A splinter hemorrhage is, quite simply, bleeding under the nail. The discoloration caused from the blood runs in the direction the nail grows, not horizontally, creating the look of a splinter under the nail. Even the color — usually a dark reddish-brown color — resembles the color of a wooden splinter.
The most common cause of a splinter hemorrhage is trauma to the capillaries under the nail. The little capillaries burst or break and then clot, leaving a thin, dark line under the nail. Often when we think of trauma to a nail, we immediately think of some type of blunt-force trauma, say from hitting the nail with a hammer. However, the trauma that causes a splinter hemorrhage may not hurt at all. One story is told of a woman who, while delivering a baby, gripped the handles on the side of the bed with such force that the little capillaries under her nail broke. The “trauma” from squeezing was enough to cause the splinter hemorrhage.
Even though trauma is the most common cause of a splinter hemorrhage, it’s not the only cause. Splinter hemorrhages can be caused by fungal infections or from psoriasis, though in both of these cases, there would likely be other symptoms beyond the appearance of the hemorrhage.
What's a Tech To Do?
When a client comes in with a splinter hemorrhage, a tech’s first response should be to help the client recall the event of the trauma. Explain that the hemorrhage is most likely the result of bleeding and clotting from tiny capillaries that run under the nails. No treatment is needed; the discoloration will grow out with the nail. There’s no reason to get particularly concerned if a client doesn’t remember the exact event that caused the trauma. Many people won’t know what caused the slight bruise.
Most of the time a splinter hemorrhage will be harmless; however, there is the slight possibility that the condition could signal a serious infection in the lining of the heart (endocarditis). If a client cannot remember when the nail was traumatized, and she has other conditions that indicate heart problems, techs should recommend that a doctor evaluate the nails. It is highly unlikely that a client with a splinter hemorrhage would suffer from endocarditis with no other symptoms. However, techs should be aware of the possibility, in case a client has been avoiding the other warning signs.
There is no treatment that a tech can offer for a splinter hemorrhage. Left alone, the “splinter” will grow out on its own, leaving a healthy nail bed in its place. It is safe to continue with the client’s regular nail services. However, since you and the client will want to watch to be sure the hemorrhage is moving toward the free edge, it may be a wise decision to choose gel or acrylic that is not colored. Colored polish is fine, since it can be removed quickly and easily from home.
Could this be a sign of a more serious problem?
Techs should be aware that they could be the first professionals to alert clients to a more serious problem. Watch to see if the splinter hemorrhage appears to widen or spread to other fingers or to toenails. This would indicate the condition could be something entirely different from a splinter hemorrhage. A change in appearance, such as widening, or a change in location, such as spreading to other nails, could be the result of a mole under the nail, which could be melanoma.
The most important role techs can play in relation to clients with splinter hemorrhages is to alert them to the possibility that hemorrhages could indicate a serious heart condition, namely endocarditis. Endocarditis is a bacterial infection that, according to the Mayo Clinic, “typically occurs when bacteria or other germs from another part of your body, such as your mouth, spread through your bloodstream and attach to damaged areas in your heart.” Left untreated, endocarditis can be life-threatening. While it’s unlikely that techs would be the first to suggest endocarditis, it’s not impossible. Err on the side of caution and let clients know of the possibility of this condition.