Subungual Haemorrhage
Author: Hagar Elgezeri
Chief Editor: Dr Daniel Keith
Subungual hemorrhage describes the collection of blood under the nail located between the nail matrix and plate usually following a recalled trauma or a non-recalled micro trauma. The patient may not always recall the trauma or injury especially in the foot affecting the toenails.
Macroscopic Appearance
A subungual hemorrhage may present as single discoloured lesion that is painful and tender. The discolouration could appear reddish, purple or brown, or a combination of these colours.
Sometimes following trauma, the nail may appear opaque due to detachment of the nail from the nail bed.
The hemorrhage may touch the proximal fold of the nail, but as the nail plate grows, a clear margin should appear separating the hemorrhage from the proximal fold.
Macroscopic example on a thumb nail
Macroscopic example on the second toe nail
Dermoscopic Appearance
The dermoscopic features may include:
-
Homogeneous pattern or varied colour pattern
-
Usually well-circumscribed edge
-
Peripheral globular patterns (CLODS)
-
Peripheral fading of the lesion
-
Streak patterns
-
Linear white marks on the nail plate may appear due to loss of transparency
Illustration courtesy of Dr Lizzy Wasson
Annotated example of two of the dermoscopic features you may see:
-
Peripheral fading
-
Peripheral globular pattern/CLODS
You may also appreciate the varied colour pattern present (mixture of red, as well as shades of brown) as well as the well circumscribed edge
Unannotated example of the same lesion for comparison
There are multiple features present in this second annotated example:
-
Varied colour pattern
-
Peripheral globular pattern/CLODS
-
Linear white marks
-
Peripheral fading
-
Well circumscribed edge
Compare to the image below which shows the same lesion without annotations.
Unannotated example of the same lesion as above for comparison.