Seeing some or all of your toenails blacken can be scary. Fortunately, the cause of blackened toenails is usually not serious and the problem is often fairly easy to treat. However, the best treatment for blackened toenails is determined by the cause. The two main causes of blackened toenails are injury to the nail bed and fungal infection. Other common causes include systemic disorders, medications, or inflammation. Although rare, dark spots or patches under the nails can also be caused by melanoma (a type of skin cancer) that grows on the nail bed. If you are unsure about the cause of blackened toenails, visit your doctor for a proper diagnosis and discuss treatment options.
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Method 1 of 3: Treating Black Toenails Due to Injury
Step 1. Watch for signs of injury to the toenail
Remember if your toenail has ever been injured. Injury to the nail bed can cause blood to accumulate under the nail, giving it a dark brown or even black appearance. This sign is called a subungual hematoma. You may also experience symptoms such as pain or pressure under the nail.
- In some cases, blackened toenails may appear to be the result of an injury. For example, if you've had an object fall on your leg or you've fallen asleep.
- Toenails may also darken gradually as a result of repeated injuries. For example, due to the pressure of shoes that are too narrow or injury to the toes due to frequent running, climbing, or exercising.
Step 2. Use the RICE technique to treat nail injuries at home
If your hematoma is mild and doesn't cause severe pain, it's possible that this problem can be treated at home without medical treatment. Use rest, ice, compression, and elevation techniques to minimize swelling and pain while speeding up toenail recovery:
- Rest: let the nail rest by reducing the movement of the injured leg as much as possible. For example, avoid running or hiking for a few weeks after the injury.
- Applying ice: place an ice pack that has been wrapped in a cloth or washcloth over the injured nail to reduce pain and swelling. You can use this compress for 20-30 minutes, a maximum of 1 hour.
- Bandaging: Gently press the injured area by wrapping a bandage. A bandage can help reduce blood accumulation under the nail.
- Elevate position: reduce swelling by elevating the leg above the heart as much as possible. For example, lie down on the couch with your feet on the armrests, or lie down on the bed with your feet on some pillows.
Step 3. Take over-the-counter pain relievers to reduce pain
If the blackened toenail hurts, try taking a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen (Ifen), naproxen (Aleve), or paracetamol (Panadol). These medications can reduce pain and swelling and inflammation.
Talk to your doctor first before using aspirin or any medication that contains aspirin, as these drugs can make bleeding under the nails worse
Step 4. See a doctor if you have severe symptoms
In some cases, home treatments alone may not be enough to treat a subungual hematoma. Make an appointment with your doctor if you experience symptoms such as unbearable pain, uncontrolled bleeding from the injured area, deep cuts to your toes or toenails, or damage to the nail bed.
- The doctor may slightly prick the toe with a laser or needle to allow blood and other fluid that has accumulated under the nail to drain out. If the injury to the nail is severe, or if there are signs of infection, the doctor may have to remove the nail completely.
- Immediately take children or babies with toenail injuries to the doctor, do not try to solve this problem yourself.
Step 5. Seek immediate medical attention if you notice any signs of infection
Watch for symptoms such as pus or other fluid oozing from under the nail, pain or swelling that gets worse, redness of the injured nail, red streaks on the skin around the nail, or fever. The area around the nail may also feel warm to the touch. If you notice these symptoms, call your doctor immediately or visit the emergency department.
Your toe may be more susceptible to infection after the nail has fallen off, and this problem is common in cases of severe subungual hematomas
Step 6. Protect the nail from further injury during the recovery period
After the initial injury, your toenail will need to rest and be cared for in order to fully heal. Wear closed shoes that are loose enough in the toe area to prevent the injured finger from being squeezed or drowsy. You can also keep your toes safe and healthy by:
- Keep your nails clean, trim your nails, and don't use nail polish during the recovery period. Nail polish or artificial nails can hinder the healing process and make signs of infection or injury difficult to detect.
- Wear shoes that fit and are comfortable, especially when running. If you run a lot, wear shoes that are size larger than your regular shoes, then tie them tightly so they don't come off easily.
- Wear thick, moisture-wicking socks to keep your feet dry and comfortable.
- Wear a toe guard or tape on a finger that is injured during running or climbing.
Step 7. Wait a few months for the injury to fully heal
The discoloration of the toenails will not go away until the old nail has grown to its full length. For some people, this process can take 6-9 months.
- If the doctor does not remove the nail through surgery, there is a chance that the nail will fall off on its own. Usually, a new nail will grow within a few months.
- If the nail bed is severely damaged, it is possible that the nail will not grow back, or grow but fall apart.
Method 2 of 3: Overcoming Toenail Fungus
Step 1. Observe the symptoms of a nail fungus infection
If you have a fungal infection of your toenail, there may be a build-up of flakes under your nail, causing it to darken. Watch for other signs of a yeast infection, such as:
- Thickening or bending of nails
- Nails that appear white or yellowish brown
- Nails that are brittle or crumble
- Bad smell
Step 2. Visit a doctor for a proper diagnosis
Since fungal infections of the toes can have symptoms similar to those of other diseases, you should see your doctor for a proper diagnosis. That way, this problem can be treated with effective treatment. Make an appointment with your doctor to undergo examinations and laboratory tests that can confirm the problem with the nail, whether it is a fungal infection or not.
- The doctor may take a sample of the nail clippings or splinters from under the nail for examination in a laboratory.
- Tell your doctor about the symptoms you are experiencing, as well as any medications you are taking or any other illnesses you may have.
Step 3. Try using an over-the-counter antifungal medication
Before trying more aggressive treatments, your doctor may recommend that you use over-the-counter medications to treat infected nails. Buy an antifungal nail cream like Dr. Scholl's Fungal Nail Treatment or Lotrimin AF, and use as directed on the package.
- These medications may be more effective if used after you have thinned and smoothed your nails. Trim the infected nail and file the thickened area, but be careful not to file the entire nail bed.
- You can also help the medication absorb more deeply by applying a urea-based cream to your nails first, such as Urea 40+ cream or Urea Care.
Step 4. Use a prescription topical antifungal medication
If the yeast infection doesn't respond to over-the-counter medications, your doctor may prescribe a topical antifungal cream, ointment, or nail polish. These medications can also be used with oral antifungals to treat stubborn infections. Follow the doctor's advice carefully.
- Topical antifungal drugs commonly prescribed by doctors include amorolfin, ciclopirox, efinaconazole, and Tavaborole.
- Some antifungal ointments may need to be used daily, and some may only need to be used once a week. You may have to use the medication for several weeks until it is effective.
- Some antifungal drugs are sold in nail polish preparations (Penlac) which must be applied daily to the infected nail.
Step 5. Talk to your doctor about taking oral antifungal medications
If your nails don't improve after using over-the-counter or prescription topical medications, see your doctor again. Your doctor may prescribe a stronger oral antifungal medication. Commonly prescribed oral antifungal drugs include Lamisil and Sporanox. These remedies will help kill the fungus as well as allow new, healthy nails to grow in place of the old ones.
- You may have to take this medicine for 6-12 weeks until the infection clears up. Damaged nails may also not completely disappear after a few months. So don't despair if you don't see your nails getting better soon.
- Oral antifungal drugs may cause serious side effects. Consult with your doctor often to make sure your body can tolerate this drug well. Tell other medications you are also taking and any other illnesses you have.
Step 6. Discuss nail removal for difficult-to-treat infections
If medication alone is not enough, or if your nail infection is very severe, your doctor may recommend that you remove the entire nail so that the infection in the nail bed can be treated immediately. The doctor may administer a chemical that makes the nail fall off or surgically remove the nail.
- In most cases, the nail will eventually grow back after treatment is complete, although it may take several months to 1 year.
- If the yeast infection persists and doesn't respond to treatment, your doctor or dermatologist may have to perform permanent nail removal surgery.
Method 3 of 3: Treating Melanoma on Toenails
Step 1. Observe the symptoms of melanoma on the nails
Melanoma under the toenail (called a subungual melanoma) can look like a thick, thick bruise that appears when the nail is injured. If you find dark patches under your nails, but there are no injuries, see a doctor immediately. Other signs and symptoms of subungual melanoma include:
- Brown or black streaks under the nail that get longer, especially those that extend from the tip of the nail to the base of the nail bed.
- Dark bruising or patches under the nail that don't shift or go away as the nail grows.
- Dislodgement of the nail from the nail bed.
- Darkening of the skin around the nails.
- Nails that are cracked, thinned, or bent.
- Bleeding under the nails.
Step 2. Immediately visit a doctor to find out the diagnosis of the disease
If you suspect you have melanoma under your toenail, don't delay. Immediately make an appointment with a doctor. Melanoma is much easier to treat effectively if detected early.
- Most likely, your doctor will ask you to undergo a biopsy. In this examination, a small amount of nail bed tissue will be taken and then examined for cancer cells.
- If the test results confirm the tissue is positive for melanoma, and the doctor suspects the cancer has started to spread, some of the surrounding lymph nodes may also need to be examined by biopsy.
Step 3. Undergo melanoma surgery
The best treatment for melanoma is the removal of cancerous tissue. Your doctor may recommend that the entire toenail or part of the affected toe be removed, depending on the thickness of the melanoma and the extent of its spread.
- If the melanoma has spread to surrounding tissues or lymph nodes, surgery may have to be combined with chemotherapy or radiation therapy.
- Although the extent of melanoma is relatively limited, your doctor may still recommend that you undergo additional therapy to prevent the disease from recurring or kill any remaining cancer cells.
- Have a follow-up examination with a post-treatment doctor and perform periodic self-examinations in case the melanoma recurs.
