Bruise under the nail: causes of blue nail

A bruise under the nail is an accumulation of blood between the nail and the nail bed. Blood under the nail of a finger or toe is also called a subungual hematoma. Blood under the nail is the result of trauma, such as dropping a (heavy) object on the toenail or a blow from a hammer to a fingernail. A small bruise without pain does not require treatment. In case of severe pain, a small hole can be made in the nail.

  • Hemorrhage under the nail
  • Symptoms of bruising under the nail
  • Phenomena
  • Differential diagnosis
  • Causes
  • Course
  • Treatment of bruising under the nail
  • No treatment
  • Hole in the nail

Hemorrhage under the nail

The medical name for a bruise under the nail is subungual hematoma . A bruise under the nail is an accumulation of blood under the nail, to be precise between the nail and the nail bed. A subungual hematoma is a result of direct trauma to the fingernail. The pressure created by this accumulation of blood under the nail can cause severe pain.

Subungual hematoma: bruising under the nail / Source: Drgnu23, Wikimedia Commons (CC BY-SA-3.0)

Symptoms of bruising under the nail

Phenomena

A bruise under the nail is visible as a blue, purple, red-black, maroon to yellow-brown discoloration; this depends on the duration of existence. The most common symptom is pain, due to increased pressure on the nail bed due to the accumulation of blood. The pain often only occurs several hours after the trauma, when the pressure has increased. But people do not always suffer from pain.

Differential diagnosis

Similar syndromes are:

  • subungual melanoma (skin cancer under a toenail or fingernail, usually visible near the thumb or big toe as a brown to black discoloration of the nail – melanoma is an aggressive form of skin cancer);
  • subungual nevus naevocellularis (birthmark under the nail);
  • dirt (for example due to professional contact with inks);
  • pigment by micro-organism (in case of bacterial or fungal infection);
  • oil stain phenomenon in psoriasis unguium (psoriasis of the nails);
  • nail discoloration due to medication.

Causes

A bruise under the nail is the result of trauma, such as a blow to the nail from a hammer or other object. or a finger in a door. What is less known is that shoes that are too narrow or a rapid braking movement during sports can also lead to a bruise under the nail. Very often the patient remembers a trauma that caused the bruising, but this is not always the case.

Course

A bruise under the nail gradually grows. This process can take up to six months. The affected nail may also fall off after a while, after which it is replaced by a new one.

Treatment of bruising under the nail

No treatment

A small bruise under the nail that does not cause pain does not require treatment.

Hole in the nail

In case of severe pain, the doctor can make a small hole in the nail, through which the blood can drain. This reduces the pressure between nail and nail bed. However, keep in mind that clotted blood under the nail is not easy to remove. The GP can use a scalpel, a drill, a disposable needle or an electrocautery. The disadvantage of these methods is that when piercing the nail you can quickly hit the nail bed, which is a painful and unpleasant (but harmless) experience.

The most useful instrument is a hot, bent out paper clip┬╣, which has been heated in the blue part of a flame (to prevent soot formation) until it is red hot. The hot tip is carefully placed on the nail where the bruise is located. Without pressing hard, a small hole slowly forms, which is painless. After puncturing the nail, the blood will drain and the pain will subside quickly. A plaster can then be stuck on it.

Note:

  1. Th. B. Voorn: Blue nail/subungual hematoma, in: Minor ailments in general practice, fifth completely revised edition, second edition, Elsevier Healthcare, Amsterdam, 2010, p.677.

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