Having partially or completely black nails can be a concern. Fortunately, what is at the root of it is usually not serious and easy to deal with. However, the best treatment will largely depend on the source of the problem. The two most common causes are trauma to the nail bed and fungal infections. Other causes that are usually at the root of darkening of the nails are systemic diseases, the use of drugs or inflammatory diseases. In rare cases, black spots or streaks under the nail may be due to melanoma (a type of skin cancer) developing below the surface of the nail. In case you're not sure what caused your nail to darken, see a doctor for an accurate diagnosis and talk to them about treatment options.
Method 1 of 3: Treat black nails caused by trauma
Step 1. Look for signs of injury to the nail
Try to determine if you've recently injured your toe in any way. In fact, an injury to the nail bed can cause blood to pool under the nail that will turn black or dark brown. This is called a subungual hematoma. Symptoms that you may have under these conditions include pain or pressure under the nail.
- Sometimes it's easy to tell if it's an injury that caused your toenail to darken. For example, if you dropped something on your foot or hit your toe.
- The nails can also gradually turn black as a result of repeated trauma, such as pressure from too tight shoes or an injury to the toes caused by sports, hiking, running that you do regularly.
Step 2. Practice the RGCE technique
Do this to care for your nails at home. You can treat yourself at home if the hematoma you have is not serious and does not hurt you too much. Treat your foot with "rest", "ice", "compression" and "elevation" (RGCE) right after the injury to limit swelling and pain. In addition, it will help the nail to heal quickly.
- Rest: Give the diseased toe rest by limiting the use of the injured foot as much as possible. For example, you should avoid hiking or running for 2 weeks after your injury.
- Apply ice: Wrap an ice pack in a cloth or plastic wrap and apply the chosen accessory to the injured toe to numb and reduce swelling. You can apply it once an hour to be safe, for twenty to thirty minutes at a time.
- Compress the area: Try applying light pressure by wrapping a bandage around the injured toe. This will have the advantage of minimizing the amount of blood accumulating under the nail.
- Elevate Foot: Reduce swelling by elevating the foot above heart level. For example, you can lie on a sofa and put your injured foot on the armrest, or lie on the bed and rest it on a pair of pillows.
Step 3. Take over-the-counter pain relievers
This will help you reduce the pain. If it hurts, try taking nonsteroidal anti-inflammatory drugs such as naproxen (Aleve), ibuprofen (Motrin) or paracetamol. In this way, you will be able to ease the pain and reduce the inflammation.
Check with your doctor before considering taking aspirin or any medicines that contain it, as aspirin may make nail bleeding worse
Step 4. See the doctor if you have severe symptoms
Home care for a subungual hematoma may not be sufficient. That is, you should make an appointment with the healthcare professional in case you have symptoms like severe or unbearable pain, uncontrollable bleeding from the injured area, a deep cut to the toe or nail. and lesions at the nail bed.
- The practitioner can use a needle or a laser to pierce your nails to drain blood or fluid under the nail. If the wound is severe or shows signs of infection, it may need to be removed.
- If it is a baby or toddler you are caring for, you should take it to the doctor immediately instead of trying to treat it at home.
Step 5. Seek emergency medical attention
Do this if you notice any signs of infection. Watch for signs of infection such as pus or any other liquid flowing under the nail, an increase in the level of pain or redness around the injured nail, fever, or streaks on the skin surrounding the nail.. The area around the nail may also feel hot to the touch. Contact the doctor or go to the emergency room as soon as possible if you notice any of these symptoms.
Toenails are more likely to become infected if they start to break off, which is common in severe subungual hematomas
Step 6. Protect it from further injury as it heals
After an injury, the nail will require time and care to fully recover. You should wear closed-toe shoes with plenty of room around the toes to prevent the injured toe from being bumped or squeezed. You can also keep it safe and healthy by doing the following.
- Always keep it clean, cut, and free of varnish while it heals. Nail polish or false nails slow down the healing process and make it harder to detect injury or signs of infection.
- Wear comfortable, well-fitting shoes, especially when running. For running, consider using pairs of shoes that are half the size of the shoes you are used to wearing, and be sure to tie the laces securely so they don't move around your feet.
- Use thick, breathable socks that can wick away moisture, so your feet stay dry and well-cushioned.
- Use duct tape to cover the injured toe while jogging or hiking.
Step 7. Wait a few months for the wound to heal completely
The black color in the nail will not go away until the old nail is fully grown. For many people, it can take around six to nine months.
- Even if the doctor will not remove your nail surgically, it may come off on its own. Usually, a new nail will grow after a few months.
- If the nail bed is badly injured, it is likely that the nail is not growing back or developing properly.
Method 2 of 3: Treat nail fungus
Step 1. See if you have symptoms of onychomycosis
If your toenail is infected with fungus, debris can collect underneath, which will turn it black. Look for other signs that show you have onychomycosis. It could be:
- thickening or deformation of the nail;
- a whitish or yellowish-brown coloration of the nail;
- crumbling or brittleness of the nail;
- an unpleasant odor.
Step 2. Go see a doctor to get an accurate diagnosis
Since the symptoms of onychomycosis are similar to the symptoms of many other diseases, it is very important to see your healthcare professional for a diagnosis so that the problem can be effectively treated. Make an appointment with the practitioner to examine the nail and do tests to confirm or rule out onychomycosis.
- Doctors can remove clippings from the nail or collect debris underneath with a scraper for laboratory analysis.
- Tell the healthcare professional about the symptoms you are having, as well as any medications you are taking or any other medical problems you may be having.
Step 3. Try over-the-counter anti-fungal medications
Before trying more aggressive approaches, your doctor may recommend over-the-counter medicines to treat onychomycosis. You can buy an antifungal cream or ointment like Lotrimin AF or Dr. Scholl's Nail Fungus Solution and use it according to the directions on the package.
- These medicines may be more effective if you thin and soften the nail before applying them. Trim the affected nail and gently file thick areas, being careful not to file the nail itself.
- You can promote deeper penetration of the medicine by first applying a urea-based cream to the nail such as EUCERIN UreaRepair.
Step 4. Check with the doctor
Do this to learn more about prescription antifungal medications. If you have not been satisfied with over-the-counter medications, your doctor may prescribe an antifungal ointment, cream, or nail polish for topical use. They can also be used in combination with oral antifungal medications for difficult-to-treat cases. Be sure to follow the healthcare professional's instructions carefully.
- Common topical prescription drugs include Amorolfine, Ciclopirox, Jublia® (efinaconazole), and tavaborole.
- Some antifungal ointments may need to be applied every day, while others may need to be applied only once a week. Medications can take several weeks to show their effectiveness.
- Some antifungal medicines come in the form of medicated nail polish (Penlac®) and should be applied to the diseased nail every day.
Step 5. Talk to your doctor about the use of oral antifungals
Consider seeing your healthcare professional if you do not see improvement after using over-the-counter medications or prescription topical medications. Your doctor may prescribe a stronger oral antifungal medicine for you. Popular options are Sporanox and Lamisil, among others. These drugs kill the fungus and allow a new healthy nail to grow to replace the infected one.
- You may need to take these medicines for six to 12 weeks before the infection is gone. It can also take several months for the damaged nail to fully grow, so don't be discouraged if you don't see a noticeable improvement immediately.
- Be aware that oral antifungal medications can cause serious side effects. You should contact your doctor regularly to make sure you are tolerating them and to inform them about any other medicines you are taking and any other medical problems you may have.
Step 6. Discuss the possibility of removing the infected nail
You may want to speak with the nail removal professional in case the infection is difficult to treat. If the medicines have been ineffective or the infection is particularly severe, the doctor may recommend that you remove the nail so that you can treat the nail bed directly. He can do this by applying a chemical to it that will cause it to come off or can remove it surgically.
- In most cases, the nail will grow back after treatment. This period can take anywhere from several months to a year.
- If the fungal infection recurs and does not respond to treatment, the dermatologist or doctor may need to perform surgery to permanently remove the nail.
Method 3 of 3: Treat melanoma under the toenail
Step 1. Examine the nail for symptoms of melanoma
Melanoma under the nail (also called subungual melanoma) can present as a black bruise that occurs when the nail is injured. If you see a black spot under your fingernail without an injury to your toe, you should see a healthcare professional immediately for examination. Other signs and symptoms of subungual melanoma include:
- black or brown streaks under the nail that may develop over time, specifically streaks that extend from the tip of the nail to the base of the bed;
- a dark spot or bruise under the nail that does not come up or go away when the nail grows;
- the nail that separates from its bed;
- darkening of the skin surrounding the nail;
- cracking, deformation or thinning of the nail;
- bleeding under the nail.
Step 2. See a doctor as soon as possible for a diagnosis
If you think you have subungual melanoma, do not hesitate and make an appointment with the doctor immediately. This condition is much easier to treat if caught at an early stage.
- Your doctor will likely order a biopsy, which involves removing a small amount of tissue from the nail bed to look for cancer cells.
- If a tissue test is positive for melanoma and the doctor suspects the cancer has started to spread, they may order a biopsy of nearby lymph nodes.
Step 3. Have surgery to remove the melanoma
The best treatment for melanoma is to remove cancerous tissue. Depending on the thickness and spread of the melanoma, your doctor may recommend that you remove some or all of the affected nail.
- If the cancer has spread to surrounding tissue or lymph nodes, you may need chemotherapy or radiation therapy in addition to surgery.
- Although melanoma is relatively less common, your healthcare professional may recommend additional treatments to prevent the disease from coming back or to destroy any remaining cancer cells.
- Have your doctor checked periodically after treatment and have routine self-exams in case the melanoma comes back.