Causes and risk factors
Trauma is the most common cause of nail discoloration. When something is dropped on the nails with great pressure, bleeding can occur under the nails or blood clots can be formed leading to discoloration. Ill-fitting or tight shoes is another contributing factor seen. Certain other causes can also lead to toenail discoloration; these are chronic ingrown nails or fungal infection. Athletes are more prone for this condition. Melanoma is another underlying cause.
Clinical presentation:
Either the entire nail or part of the nail can be involved. Black or brownish or bluish discoloration of the toenails is the characteristic feature seen. Pain in the affected area is complained by the patient. Redness of the surrounding skin and swelling is also seen. Nails can become loose and fall off. Pain is aggravated by pressure. Certain discharges or foul odor can be other associated complaints seen. Apart from the above complaints, the cosmetic appearance is also hampered.
Investigations:
Diagnosis is done on the basis of the symptoms narrated by the patient along with clinical examination carried out by the doctor. Biopsy of the nails is diagnostic. Along with this, certain other investigations like routine blood test and other specialized blood tests can also be advised.
Treatment:
In cases where the discoloration has occurred due to minor trauma, no medical intervention is needed. The nails will eventually fall off. Medications like pain relieving medicines or antibiotic ointment can be advised. In cases if secondary infection supervenes, antibiotics orally are advised. In cases of hematoma, draining of the fluid is needed. Cauterization is an effective treatment used.
Complications:
Secondary infection is a common complication seen.
Prevention:
Wear well-fitting shoes and keep the toenails short. It should be timely trimmed. One must keep the foot and nails dry and clean.
System involved: Integumentary system.
Organ involved: Skin, tissues, nails.
