Subungual Hematoma: What to Do About Blood Under Your Nail

What is Subungual Hematoma?

A subungual hematoma, or simply blood behind fingernail or toenail, is a condition where there is an accumulation of blood under the fingernail or toenail. It occurs when there is damage to the blood vessels under the nail, usually due to a blunt trauma or crush injury to the nail bed. This can cause pain and discoloration of the nail, with a dark bluish-purple color. Subungual hematomas are commonly caused by activities such as stubbing your toe, dropping something heavy on your finger, or wearing poorly fitting shoes. In most cases, small subungual hematomas with mild pain will resolve on their own without treatment. However, if there is severe damage to the nail bed or unmanageable pain, medical treatment may be necessary.

Causes and Risk Factors

Subungual hematoma, or blood behind fingernail, is typically caused by injury to the blood vessels beneath the nail bed. Some common causes include:

Trauma: An injury, such as slamming a finger in a door or crushing a toe with a heavy object, can cause blood vessels to break and bleed under the nail.
Tight shoes: Wearing shoes that are too tight, or narrow can put pressure on the toenail, leading to the rupture of blood vessels and the accumulation of blood under the nail.
Sports activities: Engaging in sports with a lot of stop-and-start action, like tennis, soccer, or basketball, can increase the risk of subungual hematoma.

Non-modifiable risk factors are risk factors that cannot be changed. Non-modifiable risk factors for subungual hematoma include:

Age: Older individuals may have thinner nails and more fragile blood vessels, making them more susceptible to injury.
Genetics: Some people may have naturally weaker blood vessels or nails that are more prone to injury.

Modifiable risk factors are risk factors that can be changed or influenced. Modifiable risk factors for subungual hematoma include:

Ill-fitting shoes: Wearing properly fitting shoes can help reduce the risk of pressure on the toenails.
Poor nail care: Trimming nails regularly and keeping them at an appropriate length can help prevent trauma to the nail bed.

Remember, these are general guidelines and individual circumstances may vary. If you have concerns about subungual hematoma or want to explore prevention strategies further, it's best to consult with your healthcare professional.

Symptoms

Symptoms of blood behind fingernail or blood behind toenail include:

Throbbing pain in the nail area
Discoloration of the nail, starting as reddish purple and eventually turning dark brown or black as the blood clots

Other common symptoms that may occur with progression of subungual hematoma include:

The nail may lift or separate from the nail bed.
The nail may split, crack, or become damaged.
In some cases, the discolored nail may fall off or need to be removed and replaced by a new, healthy one.

If you notice persistent dark marks under a nail without a known injury or experience continuous bleeding, intense pain, or severe damage to the base of the nail, it is important to seek medical attention.

Diagnosis

To diagnose a subungual hematoma, doctors typically perform the following examinations, tests, and procedures:

Physical examination: Doctors visually inspect the nail and surrounding area to assess any skin discoloration, swelling, or signs of injury.
Medical history review: Doctors inquire about recent trauma or injury to determine the cause of the hematoma.
Imaging tests: In some cases, doctors may obtain x-rays to make sure there is no fracture of the finger or toe.
Biopsy: In rare cases where subungual melanoma (a type of skin cancer) is suspected, a biopsy may be performed. A small sample is taken from the affected area and tested for melanoma.

Remember, it's important to consult with your doctor for an accurate diagnosis and appropriate treatment plan.

Treatment Options

The goals to treat blood behind fingernail or blood behind toenail are to relieve pain, reduce swelling, prevent infection, and promote healing. Here are the different treatment options and how they work to achieve these goals:

Self-care and health-behavior change measures:

Over-the-counter (OTC) pain medication: OTC pain relievers can help reduce discomfort and swelling.
Elevating the affected finger or toe: Keeping the injured area elevated can help reduce swelling.
Applying ice: Using an ice pack on the affected area can help reduce swelling and pain.
Resting the affected finger or toe: Limiting the use of the injured finger or toe can aid in healing.

Nail lancing:

A doctor may perform nail lancing to drain the accumulated blood and relieve pressure, which helps alleviate pain.

It's important to note that these treatments are generally effective for minor subungual hematomas. However, if the injury is severe or there are signs of infection, it is recommended to seek medical attention. In some cases, a severely injured nail may need to be removed or deep cuts may require stitches.

Remember, always consult with your healthcare professional before trying any home remedies or over-the-counter medications. Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Side effects can occur. Check with your health care professional or read the information provided with your medication for side effect information.