that may help alleviate symptoms and promote healing, especially for minor cases:

Cold Therapy

Applying ice or a cold compress to the affected area can help reduce pain and swelling. Wrap ice in a thin towel and apply for 15-20 minutes at a time, several times a day.

Elevation

Keeping the injured digit elevated above heart level can help reduce blood flow to the area, potentially minimizing further bleeding under the nail.

Herbal Remedies

Some people find relief using natural remedies such as:

• Arnica: Known for its anti-inflammatory properties, arnica gel or ointment may help reduce pain and bruising.
• Tea Tree Oil: With its antimicrobial properties, tea tree oil may help prevent infection when applied topically.
• Calendula: This herb is believed to promote healing and reduce inflammation when used in ointment form.

Are these alternative treatments as effective as draining for severe subungual hematomas? While these methods may provide some relief, they are generally most suitable for minor cases or as complementary treatments alongside conventional approaches.

Over-the-Counter Medications

Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help manage pain and reduce inflammation associated with subungual hematomas.

Remember, while these alternative treatments and home remedies can be helpful, they should not replace proper medical care for severe injuries or when complications are suspected. Always consult with a healthcare professional if you’re unsure about the best course of treatment for your specific situation.

How to Drain Blood From Under a Nail

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How to Drain Blood From Under a Nail

You may be able to relieve severe, throbbing pain by draining blood from under your nail. This procedure is not necessary and is not recommended if you are not having pain. This procedure is safe if done properly.

To remove blood from under a nail:

• Straighten a paper clip, and heat the tip in a flame until it is red-hot.
• Place the tip of the paper clip on the nail and let it melt through. There are no nerves in a nail, so putting a hot paper clip on a nail should not hurt.
• Do not push or apply pressure on the paper clip. There are nerves in the skin under the nail. You could accidentally touch the skin under the nail if pressure is applied to the nail.
• Go slowly, and reheat the clip as necessary. A thick nail may take several tries.
• As soon as the hole is complete, blood will escape and the pain will be relieved.
• Expect drainage of clear or slightly bloody fluid for 2 to 3 days.
• Soak the finger in warm, soapy water for 10 minutes, 3 times a day for 2 to 3 days.

You may repeat the procedure using the same hole. The pain and pressure that is immediately relieved may build back up again in a few days.

If your pain does not go away after you have drained the blood from under your nail, you may have a more serious injury. Call your doctor for an appointment.

Be sure to watch for signs of infection until your nail has healed. Signs of infection may include:

• Increased pain, swelling, redness, or warmth around the nail.
• Red streaks extending from the nail.
• Drainage of pus from the nail.
• Fever.

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Subungual hematoma: Symptoms, causes, and treatment

Subungual hematoma: Symptoms, causes, and treatment

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Medically reviewed by Judith Marcin, M. D. — By Jennifer Berry on May 17, 2018

A finger slammed in a door, a thumb hit with a hammer, a brick dropped on a toe — these nail injuries are common and extremely painful. They can cause blood to pool visibly under a nail, which is called a subungual hematoma.

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.

Share on PinterestAn injury may cause blood to collect under the damaged nail of a finger or toe.

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.

Although it is rare, melanoma can occur under a fingernail or toenail. Melanoma is the deadliest form of skin cancer.

A tumor may look like a subungual hematoma. Melanoma can cause a dark mark to form under the nail. However, it does not usually cause pain and is not linked to an injury.

Speak to a doctor about any unusual marks or colors on the nail that appear without an injury.

Share on PinterestIt can take up to 9 months for a minor subungual hematoma to heal under a toenail.

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.

Last medically reviewed on May 17, 2018

• Dermatology
• Blood / Hematology
• Melanoma / Skin Cancer

How we reviewed this article:

Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. We avoid using tertiary references. We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

• Deinlein, T., Hofmann-Wellenhof, R., & Zalaudek, I. (2016, November). Acral melanoma mimicking subungual hematoma. Journal of the American Academy of Dermatology, 75(5), e181–e183
  https://www.jaad.org/article/S0190-9622(16)01487-0/fulltext
• Gil, J. A., DeFroda, S., Reid, D., & Mansuripur, P. K. (2016, February). Closed traumatic finger tip injuries in patients with artificial nails: Removal of UV gel and acrylic nails. The American Journal of Emergency Medicine, 34(2), 335–337
  https://www.ajemjournal.com/article/S0735-6757(15)00965-1/fulltext
• Pingel, C., & McDowell, C. (2018, February 12). Subungual hematoma, drainage
  https://www.ncbi.nlm.nih.gov/books/NBK482508/
• Roberts, J. R. (2003, August). Evaluation and treatment of subungual hematoma. Emergency Medicine News, 25(8), 13–16
  https://journals. lww.com/em-news/Fulltext/2003/08000/Evaluation_and_Treatment_of_Subungual_Hematoma.12.aspx
• Subungual hematoma. (n.d.)
  http://www.aocd.org/?page=SubungualHematoma

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Medically reviewed by Judith Marcin, M.D. — By Jennifer Berry on May 17, 2018

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Hemorrhage under the nail – causes and methods of treatment of hematoma

March 04, 2022

Subungual hematomas are blue, purple, black spots under the nail plates. They occur predominantly as a result of trauma and are a difficult problem for nail technicians, as often clients insist on applying a decorative coating to mask damage, because bruises look extremely unaesthetic. When performing a manicure, many factors must be taken into account so as not to cause complications that exacerbate the problem.

The nature and causes of subungual hematoma

Subungual hemorrhage occurs as a result of blows, pressure, rupture, cuticle inflammation, unprofessional manicure and pedicure. Injuries differ according to the nature of the impact:

Acute

They occur with a sharp mechanical impact.

Chronic

Manifested as a result of constant exposure – for example, from tight shoes, and are characterized by discomfort and mild pain.

Varieties of nail injuries:

• contusion resulting from mechanical impact;
• squeezing or pinching as a result of careless handling of doors, windows, drawers;
• laceration resulting from careless handling of sharp objects, household appliances, metalwork tools;
• traumatic separation of the nail from the nail bed due to mechanical injury or fungal infection;
• damage to the cuticle or nail plate as a result of unprofessional manicure or pedicure;
• detachment of the nail plate from the bed with damage to soft tissues and phalanx bones as a result of mechanical impact;
• open or closed fracture of the superior phalanx of the finger.

Non-traumatic manifestation of hemorrhages under the nails

The appearance of hemorrhages under the nails is often provoked by:

cuticle damage due to poor quality manicure.

Diseases that cause hemorrhages

Often, hemorrhages under the nails are symptoms of chronic diseases, including:

Diabetes mellitus

One of the characteristic features of which is a circulatory disorder that causes bruising in various parts of the body, including under the nails.

Onychomycosis

An infectious fungal disease characterized by the appearance of dark spots under the nails and changes in the structure, color and thickness of the nail plates.

Subungual melanoma

A type of cancer that is difficult to diagnose and is localized under the nail plates of the hands and feet. It is characterized by long-term preservation of hematomas, mild pain syndrome, cessation of nail growth, cuticle damage, asymptomatic course in the first stages, localization features and rapid metastasis.

For people suffering from chronic pathologies, a therapeutic manicure is provided, which is performed using sparing care and hygiene products. In diseases in the acute phase, any type of manicure is undesirable.

Types, stages and symptoms of the problem

Depending on the mechanism of injury, the following types of damage to the nail plates are distinguished: spots, dents, tubercles on the surface;

subungual hematomas formed in severe trauma. They are characterized by local hyperemia, swelling of the upper phalanx or the entire finger, acute pain of a bursting or pulsating nature, fever, partial limitation of motor functions. As a result of stratification of tissues and the formation of cavities filled with blood, an extensive spot of saturated red or cherry-violet color is formed under the nail. After 2-3 days, the injured nail turns blue or black, the hematoma spreads to the skin around the nail. Without qualified help, the pain persists for several days, and the process of wound healing and restoration of natural nail growth drags on for months. The damaged nail often cracks, purulent masses accumulate between the nail plate and the nail bed, which causes additional inconvenience and pain. After some time, the nail is completely separated from the nail bed. It is impossible to save the nail plate. There is a possibility of stratification and deformation of the nail in the process of growth and development of chronic onychodystrophy;

Methods of treatment of subungual hematoma

In case of minor damage to the nail plate, it is necessary to remove the puffiness by applying a cotton pad lubricated with a thick layer of heparin ointment to the injured finger and fixing it with a sterile bandage or bactericidal adhesive plaster.

The following are used as painkillers, anti-inflammatory and antiseptic agents:

• tetracycline ointment;
• levomekol;
• synthomycin;
• ichthyol ointment;
• Vishnevsky ointment.

Treatment of subungual hematoma is a lengthy process that should not be rushed. Damaged nails grow back slowly, so a full range of manicure or pedicure procedures is only permissible after a healthy plate has grown.

Possible risks and complications

Nail injuries are often ignored by the victims themselves, the treatment is left to chance or not performed at all, which leads to unpleasant consequences in the form of complications, including:

• soft tissue rupture caused by excess blood volume;
• infection of open wounds with subsequent purulent-necrotic lesions of soft tissues;
• nail dystrophy as a result of circulatory disorders, changes in the structure of blood vessels and proliferation of connective tissues;
• detachment of the nail plate or onycholysis;
• ingrown toenail;
• deformation of the nail plate.

First aid for serious nail injuries

The sequence of medical procedures that must be performed in specialized institutions – trauma centers, medical centers, hospitals – are determined depending on the type and nature of hemorrhage under the nail. A manicurist has the right to provide only first aid, namely:

• help remove jewelry from an injured finger;
• clean the wound of impurities;
• treat with an antiseptic;
• apply an ice pack to the wound to help reduce pain and stop bleeding;
• for an open wound, wash the injured surface with hydrogen peroxide or chlorhexidine and stop bleeding by holding the limb in an upright position;
• apply a sterile dressing;
• suggest an analgesic to reduce pain;
• wait for an ambulance.

When surgery is needed

The need for surgery arises in difficult situations, namely:

• when the nail is detached from the nail bed;
• more than 25% of the nail plate is affected;
• the occurrence of deep cracks in the nails;
• presence of lacerations;
• Unnatural bending or deformity of the finger.

Sequence of surgical treatment of the nail

Surgical treatment of the nail is carried out in stages:

• a local anesthetic is injected;
• in the hematoma area, drainage is performed by puncturing the nail surface to drain accumulated blood, reduce pain and alleviate the general condition of the victim;
• exfoliated parts of the injured nail and soft tissues subject to necrosis are removed;
• to stop bleeding, cauterization of bleeding vessels with a coagulator is carried out;
• the wound is sutured;
• a sterile dressing is applied;
• , anti-inflammatory drugs are administered to prevent purulent-septic complications.

Follow-up treatment is carried out under supervision and in strict accordance with the recommendations of the physician. You should forget about decorative manicure until a complete cure, which occurs after at least 2 months, and sometimes lasts up to six months.

What should a manicurist do if a client has a subungual hemorrhage?

With a slight darkening under the nail, it is permissible to carry out a full range of hygiene and care procedures, including coating with varnishes or gel polishes. The treatment of a damaged nail must be done especially carefully so as not to cause pain. Among the permissible types of manicure:

• hardware;
• classic;
• European;
• combined;
• SPA.

The use of hot baths and heating of the nail plates in other ways should be avoided so as not to provoke the development of hemorrhage. Nail extension, the use of false plates and gel polish is also undesirable.

A client with a complex injury and a large area of ​​hematoma, a torn or cracked nail, lacerations of the skin near the nail bed should be persuaded to see a doctor.

Ways to prevent hemorrhage under the nail

Injuries resulting in subungual hemorrhages most often occur accidentally or while performing unusual activities: for example, hammering nails, repairing, participating in construction and country work. Hematomas are easy to avoid if you are careful and attentive, do not rush, do not leave your fingers in the openings of open doors, windows or in the mouth of a playing pet, use gloves when carrying out repairs, wear tight model shoes only in solemn situations. If the injury was nevertheless received, emergency measures should be taken, without waiting for the development of hemorrhage – remove the swelling, apply a compress and consult a doctor.

How to stop bleeding from a dog’s claw

Domestic dogs, especially those who constantly live in rooms and rarely walk on hard, rough surfaces on the streets, need regular shortening of their claws. Inexperienced owners can cut them incorrectly, and then they will have to decide how to stop the blood from a damaged vessel. It is important to know how to properly trim your pet’s claws and how to stop bleeding resulting from careless actions.

Features of the structure of dog claws

Just like human nails, dogs’ claws grow constantly. If they are not sheared, they can grow excessively. Long nails cause suffering to the dog, twisting and growing into the pads of the fingers. The damaged area can become inflamed and fester when an infection enters.

Even more dangerous is the situation when too long claws literally twist the joints of the toes so that the animal cannot step on them. Timely trimming of the claws can prevent a painful condition. The sooner you teach a puppy to the procedure, the easier and easier it will be to perceive it.

Unlike a human nail, dog nails are thick and have a “pulp” with blood vessels running through it. If you cut them too short, bleeding from the damaged capillary will begin. It can be very strong and long-lasting, so pet owners need to know how to stop the bleeding.

How to properly cut a nail

In order not to provoke bleeding from the claw, the first time you perform this procedure is with a veterinarian or an experienced groomer. He will show you how to do it and explain how to stop the blood from the dog’s claw.

The easiest way to trim the light claws of a dog. The border of the “pulp” is clearly visible on them, so the risk of damage to the vessel is minimal. Dark claws should be trimmed gradually, highlighting the cut with a flashlight to see when to stop.

The calmer the owners during the process, the less the risk of injury, and the dog behaves peacefully and does not break out. Nervous dogs or animals with problem plates (damaged, ingrown or thinned, inflamed) are best taken to a good groomer, he will do everything right, quickly and painlessly.

Managing nail bleeding

To reduce the risk of damage to the claw, trimming should be done regularly with a special guillotine tool. If, nevertheless, blood appeared on the claw, measures should be taken as soon as possible. An open wound threatens with infection, and getting bacteria under the claw can lead to suppuration, in severe cases, to blood poisoning. Heavy bleeding is dangerous, in such cases it is better to immediately take the dog to the veterinary clinic.

Damage can be dealt with in the following ways:

1. If, after trimming the nail, a dark speck of a blood vessel is visible on the cut, but there is no blood, you can limit yourself to disinfecting the wound with any suitable agent with alcohol, vodka, hydrogen peroxide, iodine or brilliant green. If the dog limps when moving, it means that it hurts and the nerve endings are damaged. The claw can be carefully sealed with a textile adhesive plaster, or special shoes can be put on the dog until the plate grows back a little and the soreness passes.
2. In the presence of bleeding, the most effective method would be to use a dry powder of potassium permanganate (“potassium permanganate”). The damaged area is simply “dipped” into the powder or applied to the wound with a cotton swab or match. Crystals contribute to the rapid clotting of blood and thrombosis of the vessel. The blood stops flowing. The damaged area must be covered with a sterile bandage, especially if the animal lives in a booth on the street and runs on the ground. The next day, if there are no problems, the bandage or “boots” are removed.
3. Another simple and radical remedy is alum or a special hemostatic pencil. You can buy it at any pharmacy and always keep it on hand for such cases. Like “potassium permanganate”, products based on burnt alum almost instantly stop bleeding, forming a dense clot. The pencil is simply pressed against the cut and held for a few seconds.
4. You can replace “potassium permanganate” and a pencil with talc or baby powder, but these products are less effective. Streptocide powder or any antibiotic powder is fine, but these remedies are only effective for minor injuries.
5. A small cut without a strong release of blood is cauterized with hydrogen peroxide or chlorhexidine.
6. In an emergency, you can use folk remedies crystalline sugar (used in the same way as “potassium permanganate”), as well as juice from nettle leaves, berries and viburnum leaves. They contain vitamin K, which promotes blood clotting.