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Nail Bruising: A Simple Injury or a Health Warning?

Nail Bruising on toe

Bruising under the nails, often referred to as nail bruising, is surprisingly common. It can occur from strong impacts like hitting a nail with a hammer or stubbing a toe against a door frame, as well as from wearing slightly tight shoes while running. This phenomenon, known as ‘subungual hematoma‘, requires attention as it can deform the nail if the bruise doesn’t heal over time.

1. Nail Structure and Nail Bruising Formation

Nails are composed of parallel keratin fibers. They function to protect fingers and toes from physical stress, such as running, kicking, or gripping objects, thus preventing damage and deformation. However, internal bleeding caused by these activities can lead to nail bruising, as blood is difficult to expel naturally. This trapped blood is what appears as a bruise.

2. Home Treatment

If the bruise is small and painless, a hospital visit isn’t necessary. The hematoma naturally absorbs over time. Typically, nail bruising fades within 1-2 weeks, transitioning from red to blue, purple, and black. Any remaining marks gradually disappear as the nail grows. To reduce bruising, apply a cold compress immediately after the injury to minimize bleeding, followed by warm compresses.

3. Serious Cases and the Need for Professional Treatment

However, if the bruise covers the entire nail and persists with pain, consider visiting an orthopedic clinic. Long-lasting hematomas can cause the new nail to grow lifted or deformed, and in the worst cases, the nail may fall off. Pooled blood can also increase the risk of bacterial infection. Clinics can use X-rays to check for fractures and may employ lasers or injections to create a hole in the nail to drain the hematoma.

4. Health Concerns When Nail Bruising Persists

If a bruise persists for over two weeks without an apparent reason, it may indicate other health issues, such as vasculitis or melanoma. Vasculitis, an inflammation of the blood vessel walls caused by an immune system anomaly, can appear as red or purple bruises. Melanoma, a type of skin cancer where melanin cells become cancerous, may present as black vertical lines and can spread to the entire nail. While early stages may be symptomless, cancer cells can metastasize through the blood to lymph nodes or other body parts, necessitating caution.

5. Summary

Nail bruising, or subungual hematoma, is usually caused by physical stress on the nails. Minor cases heal naturally, but persistent or painful bruises may indicate serious health concerns and require medical attention.