[18M] With sudden black discoloration on toe after popping green lesion

Patient Description

An 18-year-old male reports sudden onset of a green discoloration and swelling on his toe, which he popped, releasing blood and pus. Within one day, the area turned black. The patient denies any pain, fever, chills, spreading redness, increased swelling, or drainage since popping the lesion. He does not recall any recent injuries or trauma to the toe and has no significant past medical history, recent changes in health, or use of substances such as tobacco, alcohol, or recreational drugs. No recent travel history reported.

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Arora's Assessment

What might be happening

Based on the information you have provided, here are some possible explanations for the black spot on your toenail:

  • Subungual Hematoma: This is a collection of blood under the toenail, often caused by trauma or injury. Even if you don't recall an injury, minor trauma can sometimes go unnoticed. The black color is due to the blood trapped under the nail.

    • Treatment: Typically, subungual hematomas resolve on their own. If the pain is severe or the hematoma is large, a healthcare provider might need to drain the blood.

  • Infection: Given that you mentioned the spot was initially green and pus was present, an infection could be a possibility. The black color might indicate necrosis (dead tissue) or dried blood.

    • Treatment: Infections often require antibiotics, either topical or oral, depending on the severity. It's important to keep the area clean and monitor for signs of spreading infection.

  • Fungal Infection: Sometimes fungal infections can cause discoloration of the toenail, although they typically present as yellow or white rather than black.

    • Treatment: Antifungal treatments, either topical or oral, are usually prescribed for fungal infections.

What you can do

  1. Keep the Area Clean: Wash your toe gently with soap and water, and keep it dry.
  2. Monitor for Changes: Keep an eye on the discoloration and any other symptoms such as increased redness, swelling, or pain.
  3. Avoid Popping Blisters: If you notice any new blisters or fluid-filled areas, avoid popping them to reduce the risk of infection.
  4. Over-the-Counter Pain Relief: If you experience any discomfort, over-the-counter pain relievers like acetaminophen or ibuprofen can help.
  5. Use MDandMe: You can use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.

What you should look out for

Seek medical attention if you notice any of the following:

  • Increased Pain or Swelling: If the pain or swelling worsens, it could indicate an infection or other complication.
  • Spreading Redness: Redness spreading from the toe could be a sign of a more serious infection.
  • Fever or Chills: These could indicate a systemic infection that requires prompt medical attention.
  • Persistent or Worsening Symptoms: If the black spot does not improve or continues to worsen, it's important to see a healthcare provider for further evaluation.

Remember, while this advice can help you understand what might be happening, it's important to consult a healthcare professional for a formal diagnosis and appropriate treatment.

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4 mo ago

People Also Ask

What causes a subungual hematoma and how is it treated?

A subungual hematoma is caused by trauma or injury to the nail, leading to blood collecting under the nail. Treatment often involves monitoring as it can resolve on its own, but severe cases may require a healthcare provider to drain the blood.

How can I tell if a toe infection is serious and what should I do about it?

A serious toe infection may present with increased pain, swelling, spreading redness, or systemic symptoms like fever and chills. It's important to keep the area clean and seek medical attention if these symptoms occur.

What are the signs of a fungal infection in the toenail?

Signs of a fungal infection in the toenail include discoloration (often yellow or white), thickening of the nail, and possible crumbling at the edges. Antifungal treatments are typically used to treat these infections.

When should I seek medical attention for a discolored toenail?

You should seek medical attention for a discolored toenail if you experience increased pain, swelling, spreading redness, fever, chills, or if the discoloration persists or worsens over time.

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