Treatment for Blood Under Your Nail

nail injury
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Your fingers and toes serve as the first contact with the world. Thus, your fingernails and toenails are especially prone to injury whether it be a stubbed toe or power-tool injury.

Sometimes such injury results in a bleed under the nail, a condition called subungual hematoma. These bleeds can result in darkened discoloration (i.e., black nail), pressure and pain.﻿﻿

In addition to being painful, nail discoloration can also be unsightly, which is another reason why many people seek medical help for this condition.

If you experience a bleed under your nail, your doctor or urgent care physician can drain the excess fluid to and relieve the pressure. The procedure, called a nail trephination, is useful when performed within the first 48 hours.

Subungual Hematoma Explained

With subungual hematoma, injury to the nail results in bleeding (hematoma) at the level of the nail bed (under the nail plate) or nail matrix.

Of note, the nail matrix is a rapidly dividing layer of cells at the base of the nail lying toward the cuticle. Rapidly dividing cells of the nail matrix fill with keratin and thus become a hardened nail.

More extensive damage to the nail can not only result in bleeding under the nail (i.e., simple subungual hematoma) but also more extensive damage to the nail fold or digit itself.

If left untreated, a simple subungual hematoma typically grows out with the lengthening nail plate and resolves on its own, although sometimes subungual hematomas can result in your nail falling off (i.e., onycholysis).

Until the nail grows out, however, you can expect weeks to months of blue-black discoloration. Interestingly, fingernails grow faster than toenails so it takes longer for your toenails to grow out. 

In addition to discoloration, blood under the nail can result in pressure and pain, which can be relieved by a primary care physician or podiatrist (i.e., "foot doctor"). Delayed treatment can result in nail deformity or infection.

Finally, with pain and severe injury secondary to subungual hematoma, you should also see a health care provider because there may be a toe or finger fracture. 

What Else Could It Be?

Based on the history and physical exam, most cases of subungual hematoma can be readily diagnosed (and treated) by your health care provider. When a fracture is expected, an x-ray is needed.

Rarely, what appears to be a subungual hematoma can be something else such as:﻿﻿

  • Nail bed nevus (a mole or birthmark that grows slowly or not at all)
  • Splinter hemorrhage (indicative of psoriasis or endocarditis)
  • Longitudinal melanonychia (pigmented bands)
  • Melanoma

All these listed conditions are painless, and, unlike subungual hematomas, these lesions don't change or change slowly.

Some differential diagnoses are serious, like endocarditis (i.e., heart infection) or melanoma (i.e, skin cancer), so it's a good idea to have your nails checked out by your physician if you can't pinpoint the cause.


It takes about 48 hours for blood at the level of the nail bed to clot. During this time, this blood can be drained by a physician, a process called nail trephination. If you wait to have the blood drained, nail trephination may not be able to be performed.

Nail trephination uses hot metal wire, electrocautery device, or spinning, large-bore needle to pierce the nail bed. The hole created by piercing should be large enough to let the blood drain which takes about a day or two. During this time, the hole through which the blood oozes should be covered with sterile gauze.﻿﻿ 

After nail trephination, you won't need antibiotics although a pain reliever like ibuprofen may help with residual pain. Your physician will advise you on effective pain relief.

After trephination, make sure to follow all your physician's instructions (including instructions to soak the affected area and apply clean dressing) and follow up with your physician as prescribed. 

If the affected area reaccumulates blood or appears infected, contact your physician.

Fortunately, the nail bed lacks innervation so nail trephination doesn't hurt.

When the hematoma covers more than half the nail, your physician may choose to remove the nail completely. Moreover, if the nail injury is deep, the nail may also be removed, Before removing the nail, your physician will perform a digital block in order to anesthetize the area.﻿﻿

Finally, keep in mind that it can take several months for a nail to grow back.

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Article Sources

  1. American Osteopathic College of Dermatology. Subungual hematoma.

  2. Haenssle HA, Blum A, Hofmann-Wellenhof R, et al. When all you have is a dermatoscope- start looking at the nailsDermatol Pract Concept. 2014;4(4):11–20. Published 2014 Oct 31. doi:10.5826/dpc.0404a02

  3. Bonisteel PS. Practice tips. Trephining subungual hematomasCan Fam Physician. 2008;54(5):693.

  4. Dean B, Becker G, Little C. The management of the acute traumatic subungual haematoma: a systematic review. Hand Surg. 2012;17(1):151-4. doi:10.1142/S021881041230001X