Nail & Skin Disorders

What Is a Splinter Hemorrhage?

n. (splĭn ‘tər hem’ər-ĭj) small areas of bleeding or hemorrhage underneath the nail bed that take the shape of straight lines; usually caused by hard impact or physical trauma to the nail; usually grows out with the nail after a few months

What It Is

A splinter hemorrhage, also commonly known as a fingernail hemorrhage, actually resembles a splinter underneath the nail. These small areas of bleeding or hemorrhaging under fingernails or toenails often take the shape of straight lines.

The nail bed contains many small blood vessels. Since the nail bed’s anatomic structure is arranged in longitudinal grooves and ridges, when there is a small amount of bleeding within one of these grooves, the overlying nail plate traps the blood. The nail bed is linear in its construction so the blood takes on the appearance of a straight line. Eventually small clots form and the bleeding stops.

Symptoms

Thankfully, there is no pain or discomfort associated with splinter hemorrhages, other than the initial trauma that may have caused it, if that is the case. The only way you can tell you have a hemorrhage is by a visible red stain under the nail plate.

If the splinter hemorrhage is the result of another condition such as Raynaud’s disease, for example, then there may be discomfort as a result of that particular condition or disease.

Causes

Splinter hemorrhages are often caused by some type of hard impact or other physical trauma to the nail bed and should not be a cause for concern. “There really is no way to prevent them from occurring,” says Nancy Satur, M.D., North Coast Dermatology Associates in Encinitas, Calif.

“In healthy individuals, the most common cause is acute trauma to toenails or fingernails usually associated with tennis, jogging, or hockey,” adds Jessica Luu, D.P.M., of JT Enterprises Corporation. “But less vigorous activities such as playing with a frisbee or golf can cause trauma to the capillaries of the vascular nail bed.”

However, there are some instances where a splinter hemorrhage may be a sign of something more serious.

Onychomycosis (fungal infection), for example, can give rise to splinter hemorrhages. Nail psoriasis may also cause hemorrhaging of the nail bed. In this condition, there is a thinning of the upper layer of the nail bed. Blood vessels are closer to the nail plate , so splinter hemorrhages are easier to develop.

Some medications may also cause splinter hemorrhages. Aspirin, for example, slows the coagulation process of the blood. Medications that are sold over-the-counter for headaches, arthritis, and other minor pains may also cause nail bed hemorrhaging.

If splinter hemorrhaging occurs on more than one nail the chances of your client having an underlying disorder or disease are more likely. And if they occur on more than one nail and frequently reappear, it may be a sign of a connective tissue disorder such as lupus, which is serious and requires medical evaluation and treatment.

Clients with Raynaud’s disease may also suffer from splinter hemorrhages. Clients with this condition are oversensitive to cold and if they do develop a hemorrhage the tips of their fingers may also be discolored and look pink, blue, or white.

On rare occasions, people with endocartitis (disease of the heart valves) can develop hemorrhages. Since they suffer from high fever, anemia, and heart murmurs they are usually already under the care of a physician.

They may also be associated with vasculitis (inflammation of the blood vessels) or microscopic clots that damage small capillaries (microemboli), says Dr. Luu.

Keywords:   elderly clients     fungal infections     nail diseases     nail trauma     splinter hemorrhage  



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