Subungual hematoma
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- Localization. Nails: hands or feet
- Erythematous lesion? Non-erythematous lesion
- Evolution time. Acute: less than 2 weeks
- Skin lesion. Subcutaneous/deep: swelling
- Surface texture. Normal/smooth
- Edges Well defined and regular
- Color. Due to blood: pink, red, purple or purple
- Distribution of lesions. Discreet/isolated injury: 1 to 5 injuries
- Associated symptoms. Pain
- Additional information.
Brief information
- Subungual hematoma is a transient condition where blood accumulates under the nail.
- It generally occurs after traumatic injury to the distal phalanx of the finger.
- The color of the nail can vary: initially red-purple and later to dark brown-black.
- It is associated with pain and/or sensitivity to touch. As blood pools under the nail, the blood pressure can cause intense pain and eventually the nail can come loose.
- The pain usually disappears days after the trauma, maintaining the appearance of the injury.
Differential diagnosis
- Melanocytic nevus
- Melanonychia
- Subungual melanoma
Treatment
- Treatment is usually minimal and consists of rest, ice, elevation and compression of the finger.
- The hematoma will eventually be reabsorbed and a new nail will grow (on average, the nail takes 6 to 9 months to grow back completely)
- [!] Changes in nail growth or even lack of growth may occur if damage has occurred to the nail matrix.
- There may be indications for performing nail trepanation:
- if the subungual hemorrhage is very painful and if the trauma occurred < 48 hours ago.
- Hematoma drainage can be performed with a heated 23 g needle, aseptically making a small hole in the central part of the hematoma (with the needle oriented at 45º or 60º).
- it is not necessary to apply anesthesia. The intense pain related to the compression of the hematoma will disappear immediately after the blood drains.
- if the subungual hemorrhage is very painful and if the trauma occurred < 48 hours ago.
- Consider taking an x-ray if you suspect a phalanx fracture.
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