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This article was co-written by Luba Lee, FNP-BC, MS. Luba Lee is a licensed family physician practicing in Tennessee. She received her MSN from the University of Tennessee in 2006.
There are 11 references cited in this article that you can view at the bottom of the page.
This article has been viewed 28,349 times.
Partial or total blackening of the toenails can be an ominous sign. Fortunately, the cause of black toenails is usually not serious and easy to treat. The best treatment will depend on the cause of the black nail. The two most common causes are nail bed injuries and fungal infections. Other common causes include systemic diseases, drug use, or inflammatory diseases. In rare cases, dark spots or streaks under the nail can be caused by melanoma (a form of skin cancer) that develops in the nail bed. If you’re not sure what’s causing your black nails, see your doctor for an accurate diagnosis and discuss treatment options. [1] X Research Source
Steps
Cure black toenails due to injury
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Look for signs of toenail injury. Remember to see if you have recently injured your toe. Damage to the nail bed can cause blood to pool under the nail and turn black or dark brown. This condition is called a subungual hematoma. Accompanying symptom may be pain or tightness under the nail. [2] X Research Source
- In some cases, it’s easy to tell if a black toenail is caused by an injury – like if you dropped something on your foot or tripped your toe.
- Toenails can also gradually darken from repetitive stress, such as excessive pressure from tight shoes or toe injury from frequent running, hiking, or playing sports.
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Apply the RICE rule to treating toenails at home. You can usually treat it at home if the hematoma under the nail is mild and doesn’t cause much pain. Apply the RICE rule – the first letters of English words – Rest, Ice, Compression and Elevation immediately after injury to limit swelling and pain, while helping toenails to heal: [3] X Research source
- Rest: Give the toenail a rest by limiting the use of the injured foot as much as possible. For example, you should avoid running or hiking for several weeks after your injury.
- Apply ice: Wrap an ice pack in cloth or cling film and apply it to the injured toe to numb and reduce swelling. You can use the ice pack once every hour, 20-30 minutes each time. [4] X Trusted Source HealthyChildren.org Go to Source
- Compression: Apply gentle pressure by wrapping the bandage around the injured toe. This therapy can help limit the amount of hematoma under the nail.
- Elevation: Reduce swelling by elevating the foot as high as heart level as possible. For example, you can lie on the sofa and rest your feet on the armrests, or lie on the bed and rest your feet on a stack of pillows.
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Take over-the-counter pain relievers. If your dark toe is painful, try taking a nonsteroidal anti-inflammatory drug such as ibuprofen (Motrin), naproxen (Aleve), or acetaminophen (Tylep). Medicines will help relieve pain and reduce inflammation. [5] X Research Sources
- Ask your doctor before taking aspirin or medications that contain aspirin, as these can make bleeding under the nail worse.
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See your doctor if you have severe symptoms. In some cases, home treatments for subungual hematomas may not be enough. You should make an appointment with your doctor if you develop symptoms such as severe pain, uncontrollable bleeding, a deep cut in your toe or nail, or damage to the nail bed. [6] X Research Sources
- The doctor may insert a laser or needle into the toenail to drain blood or fluid from under the nail. If the nail wound is severe or shows signs of infection, they may have to remove the toenail.
- You need to take babies and young children with injured toenails to the doctor immediately instead of treating them at home.
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Seek emergency medical attention if you notice signs of infection. Watch for signs of infection such as pus or other fluid oozing under the nail, increased pain or redness around the injured nail, red streaks appearing on the skin around the nail, fever. The skin around the nail may also be hot to the touch. If you notice any of these symptoms, call your doctor or go to the emergency room right away. [7] X Research Sources
- Toenails are more susceptible to infection if the nail begins to loosen, which is common in severe subungual hematomas.
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Protects the nail from further injury while it heals. After an injury, your toenail needs time and care to fully heal. You should wear closed-toe shoes with a wide toe to prevent tripping or pinching your toes. You can also keep your toenails safe and healthy by: [8] X Research Source
- Keep nails clean, trim, and don’t paint while they heal. Nail polish or nails that aren’t properly cared for can slow down the healing process and make it harder to spot signs of infection or damage.
- Wear comfortable, well-fitting shoes, especially when running. When running, you should use shoes that are about half a size larger than your usual shoes, and be sure to tie the shoelaces tightly so that the shoes do not move around the foot.
- Use thick, moisture-wicking socks to keep your feet cool and dry.
- Use a toe cap or tape to your injured toe when running or hiking.
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Wait a few months for the wound to fully heal. The black color on the toenail will only disappear when the old nail grows out. For most people, this process takes about 6-9 months. [9] X Research Source
- Even if the doctor does not surgically remove the nail, the toenail can fall off on its own. Usually the new nail will grow back after a few months.
- If the nail bed is severely damaged, it is likely that the nail will not grow back or grow abnormally.
Toenail fungus treatment
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Check for symptoms of a fungal nail infection. If the toenail is infected with a fungus, debris can build up under the nail, causing the toenail to turn black. Look for other signs of onychomycosis, such as: [10] X Trusted Source Mayo Clinic Go to Source
- Thick or warped nails
- Nails turn white or golden brown
- Crispy and friable nails
- The offensive smell of
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See your doctor for an accurate diagnosis. Toenail fungus has similar symptoms to many other illnesses, so it’s important to see your doctor for an effective diagnosis and treatment. Schedule a visit to have your doctor examine your nails and do some tests to confirm or rule out fungal nail disease. [11] X Trusted Source Mayo Clinic Go to Source
- Your doctor may take a few toenails or scrape debris under your nail for testing.
- Tell your doctor about your symptoms and medications you are taking or any other health problems you may have.
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Try an over-the-counter antifungal medication. Before using more aggressive treatments, your doctor may prescribe an over-the-counter medication to treat nail fungus. You can buy antifungal creams or ointments like Dr. Schpl’s Fungal Nail Treatment or Lotrimin AF and apply as directed on the label. [12] X Trusted Source Mayo Clinic Go to Source
- The medication may be more effective if you grind and soften your nails before applying the medication. Cut nails short and file thick areas lightly, being careful not to puncture the nail.
- You can also help it penetrate deeper by applying a urea cream to your nail before applying it, such as Urea 40+ or Urea Care.
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Ask your doctor about prescription antifungal creams. If your condition doesn’t respond to over-the-counter medications, your doctor may prescribe antifungal creams, ointments, or nail polishes. These drugs can also be used in tandem with oral antifungals for difficult-to-treat cases. Carefully follow your doctor’s instructions. [13] X Trusted Source American Academy of Dermatpogy Go to Source
- Common prescription topical medications include amorpfine, ciclopirox, Efinaconazpe, and Tavaborpe.
- Some antifungal ointments may have to be applied daily, others only need to be applied once a week. The medication can take several weeks of treatment to work.
- Some antifungals come in the form of medicated nail polish (Penlac) that is applied daily to the infected nail. [14] X Trusted Source Mayo Clinic Go to Source
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Talk to your doctor about using oral antifungal medications. If you don’t see improvement after using an over-the-counter or prescription antifungal topical, see your doctor. Your doctor may prescribe stronger oral antifungal medications. Popular choices include Lamisil and Sporanox. These medications work to kill the fungus and allow a healthy new nail to grow back in place of the infected nail. [15] X Trusted Source Mayo Clinic Go to Source
- You may need to take these medications for 6-12 weeks to get rid of the fungus, and it may take a few more months for the damaged nail to grow out, so don’t be discouraged if you don’t see noticeable improvement right away. instantly.
- Oral antifungal medications can cause serious side effects. Keep in touch with your doctor regularly to make sure you are tolerating the medication well. Tell your doctor about the medications you are taking and your concerns.
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Talk about getting rid of hard-to-treat fungal nail infections. If medication doesn’t work in a severe fungal infection, your doctor may recommend removing the nail so that the nail bed can be treated directly. You may have chemical peels or surgery to remove the nail. [16] X Trusted Source American Academy of Dermatpogy Go to Source
- In most cases, the nail will grow back after being treated. This can take months to a year.
- If the fungal infection keeps recurring and doesn’t respond to medication, your dermatologist may need to do permanent nail removal surgery.
Treatment of melanoma in toenails
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Review the symptoms of melanoma. Melanoma (also called subungual melanoma) can resemble the black bruise that occurs when a nail is injured. If you see a black spot under your nail without trauma, see your doctor right away. Other signs and symptoms of subungual melanoma include: [17] X Research Source
- Brown or black stripes under the nail can develop over time – especially streaks from the tip to the bottom of the nail bed.
- Bruises or dark spots under the nail that do not move upwards or do not go away as the nail grows out
- The nail separates from the nail bed
- The skin around the nail is darker
- Cracked, thin or warped nails
- Bleeding under the nail
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See your doctor immediately for a diagnosis. If you suspect you have subungual melanoma, don’t delay – seek medical attention immediately. Melanoma is much easier to treat if caught early. [18] X Research Sources
- The doctor will usually order a biopsy, which involves taking a small amount of tissue from the nail bed to look for cancer cells.
- If tissue tests are positive for melanoma and there is suspicion that the cancer has begun to spread, your doctor may order a biopsy of a nearby lymph node. [19] X Trusted Source Mayo Clinic Go to Source
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Surgery to remove melanoma. The best treatment for melanoma is to remove the cancerous tissue. Depending on the thickness and spread of the melanoma, your doctor may recommend removal of part or all of the affected nail. [20] X Research Source
- If the melanoma has spread to surrounding tissues or lymph nodes, you may need chemotherapy or radiation along with surgery.
- Even if melanoma has relatively little spread, your doctor may be able to prescribe treatments to prevent the melanoma from coming back or to kill all remaining cancer cells.
- Periodic follow-up after treatment and self-examination to prevent melanoma recurrence.
Advice
- Discoloration of toenails can be caused by other causes, such as a change in the natural pigment of the skin. It can also be associated with various medical conditions, such as diabetes, kidney disease, heart disease, or anemia. [21] X Research Source Work with your doctor to identify any underlying medical conditions that may be causing your toenails to darken.
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This article was co-written by Luba Lee, FNP-BC, MS. Luba Lee is a licensed family physician practicing in Tennessee. She received her MSN from the University of Tennessee in 2006.
There are 11 references cited in this article that you can view at the bottom of the page.
This article has been viewed 28,349 times.
Partial or total blackening of the toenails can be an ominous sign. Fortunately, the cause of black toenails is usually not serious and easy to treat. The best treatment will depend on the cause of the black nail. The two most common causes are nail bed injuries and fungal infections. Other common causes include systemic diseases, drug use, or inflammatory diseases. In rare cases, dark spots or streaks under the nail can be caused by melanoma (a form of skin cancer) that develops in the nail bed. If you’re not sure what’s causing your black nails, see your doctor for an accurate diagnosis and discuss treatment options. [1] X Research Source
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