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Dr. Nair
Dr. Nair, Dermatologist
Category: Dermatology
Satisfied Customers: 9190
Experience:  MBBS, MD (Dermatology, Venereology & Leprology)
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I have a small black spot under my toe nail. It looks like I

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I have a small black spot under my toe nail. It looks like I may also have a toe fungus as the spot is on the edge of where the nail is yellowish.
Would it be possible to take a photograph of the affected nail at your convenience?
Customer: replied 5 years ago.
I don't know how to do that. It's on the left side of the toenail in the middle....
Okay - how long have you had this spot? Has it remained the same during this time?

Does it look like the nail has any debris under it on the affected side?
Customer: replied 5 years ago.

I noticed it when I had a pedicure in June. I thought it might be a blood blister. It wasn't there in April when I had the last one. NO it has not changed.

Thank you for the information. Typing out an answer, be back with you shortly.
The two most common causes of a dark spot under the nail on the margin are onychomycosis (fungal infection of the nail) and a traumatic blood blister or hemorrhage under the nail. Any traumatic lesion should grow out with the nail and reach the free edge in a few months. Onychomycosis does not grow out. The concern with a dark spot under the nail is nail bed melanoma (also called a subungual melanoma) - however this does not have a yellowish component and keeps increasing in size. Your doctor can easily confirm the diagnosis with a simple test called nail clipping for fungal examination. The nail plate can also be sent for fungal culture. If either one of these is positive then onychomycosis is confirmed.

Onychomycosis is best treated with oral antifungals like terbinafine and itraconazole and these require a prescription. The dose is 250 mg once a day for 12 weeks for terbinafine and itraconazole 200 mg twice a day for 7 days (1 week) for 3 consecutive months, or 100mg twice a day daily for the same duration.The success rate is normally high (over 70%). This can be further improved by using a ciclopirox or amorolfine nail lacquer on the affected nail for 6-12 months. Again this will require a prescription.

Hope this information is useful, please feel free to ask if you have any queries.

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