Clinical and dermoscopic progression of subungual hematomas

Subungual pigmentation is a very common problem and can result from pigments derived from melanin, blood, or fungi. Subungual hematoma usually appears as a reddish to reddish-black pigment depending on the age of the bleed, and it can easily be misdiagnosed as melanoma. In this study, we tried to show the clinical and dermoscopic progression of subungual hematomas. Thirty-six patients with the history of first nail trauma within the last 7 days were included in the study. All the patients were evaluated three times with 3-week intervals. The distance from proximal nail fold to the hematoma was measured by a paper ruler. The area and the largest diameter of the hematoma were calculated by using the Molescore software. At the beginning, the most common dermoscopic finding was the homogen area (n = 36, 100%) followed by small globules (n = 32, 88.9%), large globules (n = 29, 80.6%), and streaks (n = 19, 52.8%). At week 3, the most common dermoscopic finding was the homogen area (n = 36, 100%) followed by large globules (n = 27, 75%), small globules (n = 19, 52.8%), and streaks (n = 11, 30.6%). At the sixth week, the most common dermoscopic finding was homogen area (n = 36, 100%) followed by large globules (n = 16, 44.4%), small globules (n = 7, 19.4%), and streaks (n = 2, 5.6%). The diameter and the area of the hematoma shrunk gradually between weeks 0, 3, and 6 (P < 0.001). Dermoscopy is a very useful tool in the evaluation and differential diagnosis of subungual hematomas. Determination that the pigmented plague grows out distally and shrinks gradually will support the diagnosis of subungual hematoma.