Three dots under right toenail

by Rubén
(Zaragoza, Spain)

On 1st October I noticed three black dots under my right toenail. No pain or other symptoms. The night before I wore tight new shoes and had a family dinner with lots of food, beer, red wine and licors. It lasted from lunch to dinner and I wore that shoes all the time.

The dots haven't moved during this months. The right down one (the one closest to the toe skin) has grown towards the skin forming a line (as it can be seen in the pictures I attach). The other ones remained stable.

At this time, three different family doctors has said me that it may probably be a hematoma or fungus. I can't have and appointment with a dermatologist until January (I wish I could go tomorrow, but my insurance won't allow it until January and the National Health System will take months to appoint me a dermatologist) so I would be very grateful for any information.

Thank you very much.

The first pic is from 11st December.

The second one is from 22st December.

I have no earlier pics.

RESPONSE

Hi Ruben,

Looking at the enclosed pictures, my best guess would be that of fungus as well as dry blood under the nail.
As you point out, the discoloration does not appear to be growing forward.
Because of the fact that the discoloration is not growing forward, you have to be concerned about the possibility of some type of growth on the nail bed which is the skin underneath the nail.
The only way to actually know what is going on would be to have the nail removed and the nail bed (plus the underside of the nail) inspected.
In our country this is something that is done in the office, under local anesthesia, with just the toe being put to "sleep".
It is not an especially painful procedure and unless there are mitigating circumstances such as diabetes or bleeding tendencies, you can usually go about your business after you leave the doctor's office.
Assuming it is nothing but dry blood and fungus, a new nail should grow out, usually healthy. Sometimes, however, the new nail may grow out a bit thicker then the original nail. This is usually due to some degree of trauma to the growth plate of the nail during the removal process.
You might ask your family doctors if one of them feels comfortable enough to remove the nail, otherwise I guess you will have to wait until you can finally see the dermatologist.

Marc Mitnick DPM
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