Nail & Skin Disorders

Under the Microscope: Splinter Hemorrhages

A splinter hemorrhage is a small area of bleeding under the fingernails or toenails that usually requires no treatment.

What is it? 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.

How do you get it? 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. Although trauma is the most common cause, splinter hemorrhages can also 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.

How is it treated? No treatment is needed; the discoloration will grow out with the nail, leaving a healthy nail bed in its place. 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.

What can a tech do? 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 by the client. 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.

What else? 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.

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