Splinter hemorrhages: Causes and treatment

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Woman inspecting her fingernails.
Unusual marks, colors, and stains on or under the nails may sometimes indicate underlying health problems.
A splinter hemorrhage is an abnormality that occurs in someone’s fingernail. The name comes from the fact that a splinter hemorrhage resembles having a splinter underneath the fingernail, and it looks red.

 

What is a splinter hemorrhage?

Splinter hemorrhage.
Splinter hemorrhages are characterised by red, splinter-like streaks under the nails.
Image credit: Splarka, MD, (2010, August 23).

A splinter hemorrhage causes a person to have longitudinal streaks down the nails, which usually appear as small red blood vessels or streaks under the nails.

A person’s fingernails are composed mostly of a protein called keratin, which gives them their strength and flexibility.

The fingernails grow from a part of the nail known as the matrix, which creates keratin cells that layer over each other and move forward.

Once the nails are present on the skin, they are composed only of dead keratin cells. Consequently, a person can clip their fingernails without feeling any pain. While people’s nails can grow at different rates, most grow at a rate of 2 inches a year.

Some splinter hemorrhages may be an indicator of an underlying disease. However, they are sometimes just another harmless abnormality that can occur in the body.

 

Causes

Splinter hemorrhages occur when blood leaks or swells from small blood vessels that run up and down the nail bed. Tiny blood clots known as microemboli in the capillaries can also cause splinter hemorrhages.

One of the most common causes of splinter hemorrhages is trauma to the nails. According to the American Academy of Family Physicians, an estimated 20 percent of splinter hemorrhages are due to nail trauma.

Dropping something on the nails, hitting the fingernails against something, or getting them stuck in an obstacle can cause splinter hemorrhages to appear.

However, if a person is unable to identify the cause of splinter hemorrhages, the hemorrhages could be the result of an underlying medical condition.

Some medical conditions that cause splinter hemorrhages include:

  • Antiphospholipid syndrome: This syndrome causes blood clots to develop in the arteries and veins. It can be the result of another medical condition, such as lupus, or can occur without having a known condition.
  • Infectious endocarditis: This condition happens when a person has an underlying infection, such as strep. People who abuse drugs intravenously are at greater risk for this condition, which can damage the heart valves. Splinter hemorrhages are usually one of the later signs of infective endocarditis.
  • IV drug abuse: When a person injects illegal drugs, such as heroin, they are at greater risk of infectious diseases.
  • Nail psoriasis: This is an autoimmune disorder that causes excess skin cells to build up on the nails, which can result in pitting of the nails. Sometimes, the nails will also split or separate from the nail bed.
  • Rheumatic heart disease: This condition occurs when a person has strep throat as a child that progresses to a more serious infection that damages an individual’s heart.
  • Systemic lupus erythematosus (SLE): This autoimmune disorder causes joint pain, blood clotting, and changes to the circulation in the fingers.

In rare instances, splinter hemorrhages can be the result of taking certain medications. Examples of drugs that can cause this include aspirin, warfarin (Coumadin), and some chemotherapymedications, such as tetracycline or ganciclovir (Cytovene).

When a person has splinter hemorrhages that have no known cause, it is referred to as idiopathic splinter hemorrhaging.

 

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