Blackened toenails or Melanonychia is a change in the color of the nail to dark brown or black. It may be diffuse or have the shape of a longitudinal stripe.
This problem is quite common; almost every person has encountered it.
Darkening can be the result of a minor injury, but often black spots on the nails are harbingers of dangerous internal diseases. Darkening of the nail plate is not always painful. The problem may not cause physical inconvenience to its owner.
Benign longitudinal melanonychia can occur in patients of all ages, including children, and affects both sexes equally. Darkening of the nails most often occurs in people with dark skin, especially in people with Fitzpatrick skin types V and VI.
Blackening of the nail beds may be due to genetic disorders, injury, medications, nutritional deficiencies, endocrine disease, connective tissue disease, inflammatory skin disease, tumor or fungal infection of the nails.
Causes of the disease
While other types of melanoma are often associated with excessive sun exposure, here the situation is radically different. Most often, this type of oncology develops on the toes, which are constantly protected from sunlight. Therefore, the causes of subungual melanoma do not include insolation, they look like this:
- mechanical injuries of the nail. This includes surgical and cosmetic intervention options in which the nail plate is damaged;
- physical injuries: burns, frostbite, etc.;
- chemical injuries. Usually we are talking about long-term exposure to aggressive chemicals, for example, in production;
- heredity. Up to 14% of all patients diagnosed with nail melanoma have mutations in certain genes4
- existing benign neoplasms, for example, dysplastic nevi, which are prone to transformation into malignant ones.
Most often, this disease occurs in people over 60 years of age. And there is another interesting fact: obviously, it depends on the race, because representatives of the Negroid, as well as Mongoloid races, suffer from the disease much more often - 40% more often than Caucasians. Among the latter, people at risk are fair-skinned, red-haired people, as well as people with a lot of freckles.
Types and symptoms
The classification of nail melanoma provides for two variants of the course of the disease: horizontal and vertical stages. Symptoms of the disease will depend on what type we are talking about.
In the horizontal stage, the patient observes a brown or black stripe on the nail (under the plate). The strip is not necessarily uniform; it can expand, capture more of the free nail edge, and transfer to the skin.
During the vertical stage, the tumor begins to grow into the surrounding tissues, deformation of the nail occurs, and it becomes fragile. As the tumor grows, the nail cracks, the surface becomes covered with bumps, and at the slightest mechanical impact it begins to bleed. The pigment in this case can also be either brown or black.
It is important to understand that nail melanoma can be non-pigmented until a serious stage. For this reason, until the tumor begins to spread vertically, it may not be noticed. This is typical for approximately 30% of cases.
Not always, but the disease can also manifest itself with the following symptoms:
- burning, itching in the area of the tumor;
- feeling of fullness;
- pain that increases as the tumor develops;
- decreased functionality of the limb.
Common symptoms on the toenail or fingernail include fever, weakness, and severe weight loss. With the development of metastases, local symptoms are added - those that are characteristic of diseases of the affected organs.
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Why does my toenail turn black and come away from my finger?
If you have a finger ear injury, it is quite possible to expect hemorrhage due to rupture of blood vessels. This blood enters the soft tissue, where it coagulates and forms a dark spot. Often the bruise is so severe that it provokes the appearance of a tumor.
This tumor bursts the nail plate and causes it to rise, while “giving” the person very unpleasant painful sensations. The finger tries to tear off the affected nail, which by this time may become rough and flake. It should not be pulled out under any circumstances.
The nail that grows over time should be carefully cut off with nail scissors, avoiding pain. Over time, the damaged nail will be replaced by a whole new layer and the finger will recover; this is a completely natural process.
nail plate rejection
Stages of the disease
The classification of nail melanoma involves (like any other cancer) several stages:
- zero (in situ). At this stage, non-invasive damage by malignant cells is detected;
- first. The thickness of the formation is either up to 1 millimeter or up to 2, but without ulceration;
- second. It is placed if the thickness of the tumor is no more than 2 millimeters or no more than 4, but without ulceration;
- third. It is placed regardless of the size of the melanoma itself, provided that metastases are detected in the regional lymph nodes;
- fourth. Suggests the presence of metastases in internal organs.
Obviously, the lower the stage, the higher the patient’s chances of effective treatment and longer life expectancy.
Preventive actions
It has long been known that the best treatment is prevention. You need to follow the rules to help you avoid problems in the future. By spending time on procedures, in the future you will save money required for medications for treatment, and your nails will be healthy.
Rules to follow:
- Use rubber shoes when visiting public places with high humidity.
- Regular cleaning using disinfectants. Pay close attention to rugs in the bathroom and grates in the shower.
- Personal shoes should be worn.
- Full compliance with personal hygiene.
There are a lot of reasons that influence the color change; this phenomenon should not be ignored. If the color of the nail is not restored, or is accompanied by unpleasant sensations, consult a doctor.
Self-medication leads to disastrous consequences. Of course, they also use folk recipes, agreed upon with the attending physician. The doctor will assess the rationality of use for a particular case. Some traditional medicines can cause serious allergic reactions.
Diagnostics
Diagnosing melanoma under the nail is not so easy, because it is often similar to other diseases or problems, for example, subungual hematomas. To exclude simpler situations and make an accurate diagnosis, doctors use dermatoscopy (examination of tissue under high magnification), as well as epiluminescence microscopy. The latter method involves examining changed areas of tissue in a special environment. Thanks to it, it is possible to distinguish a benign disease from a malignant one.
Cytological studies are carried out, but a biopsy in this case is undesirable, since it can provoke the development of metastases. Additional tissue examination is carried out after surgery, when the tissues are removed.
If nail melanoma is not excluded after examination, marginal resection of the nail is performed followed by tissue examination. When the diagnosis is confirmed, the patient is indicated for radical surgery.
Additionally, the following research methods are used:
- Ultrasound;
- CT;
- MRI.
They are needed to verify the presence or absence of metastases.
Infections
Infections include fungus and plate damage with Pseudomonas aeruginosa in the form of black spots.
With a fungal infection or onychomycosis, the affected areas become yellow or yellow-brown. But in advanced cases, the fungus under the nail can be black. In addition to changes in color, onychomycosis is characterized by thickening, crumbling, deformation of the plate, and an unpleasant odor. Fungal infections are more common on the toes. Antifungal ointments, creams, varnishes, and tablets are used to treat onychomycosis. The doctor selects the regimen taking into account the severity of the condition.
Unlike nail fungus, which is not life-threatening, bacterial infections require immediate treatment. They are fraught with the pathogen entering the bloodstream and the development of sepsis. Pseudomonas aeruginosa is characterized by black-green coloration of nails. More often the infection affects the fingers. Sometimes a black nail caused by a bacterial infection is found under gel polish or other coating if the extension was done without following the rules of antiseptic treatment.
How the treatment works, methods
The main treatments for melanoma under the nail include:
- resection at the level of the middle phalanx of the finger. The formation is removed in such a way as to preserve the patient’s quality of life as much as possible;
- radiation therapy. It is carried out to exclude tumor recurrence in the area of surgical scars, as well as to influence the primary lymph nodes to prevent the development of metastases;
- chemotherapy. Depending on the situation, it can be used before surgery and after surgery. There are different program options that are selected individually;
- immunotherapy. The use of certain drugs prolongs the period without recurrence and increases the overall survival of patients with this type of cancer.
It is assumed that gene therapy can also play a positive role in treatment.
Complications and prognosis
With the development of nail melanoma, the risk of metastases is very high. As a rule, they appear in the liver and lungs. However, resection does not protect 100% from these processes.
Another difficulty is that surgery always (but to varying degrees) reduces the functionality of the limb. Patients also experience psychological difficulties, since their lifestyle changes, and in the case of hand operations, difficulties arise with the perception of their new appearance, which is difficult to hide from others.
In the absence of metastases, the five-year survival rate of patients is about 60%, but if metastases are already present, the average survival rate ranges from 7-8 months. The specific timing depends on individual characteristics, as well as the size, thickness of the tumor and other factors.
Help for blackened nails
To begin proper treatment of the nail plate, you need to determine the causes of such negative changes. A doctor will be able to help with this after conducting a series of studies.
What to do if you are injured
Trauma to the area under the nail plate is no different from ordinary hematomas. Therefore, the treatment should be carried out similarly. It is important to respond to injury correctly and quickly. This will make the hematoma disappear in a short time, and the nail will grow back faster.
Immediately after receiving an injury, it is recommended to immerse the injured area in cold water (or apply ice). Cold baths are taken until the new nail grows completely, at intervals of 2 days.
You should also perform the following manipulations:
- Disinfect the nail to prevent infections and bacteria.
- If the injury is significant, the hematoma will need to be opened. To do this, it is recommended to consult a doctor. He will be able to carry out the procedure painlessly and quickly. In this case, infections will not enter the body and the process of inflammation will not begin.
What to do for nail fungus
It is not recommended to treat fungal infections on your own. Only a doctor can prescribe competent treatment. First, you need to take all possible measures to prevent the infection from spreading to other nails. All recommendations boil down to observing the rules of personal hygiene:
- change socks as often as possible;
- visit baths, saunas, swimming pools only in closed rubber shoes;
- do not give your clothes and shoes to others;
- do not walk barefoot;
- keep your feet dry, as high humidity promotes the spread of fungus;
- pedicure should be done only with separate tools;
- Treat the surface of the affected plate with iodine twice a day.
Disease prevention
Prevention of subungual melanoma can include:
- protection of fingernails and toenails from physical and chemical injuries, exposure to aggressive chemicals;
- additional examinations of those people who have had cases of melanoma among their close relatives;
- monitoring existing benign neoplasms (nevi) and their timely removal.
Also, do not ignore the primary signs of melanoma of the nail plate. In many cases, they talk about other, simpler symptoms or diseases, but you shouldn’t count on it.
