Bruise underneath the toenail (subungual hematoma)

What is a bruise underneath a nail?

 A bruise underneath a toenail can be caused from either acute injury or repetitive micro trauma that causes blood vessels to burst. A bruise underneath a nail is a dark discoloration underneath that nail that is harmless, but often is thought to be possible melanoma.

What are the complications of an injury to the toenail?

Nail injuries can lead to a permeant nail deformity depending on how badly the nail matrix was damaged and a nail injury allows possible entry of fungal toenail infection.

How to treat bruises underneath the nail?

If the bruise underneath the nail is painless and covers <25% of the nail than nothing is done. If the nail is painful and the bruise is larger than 25% of the nail than it is recommended to either remove the entire nail or trephination of the nail to release the pressure. If the nail is loose than it is typically removed. With larger bruises underneath the nail and an acute injury, often the nail will be removed to exam the nail bed for any lacerations. 

How long will the nail stay discolored?

The nail will stay discolored for about 1 whole year as it grows out. Unfortunately as the body absorbs the bruise underneath the nail, the blood will stain the nail permanently. 

How to distinguish between a bruise underneath a nail vs melanoma?

Typically if the discoloration of nail occurs after physical activity such as hiking, running or traumatic injury than it is more likely to be a bruise. If the discoloration of the nail has been present for years, does not disappear with nail growth, and extends to the skin on the toes then it is most likely a melanoma.