A young woman presented to Primary Care clinic with bilateral hematomas under the nails of her great toes. The woman reported wearing high-heeled shoes for an extended period of time on the night prior to her visit, which may have been responsible for the trauma to her nails. Subungual hematomas are a common complaint in general dermatology, and are typically caused by crushing or traumatic injury. Following injury, blood and fluid accumulates under the nail, causing pain from the pressure buildup, and sometimes leading to separation of the nail plate from the nail bed. Pressure may be relieved by trephination, which involves using a paperclip or small needle to puncture the nail plate. The nail bed should return to its normal color as the nail grows out. If the discoloration from the hematoma does not migrate as the nail grows out, subungual melanoma should be ruled out.
KeywordsTrauma Traumatic injury Nail bed Bruise Hematoma Subungual Trephination
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