Subungual hemorrhage

From dermoscopedia

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 Authored by: Amélie Boespflug     ·  Luc Thomas     ·  Chapter available soon

 Keywords:   subungual hemorrhage
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Author(s) Amélie Boespflug · Luc Thomas · Chapter available soon
Owner Luc Thomas→ send e-mail
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Status update May 14, 2017
Status by Ralph P. Braun


Subungual hemorrhages, also called subungual haematomas, are collections of blood in the space between the nailThis glossary term has not yet been described. bed ormatrix and the nail plate and may result from an acute injury or repetitive minor trauma to the nail apparatus[1]. Their most frequent location are the thumb and the hallux.

Most subungual hemorrhages are clinically evident with well-circumscribed dots or blotches of red to black pigmentation but in some cases a subungual hemorrhageThis glossary term has not yet been described. may mimic a subungual melanomaThis glossary term has not yet been described.[2]. In these cases dermoscopyDermoscopy is a non invasive diagnostic method. may helpRefers to giving assistance or support to others for mutual benefit to eliminate differential diagnosisis the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines with variations in the use of logic, analytics, and experience to determine "cause and effect". In systems engineering and computer science, it is typically used to determine the causes of symptoms, mitigations, and solutions[1].

The clinical features of subungual haemorrhages are characterized by well-circumscribed dots or blotches with a red to red–black pigmentation. Dermoscopic examination of subungual hemorrhages shows in most cases the presence of several colors, with purple-black being the most frequent colorColor (American English) or colour (Commonwealth English) is the characteristic of human visual perception described through color categories, with names such as red, yellow, purple, or blue.[1]. In the case of an acute injury the main colors visualized change over time, in early lesions the colors are mostly pink, purple and red, whereas in older lesions colors tend to be darker purple-black, red black, and brown-black[1]. Lesions migrate proximally as the nail plate grows except in 15% of the cases[1].

The most frequent dermoscopic structure is homogeneous blotches, but globular patterns and streakslines radial (always at periphery) streaks Reed nevus melanoma recurrent nevus (also called splinter hemorrhages) can be seen as well in combination or alone[3]. Other dermoscopic features that can be present in subungual hemorrhages are peripheral fading and periungual hemorrages[1].

Subungual hemorrhageThis glossary term has not yet been described. are frequently seen in subungual melanomas (23%)[4], therefore when a subungual hemorrhage is suspected, subungual melanoma should always be eliminated in a two step algorithmIn mathematics and computer science, an algorithm (Listeni/ˈælɡərɪðəm/ AL-gə-ri-dhəm) is a self-contained sequence of actions to be performed. Algorithms can perform calculation, data processing and automated reasoning tasks.. In the first step, the presence of subungual hemorrhage associated features should be assessed. In the second step, the presence of other nail pigmented lesions should be assessed, especially melanoma-related features (Hutchinson sign, longitudinal irregular line, triangular shape of the band, vascular pattern, and ulcer). Subungual hemorrhages don’t show signs of melanoma-related features, in the presence of such lesions, a biospy should be made exclude a melanoma.

Digital dermoscopyDermoscopy using digital images. This is used for telemedicine and monitoring. follow-up can be performed in unclear cases, it consists in a first short evaluation after 3 to 4 months followed by another evaluation a year later. It can show, a disappearance of the lesion, its migration with nail growth and the darkening of the previous colors with no appearance of melanoma-related dermoscopic features.

ReferencesThis glossary term has not yet been described.
  1. 1.0 1.1 1.2 1.3 1.4 1.5 Mun J-H, Kim G-W, Jwa S-W, Song M, Kim H-S, Ko H-C, et al. Dermoscopy of subungual haemorrhage: its usefulness in differential diagnosis from nail-unit melanoma. British Journal of Dermatology 2013;168:1224–9.
  2. Braun RP, Baran R, Le Gal FA, Dalle S, Ronger S, Pandolfi R, et al. Diagnosis and management of nail pigmentations. Journal of the American Academy of Dermatology 2007;56:835–47.
  3. Ronger S, Touzet S, Ligeron C, Balme B, Viallard AM, Barrut D, et al. Dermoscopic examination of nail pigmentation. Archives of Dermatology 2002;138:1327–33.
  4. Phan A, Dalle S, Touzet S, Ronger-Savlé S, Balme B, Thomas L. Dermoscopic features of acral lentiginous melanoma in a large series of 110 cases in a white population. British Journal of Dermatology 2009;162:765–71.