Subunguale

Subunguale is an adjective used in several Romance languages, including Italian, to describe structures or conditions located beneath the nail plate. In anatomical terms, the subungual space lies between the nail bed and the distal phalanx and includes the nail bed, the surrounding soft tissues, and the portion of the nail plate close to the fingertip or toe.

Clinically, subungual conditions commonly present with pain, swelling, deformity of the nail, or discoloration. Subungual hematoma is a frequent traumatic condition characterized by blood accumulation under the nail, which can cause pressure and pain and may require drainage or nail removal in persistent or severe cases. Other subungual conditions include glomus tumors, which cause intense localized pain; subungual exostosis, a benign bony outgrowth beneath the nail; cysts or keratoacanthoma involving the nail unit; and less frequently malignant lesions such as subungual melanoma.

Subungual melanoma is a rare but important diagnosis to consider when there is a new or changing pigmented band under the nail, irregular borders, or other suspicious changes in color or nail growth. Evaluation typically includes physical examination, dermoscopy, imaging (such as X-ray to assess bone involvement or MRI/ultrasound for soft tissue), and biopsy for definitive diagnosis. Management depends on the underlying condition and can range from observation and symptomatic care to surgical intervention, including drainage, nail plate removal, or oncologic treatment in the case of malignancy. Early recognition and appropriate referral are important for subungual lesions.