Nail hematoma - Altmeyers Encyclopedia

Synonym(s)

Hematoma under the nails; Nail bed bleeding; Nail bleeding; Subungual hematoma

Definition
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Subungual bleeding of varying severity. The term "nail haematoma" is incorrect from an etiopathological point of view, as it is not a bleeding into the nail plate, but a subungual bleeding of different age under the nail plate. Nail hematomas have a differential diagnostic significance, as they must be clearly distinguished from subungual malignant melanoma.

Etiopathogenesis
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Traumatic condition.

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Clinical features
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Strong, mostly irregularly configured, mostly sharp-edged, red-brown, blue or even blue-black subungual spot. Even if the hematoma is more proximally located, it loses contact with the proximal nail wall due to outgrowth of the nail distally. Recurrent haematomas, e.g. in athletes or craftsmen, can simulate a longitudinal stripe, which is, however, more irregularly limited overall than in melanocytic tumours.

Differential diagnosis
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Melanoma, malignes, subunguales: In a circumscribed subungual malignant melanoma, melanin is always (most important differential diagnostic sign) released to the nail plate. This leads to localized longitudinal nail pigmentation distal to the lesion (see Melanonychia striata longitudinalis below).
Naevus, melanocytic, subungual: Identical clinical sign of Melanonychia striata longitudinalis.
Glomus tumor: Appears subungual (frequent localization) as circumscribed, very unpleasantly painful, rather discrete blue to blue-grey discolorations.
Other types of nail dyschromas (DD see there).

General therapy
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Harmless findings, no specific therapy required. In case of severe involvement of the proximal finger or toe phalanx (contusion), radiological exclusion of fractures is recommended.

Note(s)
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To confirm a clinical suspicion of nail hematoma, pigmented material can be obtained from the free edge of the nail or, after trepanation of the nail plate (e.g. punch biopsy of the nail plate), also from the underside of the nail for examination. Nail hematomas have hardly any oxygen contact, are not converted into hemosiderin and are therefore negative in iron staining. With the help of the peroxidase reaction a histochemical proof can be made.