From the Guidelines
For a subungual hematoma, especially when painful or associated with a pressure hematoma or subungual abscess, partial or total nail avulsion is required to relieve pressure and prevent infection, as recommended by the most recent guidelines 1. When managing a subungual hematoma, it's crucial to assess the severity and impact on the patient's activities of daily living. The condition can result from trauma, leading to blood accumulation between the nail plate and nail bed, causing pressure and pain.
Key Considerations
- For small, minimally painful hematomas, conservative treatment with ice, elevation, and over-the-counter pain medications may suffice.
- Larger or more painful hematomas require prompt intervention, such as nail trephination (drainage) within the first 48 hours to release trapped blood and relieve pressure.
- After drainage or avulsion, keeping the area clean and covered with an antibiotic ointment and bandage for 2-3 days is essential to prevent infection.
- Signs of infection, such as increasing pain, redness, warmth, swelling, or a severe nail bed injury, necessitate immediate medical attention.
Management Approach
According to the ESMO clinical practice guidelines for the prevention and management of dermatological toxicities related to anticancer agents 1, the management of onycholysis, which can be associated with subungual hematoma, depends on the clinical grading and impact on activities of daily living.
- For Grade 2 or worse reactions, including painful hematoma or subungual abscess, partial or total nail avulsion may be necessary, along with appropriate antibiotic treatment if an infection is suspected 1.
- The therapeutic management of onycholysis emphasizes the importance of promoting nail reattachment as early as possible to prevent permanent onycholysis and associated complications like nail bed keratinization and subungual hyperkeratosis 1.
Conclusion Approach Not Applicable
Instead, focusing on the key aspects of subungual hematoma management:
- Regular follow-up is crucial to monitor the healing process and address any complications promptly.
- Patient education on preventive measures, such as avoiding further trauma to the nail and keeping the nail area clean, is vital for optimal recovery. By prioritizing these aspects, healthcare providers can effectively manage subungual hematomas, minimizing morbidity, mortality, and impact on quality of life, as supported by the latest clinical guidelines 1.
From the Research
Definition and Causes of Subungal Hematoma
- A subungual hematoma is a collection of blood beneath a finger or toe nail, often caused by a crush injury, such as shutting a finger in a door or other types of trauma 2.
- Repetitive trauma in athletes, such as runners and dancers, can also cause subungual hematomas 2.
Management and Treatment
- The management of subungual hematoma includes the trephination procedure, which involves draining the hematoma to relieve pain 3.
- There is no consensus regarding the optimal mode of managing the acute traumatic subungual haematoma in the hand, but decompression, whether by trephining or nail removal, is recommended for acutely painful subungual hematomas 4.
- The complication rates of all forms of treatment are low, and the outcome in terms of nail cosmesis is generally good 4.
Potential Complications
- Potential complications of subungual hematoma, although rare, can occur and are reviewed in the literature 3.
- The use of topical hemostatic agents may be considered to facilitate hemostasis and prevent further bleeding 5.
- Topical antibacterial agents may also be used to prevent infection and promote wound healing 6.