What is it? A subungual hematoma is a collection of blood that forms under a fingernail or a toenail. Damage occurs to the nail and the skin beneath the nail, and the lacerated skin begins bleeding. The blood pools under the nail and can cause severe pain and intense pressure.

How do you get it? Subungual hematomas are caused by injury to the nail. Most commonly this happens in two ways: either through blunt trauma or through repetitive pressure. Examples of blunt trauma would include hitting the finger with a hammer, slamming a finger in the car door, or dropping a heavy object on the toe. Repetitive pressure is often the result of regular activities, such as running, hiking, tennis, or soccer. Most often, the hematoma caused by the repetitive pounding of these activities can be attributed to shoes being too small rather than to any dangers of the sport.

How is it treated? If the hematoma is small and the nail isn’t in danger of falling off, no treatment may be required. In more serious cases, however, as the blood pools under the nail, the finger becomes warm and pressure builds. Often the nail will need to be punctured by a doctor to drain the blood. The basic procedure is simple. The nail is submerged in ice water to numb the area. Once dried, the area is sanitized. To create a way for the blood to drain, a needle is heated to red hot and then used to puncture the nail with steady pressure. This is done very carefully to avoid breaking through the nail and touching the already damaged skin below. As soon as the nail is punctured, blood is released and the pressure subsides. The hole provides a doorway that allows bacteria to get under the nail, so it’s important to keep the nail dry and clean. As a new nail grows in, the damaged nail will grow out.

What can a tech do? If you feel heat when you touch a client’s finger, or if the client complains of pain, refer her to a doctor. Assuming the client arrives with a subungual hematoma that is no longer causing her pain, the first thing a tech should do is shorten the nail and remove any product. Even as the nail is growing out, don’t cover the area with product because with the subungual hematoma, the nail has actually pulled away from the nail bed. Applying product over this could trap bacteria between the nail plate and the nail bed, especially if the nail has been punctured to drain the blood.

What else? There are times when an injury causes damage to the matrix and the new nail that grows in will have ridges or waves. If the matrix isn’t damaged, the nail will grow in just as it was before the injury. This could take anywhere from six to 18 months. As soon as the skin of the nail bed heals and new nail growth reaches the free edge, it’s safe to apply enhancement product.


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