Clinical and Dermoscopic Features of Subungual Hemorrhage: A Retrospective Study of 420 Cases
8 affiliations
- 1Department of Dermatology and Venereology the Second Affiliated Hospital of Anhui Medical University Hefei Anhui China
- 2Joint Laboratory for Plasma Clinical Applications the Second Affiliated Hospital of Anhui Medical University Hefei Anhui China
- 3Department of Dermatology Peking University Shenzhen Hospital Shenzhen Guangdong China
- 4Shenzhen Key Laboratory for Translational Medicine of Dermatology, Institute of Dermatology Shenzhen Peking University ‐ The Hong Kong University of Science and Technology Medical Center Shenzhen Guangdong China
- 5PKU‐Shenzhen Clinical Institute of Shantou University Medical College Shenzhen Guangdong China
- 6Department of Dermatology, Sichuan University Affiliated Chengdu Second People's Hospital, Chengdu Second People's Hospital, West China School of Medicine Sichuan University Chengdu Sichuan China
- 7Department of Dermatology Shenzhen Xinhua Hospital Shenzhen Guangdong China
- 8The Second Clinical Medical College Anhui Medical University Hefei Anhui China
Abstract
Background: Subungual hemorrhage (SH) may be difficult to distinguish from nail unit melanoma, onychomycosis, and other nail disorders. Dermoscopy enables non‐invasive visualization of subtle subungual structures and provides useful information for differential diagnosis. This study aimed to analyze the clinical and dermoscopic features of SH and explore their associations with lesion location, disease course, and nail involvement.
Materials and methods: Clinical and dermoscopic data of 420 patients diagnosed with SH between December 2018 and March 2024 were retrospectively collected from two tertiary hospitals in China.
Results: Patients aged 18–45 years accounted for 65.5% of the cohort, and 84.3% of lesions were located on the toenails. Most patients (69.5%) had a single lesion, and 73.8% and 79.3% showed no nail margin involvement or nail plate damage, respectively. Toenail involvement was more frequent in female (p = 0.003) and young adult (p = 0.002) patients. The predominant dermoscopic features were purplish‐red/black pigmentation (72.9%), irregular morphology (71.0%), and linear or striated pseudopods surrounding the lesion (56.7%). Irregular morphology was significantly more frequent in toenail lesions, whereas linear morphology was more common in fingernail lesions (both p < 0.001). Irregular shapes were predominant (73.6%) in cases with a short‐term course (< 3 months), whereas linear lesions accounted for 31.6% of lesions in patients with a long disease course (≥ 12 months). Lesion morphology was significantly associated with disease course (p < 0.001). Irregular morphology was also significantly associated with nail margin involvement (p < 0.001) and nail plate damage (p = 0.007), while linear or striated pseudopod lesions showed a significant association with nail margin involvement (p < 0.001).
Conclusion: In this cohort, SH predominantly affected females and young adults and typically presented as a single toenail lesion. Dermoscopic features of SH varied according to lesion location and disease course, and irregular morphology was associated with nail margin involvement and nail plate damage. Recognition of characteristic dermoscopic features, together with clinical history and lesion evolution, may facilitate differentiation of SH from nail unit melanoma and other nail disorders, help avoid unnecessary biopsy in typical cases, and prompt further evaluation of suspicious lesions.
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BibTeX
@article{wu2026clinical,
title = {{Clinical and Dermoscopic Features of Subungual Hemorrhage: A Retrospective Study of 420 Cases}},
author = {Xiaoting Wu and Zhaoping Lin and Xue Shen and Jieyi Wang and Dongying Luo and Kaoyuan Zhang and Fei Ma and Hui Li and Hongyi Wang and Ruiyang Ni and Yurao Wang and Bo Yu and Changbing Shen and Jing Gao},
journal = {Skin Research and Technology},
year = {2026},
month = oct,
doi = {10.1111/srt.70400},
url = {https://doi.org/10.1111/srt.70400},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Clinical and Dermoscopic Features of Subungual Hemorrhage: A Retrospective Study of 420 Cases
AU - Xiaoting Wu
AU - Zhaoping Lin
AU - Xue Shen
AU - Jieyi Wang
AU - Dongying Luo
AU - Kaoyuan Zhang
AU - Fei Ma
AU - Hui Li
AU - Hongyi Wang
AU - Ruiyang Ni
AU - Yurao Wang
AU - Bo Yu
AU - Changbing Shen
AU - Jing Gao
PY - 2026
DA - 2026/10/01
JO - Skin Research and Technology
DO - 10.1111/srt.70400
UR - https://doi.org/10.1111/srt.70400
AB - Background: Subungual hemorrhage (SH) may be difficult to distinguish from nail unit melanoma, onychomycosis, and other nail disorders. Dermoscopy enables non‐invasive visualization of subtle subungual structures and provides useful information for differential diagnosis. This study aimed to analyze the clinical and dermoscopic features of SH and explore their associations with lesion location, disease course, and nail involvement. Materials and methods: Clinical and dermoscopic data of 420 patients diagnosed with SH between December 2018 and March 2024 were retrospectively collected from two tertiary hospitals in China. Results: Patients aged 18–45 years accounted for 65.5% of the cohort, and 84.3% of lesions were located on the toenails. Most patients (69.5%) had a single lesion, and 73.8% and 79.3% showed no nail margin involvement or nail plate damage, respectively. Toenail involvement was more frequent in female (p = 0.003) and young adult (p = 0.002) patients. The predominant dermoscopic features were purplish‐red/black pigmentation (72.9%), irregular morphology (71.0%), and linear or striated pseudopods surrounding the lesion (56.7%). Irregular morphology was significantly more frequent in toenail lesions, whereas linear morphology was more common in fingernail lesions (both p < 0.001). Irregular shapes were predominant (73.6%) in cases with a short‐term course (< 3 months), whereas linear lesions accounted for 31.6% of lesions in patients with a long disease course (≥ 12 months). Lesion morphology was significantly associated with disease course (p < 0.001). Irregular morphology was also significantly associated with nail margin involvement (p < 0.001) and nail plate damage (p = 0.007), while linear or striated pseudopod lesions showed a significant association with nail margin involvement (p < 0.001). Conclusion: In this cohort, SH predominantly affected females and young adults and typically presented as a single toenail lesion. Dermoscopic features of SH varied according to lesion location and disease course, and irregular morphology was associated with nail margin involvement and nail plate damage. Recognition of characteristic dermoscopic features, together with clinical history and lesion evolution, may facilitate differentiation of SH from nail unit melanoma and other nail disorders, help avoid unnecessary biopsy in typical cases, and prompt further evaluation of suspicious lesions.
SN - 0909-752X
SN - 1600-0846
ER -