tag:blogger.com,1999:blog-9870114.post1401016268913531105..comments2024-03-10T08:41:32.400+00:00Comments on VIRTUAL GRAND ROUNDS IN DERMATOLOGY 2.0: Renal Transplant Patient with a Black ToeHumane Medicine Huihttp://www.blogger.com/profile/07113291188306363130noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-9870114.post-54278551717795297022018-07-08T13:15:29.161+00:002018-07-08T13:15:29.161+00:00I think its a sublingual hematoma too and she is p...I think its a sublingual hematoma too and she is probably getting repeated trauma to the nail due to the length of her toe and also the thickening of the nail. Could you treat her with weekly diflucan 200 mg also to see if she gets some response after 3 months.<br />Then if the pigmentation has not moved distally due a nail biopsy if you are still concerned about melanoma.Brendahttps://www.blogger.com/profile/08506887593851634737noreply@blogger.comtag:blogger.com,1999:blog-9870114.post-31607560396213995042018-07-04T01:54:25.610+00:002018-07-04T01:54:25.610+00:00from Dr. Cheng Leng, Malaysia: I agree with you mo...from Dr. Cheng Leng, Malaysia: I agree with you most probably it’s Subungal hematoma. Its history is a bit long but we have seen splinter haemorrhage hanging around for long time too.<br /><br />In view of his ten years of immunosuppression, the other possibility is pseudomonas nail infection, which usually gives a green or bluish discolouration. Getting the right chemical mix, it may turn dark? But I haven’t seen it this dark, has anyone else?<br /><br />His great toe, the affected second toe and the last toe also show nail changes suggesting onychomycosis. Nail scraping for microscopy is necessary. I usually shy away from Fungal nail culture as it may bring in many distant microbe relatives, with unfamiliar names, many being contaminants. Fungal infection may have paved the way for pseudomonas secondary infection.<br /><br />If patient is worried about melanoma, we may be pushed to rush things a bit. Otherwise may be better to treat the infections first before biopsy? I find pushing up gentamicin ointment ( you can use eye ointment if you can’t get skin ointment) under the nail helpful.Humane Medicine Huihttps://www.blogger.com/profile/07113291188306363130noreply@blogger.comtag:blogger.com,1999:blog-9870114.post-19090940901528027212018-07-04T01:37:06.187+00:002018-07-04T01:37:06.187+00:00from Patrick Kenny, Voctoria, BC: To me also subun...from Patrick Kenny, Voctoria, BC: To me also subungal hemorrhage is the likley answer . What I do is measure distance from proximal part of discolouration to proximal nail fold , and review after two months , and can then demonstrate to patient how the discolouration has moved forward free end of nail . A photograph on smart phone works well . Humane Medicine Huihttps://www.blogger.com/profile/07113291188306363130noreply@blogger.com