Finger Nail Blood Spots: When to Seek Medical Advice

Subungual hematoma

Hello Doctor, after taking a shower, I noticed a small black dot at the tip of my left index finger nail.
I previously read that skin lesions could also present this way, although they usually appear as a line.
However, when I examined the area just in front of the nail, it seemed like dried blood or dirt, as it disappeared when I cleaned it.
I'm a bit confused about how there could be dried blood inside if it was indeed a scab.
Since the spot is small, I'm unsure if it might just be dirt.
I also trimmed a bit of the nail, which caused a small cut that bled slightly, and I applied iodine and fusidic acid to the wound.
I'm not sure if this is appropriate, but I had previously seen a dermatologist for a minor paronychia during the Mid-Autumn Festival in Taiwan, and the doctor prescribed this for me to prevent infection.

Do you think these symptoms are not consistent with what I read, or should I really see an internal medicine or dermatology specialist? I study on an outlying island, and while there is a hospital here, I'm uncertain if I should return to the main island for treatment, especially since the spot seems to have disappeared after cleaning.
I'm really worried but don't know what to do.
Please help me, thank you.

Xiao Huang, 20~29 year old female. Ask Date: 2020/10/23

Dr. Hong Yuanbin reply Internal Medicine

Hello, since I cannot assess the actual situation in detail, I can only speculate based on your description.
It does seem likely that it could be scabbing or dirt, which are quite common on the fingers.
If it has already fallen off, there is no need to worry.
The iodine tincture and fusidic acid you mentioned both have antibacterial effects, and if there is a wound, you can use them initially.
Given the current situation, there is no need for a medical visit unless you experience fever or redness, swelling, heat, or pain in the hand later on.
Thank you for your question.

Reply Date: 2020/10/23

More Info

When it comes to understanding blood spots under the fingernails, especially in the context of potential underlying health issues, it is essential to approach the situation with caution and awareness. The appearance of a small black dot at the tip of your left index finger's nail could be indicative of several things, including a bruise, a blood spot, or even a sign of a more serious condition.
Firstly, it's important to note that blood spots under the nails can occur due to trauma, even if you do not recall any specific injury. The nail bed is rich in blood vessels, and minor trauma can lead to bleeding beneath the nail, resulting in a dark spot. This is often harmless and may resolve on its own as the nail grows out. However, if the spot is accompanied by pain, swelling, or changes in the nail's appearance, it may warrant further investigation.

In your case, since you mentioned that you noticed the spot after showering and that it seemed to disappear when you cleaned it, it could very well be a combination of dried blood and dirt. The fact that you also trimmed your nail and experienced slight bleeding could suggest that the area was sensitive or already compromised, possibly from the previous paronychia (nail fold infection) you experienced. Using iodine and fusidic acid is generally appropriate for cleaning minor wounds and preventing infection, especially if these were recommended by your dermatologist during your last visit.

However, there are a few considerations to keep in mind. If the black spot reappears, grows larger, or if you experience persistent pain, swelling, or any signs of infection (such as increased redness, warmth, or pus), it would be prudent to seek medical attention. While it may be inconvenient to travel back to the main island for care, prioritizing your health is essential. If you have access to a local healthcare provider, they may be able to assess the situation and provide guidance without necessitating a trip.

Additionally, if you notice any changes in the nail itself, such as discoloration, distortion, or separation from the nail bed, these could be signs of a more serious condition, such as a fungal infection or even a potential malignancy, although the latter is much less common.
In summary, while the symptoms you describe may not immediately suggest a severe issue, it is crucial to monitor the situation closely. If the black spot persists or worsens, or if you have any concerns about your overall health, do not hesitate to seek medical advice. Your well-being is paramount, and healthcare professionals are equipped to provide the necessary evaluations and treatments.

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