[21F] With dark brown stripe on toe and black discoloration on thumb

Patient Description

A 21-year-old female has been experiencing a dark brown stripe on her toe and black discoloration on one side of her thumb for about a year. The discoloration does not cause pain, and no treatments have been effective in reducing or improving it. There have been no changes in the size, shape, or color of the discoloration over time. The patient has not noticed any changes in the thickness or shape of her nails, nor has she experienced any trauma, redness, swelling, or sores around the affected areas. She is unaware of any family history of skin cancer or other types of cancer and has not been diagnosed with any skin conditions or other medical conditions in the past. The patient has not been exposed to any chemicals, dyes, or other substances that might have caused the discoloration. She is taking her medications, Fluoxetine (25 mg every morning) and Mucinex (600 mg as needed), as prescribed.

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Arora's Assessment

What might be happening

Based on the information you provided, here are some possible explanations for the dark brown stripe on your toe and the black discoloration on your thumb:

  1. Subungual Melanoma:

    • This is a type of skin cancer that occurs under the nails. It can present as a dark stripe or discoloration on the nail. Although it is rare, it is important to rule out this serious condition.
    • Typical treatments include surgical removal of the affected area and possibly additional treatments if the cancer has spread.

  2. Fungal Infection:

    • Fungal infections can sometimes cause discoloration of the nails, although they are usually accompanied by other symptoms like thickening or crumbling of the nail.
    • Treatment typically involves antifungal medications, either topical or oral.

  3. Nail Trauma:

    • Even if you don't recall any specific injury, minor trauma to the nail can sometimes cause discoloration that persists for a long time.
    • Treatment usually involves protecting the nail and allowing it to grow out naturally.

  4. Benign Pigmentation:

    • Sometimes, benign conditions like melanonychia (pigmentation of the nail) can cause dark stripes or discoloration. This is more common in people with darker skin tones.
    • No treatment is usually necessary, but monitoring for changes is important.

What you can do

Dark Brown Stripe on Toe and Black Discoloration on Thumb:

  1. See a Dermatologist:

    • Given the duration and nature of your symptoms, it is important to consult a dermatologist to rule out serious conditions like subungual melanoma. They may perform a biopsy or other diagnostic tests.

  2. Monitor for Changes:

    • Keep an eye on the discoloration for any changes in size, shape, or color. Document these changes using the MDandMe journal to track your symptoms and share this information with your healthcare provider.

  3. Protect Your Nails:

    • Avoid any potential trauma to the affected nails. Wear protective footwear and gloves if necessary.

  4. Maintain Nail Hygiene:

    • Keep your nails clean and dry to prevent any potential infections. Avoid using harsh chemicals or nail products that could irritate the area.

What you should look out for

Given the potential seriousness of your symptoms, you should seek medical care as soon as possible. Reasons to seek care even more urgently include:

  • Rapid changes in the size, shape, or color of the discoloration
  • Development of pain, redness, swelling, or sores around the affected nails
  • Any new symptoms such as bleeding or discharge from the nails

Remember, while I can provide information and suggestions, it is crucial to consult a healthcare professional for a formal diagnosis and appropriate treatment. If you have more questions or need further assistance, feel free to continue the conversation.

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4 mo ago

People Also Ask

What is subungual melanoma and how is it diagnosed?

Subungual melanoma is a rare type of skin cancer that occurs under the nails, presenting as a dark stripe or discoloration. It is diagnosed through a clinical examination by a dermatologist, often followed by a biopsy to confirm the presence of cancer cells.

Can a fungal infection cause nail discoloration without other symptoms?

Yes, a fungal infection can sometimes cause nail discoloration without other symptoms like thickening or crumbling, although these are more common. A healthcare provider can perform tests to confirm a fungal infection.

How can I differentiate between nail trauma and other causes of discoloration?

Nail trauma can cause discoloration that persists, even if the injury was minor or unnoticed. Unlike other causes, trauma-related discoloration often resolves as the nail grows out. A healthcare provider can help differentiate between trauma and other conditions through examination and history.

What is melanonychia and is it a cause for concern?

Melanonychia is a benign condition characterized by pigmentation of the nail, often appearing as a dark stripe. It is more common in people with darker skin tones and is usually not a cause for concern unless there are changes in the stripe's appearance, which should be evaluated by a healthcare provider.

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