Indian Dermatology Online Journal

: 2018  |  Volume : 9  |  Issue : 2  |  Page : 105--106

Nail transillumination combined with dermoscopy for enhancing diagnosis of subungual hematoma

Feroze Kaliyadan1, Karalikkattil T Ashique2,  
1 Department of Dermatology, King Faisal University, Al Hasa, Kingdom of Saudi Arabia
2 Department of Dermatology, KIMS Al Shifa Super Specialty Hospital, Perinthalmanna, Kerala, India

Correspondence Address:
Feroze Kaliyadan
Department of Dermatology, King Faisal University, Al-Hasa Campus, Al Hasa
Kingdom of Saudi Arabia

How to cite this article:
Kaliyadan F, Ashique KT. Nail transillumination combined with dermoscopy for enhancing diagnosis of subungual hematoma.Indian Dermatol Online J 2018;9:105-106

How to cite this URL:
Kaliyadan F, Ashique KT. Nail transillumination combined with dermoscopy for enhancing diagnosis of subungual hematoma. Indian Dermatol Online J [serial online] 2018 [cited 2022 Jan 17 ];9:105-106
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Full Text

Transillumination of the nails has been shown to be useful in the diagnosis of some conditions such as periungual warts.[1] We describe the use of nail transillumination in combination with dermoscopy for the diagnosis of subungual hematomas.

Dermoscopy is considered an effective tool in the diagnosis of subungual hematoma and differentiating it from melanoma. Dermoscopy can also be useful in assessing the progression of subungual hematoma. The typical dermoscopic features described in subungual hematoma include dark blue or purple homogenous areas, followed by globules (which can be large or small) and streaks.[2]

We used a combination of standard contact dermoscopy and transillumination in a 40-year-old male patient who presented to us with dark pigmentation of the left thumb [Figure 1]. There was history of trauma to the nail a few days before. Clinically, a diagnosis of subungual hematoma was made, which was confirmed by contact dermoscopy (Dermlite® foto II pro, 10×, nonpolarized, contact dermoscopy, attached to Canon 650D digital SLR camera), showing a homogenous dark purple area with lighter shades in some areas with purple and red globules and streaks in the periphery of the lesion [Figure 2]a. We used transillumination combined with dermoscopy. A pen torch was placed on the volar surface of the thumb, and imaging was done using the same contact dermoscopy technique but with the inbuilt dermoscope lights switched off. The combined imaging also showed homogenous areas with globules, but we felt that we could visualize the areas where the hematoma was resolving better [Figure 2]b; areas marked with black arrows].{Figure 1}{Figure 2}

Transillumination in medicine refers to tissue visualization after transmitting light through it. Some conditions produce specific patterns when light is transmitted through affected tissues. In case of normal finger nails, transillumination produces a uniform red field. Any abnormality (a subungual wart or hematoma) can be seen interrupting this uniform red field. It is possible that, in the case of a hematoma, the intensity of the transmitted red light is dependent on the thickness and stage of the hematoma, and hence, resolving areas might show a lighter shade of red, which might be appreciated better with transillumination compared to direct surface imaging (such as dermoscopy). Combining with dermoscopy might further improve the imaging quality by reducing reflections from the nail surface.

We would like to suggest that combining transillumination with standard dermoscopy is a simple technique, which could help visualize the extent and resolution of subungual hematomas better.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that name and initial will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.


1Ashique KT, Kaliyadan F. Transillumination: A simple tool to assess subungual extension in periungual warts. Indian Dermatol Online J 2013;4:131-2.
2Oztas MO. Clinical and dermoscopic progression of subungual hematomas. Int Surg 2010;95:239-41.