Injury to Toenail: Treatment Options for Bruising and Infection - Dermatology

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Injuries to the toenail, particularly those resulting from trauma such as being crushed, can lead to various complications, including bruising (subungual hematoma) and potential infection. Based on your description, it sounds like you have sustained a significant injury to your toenail, which is characterized by discoloration and the presence of a wound beneath the nail. Here’s a comprehensive overview of treatment options and considerations for your situation.


Initial Assessment
First and foremost, it’s essential to assess the extent of the injury. The presence of a bruise (purple discoloration) indicates bleeding beneath the nail, while the red color suggests inflammation or possible infection. The horizontal groove across the nail may be a sign of trauma to the nail matrix, which can affect future nail growth.


Treatment Options
1. Observation: If the injury is not causing severe pain and there are no signs of infection (such as increased redness, swelling, warmth, or pus), you may choose to monitor the injury. Bruising under the nail often resolves on its own as the blood is reabsorbed.

2. Pain Management: Over-the-counter pain relievers such as acetaminophen or ibuprofen can help manage discomfort. However, be cautious with ibuprofen if you have a history of gastrointestinal issues, as it can irritate the stomach lining.

3. Drainage of Hematoma: If the bruising is extensive and causing significant pain, it may be necessary to relieve the pressure by draining the hematoma. This procedure involves making a small hole in the nail to allow the trapped blood to escape. It can often be done in a clinical setting by a healthcare professional.

4. Nail Care: Keep the affected area clean and dry. If there is an open wound, apply a sterile bandage to protect it from infection. Avoid exposing the area to excessive moisture, which can promote bacterial growth.

5. Antibiotics: If you notice signs of infection, such as pus or increasing redness, you may require topical or oral antibiotics. It’s crucial to consult a healthcare provider for an appropriate prescription.

6. Nail Removal: In some cases, if the nail is severely damaged or if there is significant pain and pressure, partial or complete nail removal may be necessary. This is typically a last resort and should be performed by a healthcare professional.


When to Seek Medical Attention
You should seek medical attention if:
- The pain becomes severe or unbearable.

- You notice signs of infection (increased redness, swelling, warmth, or pus).

- The nail appears to be lifting or separating from the nail bed.

- You have difficulty walking or putting weight on the toe.


Conclusion
In summary, the treatment for your toenail injury will depend on the severity of the symptoms and the presence of any complications. While minor injuries may heal with conservative management, more significant injuries may require intervention such as drainage or nail removal. Always consult with a healthcare professional for a thorough evaluation and tailored treatment plan. Taking prompt action can help prevent complications and ensure proper healing of your toenail.