Hematoma of the proximal nail fold due to oximeter in a child

Abstract

Boy 4 years old, hospitalized due to hemorrhagic chickenpox and sepsis during his clinical examination besides hemorrhagic crust, vesicles and bullous he has also a cutaneous red lesion localized at the right proximal nail fold of the big toenail (Fig. 1), dermatoscopic view of the lesion (Fig. 2). The diagnosis of hematoma of the proximal nail fold due to oximeter was done. The proximal nail fold hematomas due to oximeter are uncommon dermatoses at this level that are caused for the pressure of the oximeter and it has been seeing in patient in Unit Intensive or Intermediate Unit Care since 2007. Hematomas are blood collections located at any part of the body. The hematoma of the nail or periungual tissues can be caused by trauma or systemic diseases [1,2]. Usually the proximal nail folds of fingers, are exposed to receive minor and mayor traumas, and it is important to distinguish clinically from other diseases [1,3]. These kinds of hematomas go unnoticed, and are resulted by constant friction caused by the use of oximeter. The proximal nail fold hematoma affects the free edge letting off the cuticle; its appearance has been seen after 1 to 3 days of using the oximeter. One or more folds can be affected according to where the oximeter is placed proximal nail [1,4]. However, it is important to know other hematomas at this level, as those are produced by the oximeter use; their presence in several digits and no history of oximeter use; make us suspect other diseases that can be presented such as repeated collagen diseases or sepsis [5]. Chang and Haneke reported the first 3 cases of proximal nail fold hematoma on 2008, later reported 41 cases of the proximal nail fold hematoma in adult patients from the intermediate and intensive care unit at the Hospital General de Enfermedades on 2011 [4]. Also this pathology has been described in children, 5 cases were reported in children between the ages of 5 months to 4 years old on 2013 [6]. There is no treatment for this affection; prevention of injury is to rotate the oximeter every two or three hours to prevent the formation of hematoma [6]. HEMATOMA OF THE PROXIMAL NAIL FOLD DUE TO OXIMETER IN A CHILD