Splinter hemorrhages: MedlinePlus Medical Encyclopedia

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Splinter hemorrhages are small areas of bleeding (hemorrhage) under the fingernails or toenails.

Splinter hemorrhages look like thin, red to reddish-brown lines of blood under the nails. They run in the direction of nail growth.

They are named splinter hemorrhages because they look like a splinter under the fingernail. The hemorrhages may be caused by tiny clots that damage the small capillaries under the nails.

Splinter hemorrhages can occur with infection of the heart valves (endocarditis). They may be caused by vessel damage from swelling of the blood vessels (vasculitis) or tiny clots that damage the small capillaries (microemboli).

Causes may include:

• Bacterial endocarditis
• Injury to the nail

There is no specific care for splinter hemorrhages. Follow your health care provider’s instructions for treating endocarditis.

Contact your provider if you notice splinter hemorrhages and you haven’t had any recent injury to the nail.

Splinter hemorrhages most often appear late in endocarditis. In most cases, other symptoms will cause you to visit your provider before splinter hemorrhages appear.

Your provider will examine you to look for the cause of splinter hemorrhages. You may be asked questions such as:

• When did you first notice this?
• Have you had an injury to the nails recently?
• Do you have endocarditis, or has your provider suspected that you have endocarditis?
• What other symptoms do you have, such as shortness of breath, fever, general ill feeling, or muscle aches?

The physical exam may include special attention to the heart and blood circulation systems.

Laboratory studies may include:

• Blood cultures
• Complete blood count (CBC)
• Erythrocyte sedimentation rate (ESR)

In addition, your provider may order:

• Chest x-ray
• Electrocardiogram (ECG)
• Echocardiogram

After seeing your provider, you may want to add a diagnosis of splinter hemorrhages to your personal medical record.

Fingernail hemorrhage

Lipner SR, Scher RK. Nail signs of systemic disease. In: Callen JP, Jorizzo JL, Zone JJ, Piette WW, Rosenbach MA, Vleugels RA, eds. Dermatological Signs of Systemic Disease. 5th ed. Philadelphia, PA: Elsevier; 2017:chap 44.

Tosti A. Diseases of hair and nails. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 413.

Wright WF. Fever of unknown origin. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 56.

Updated by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Splinter Hemorrhages: Symptoms, Causes, and Treatments

A splinter hemorrhage is when small blood spots appear under the nail. They are caused by damaged blood vessels.

What is a splinter hemorrhage?

Splinter hemorrhages are tiny blood spots that appear underneath the nail. They look like splinters and occur when tiny blood vessels (capillaries) along the nail bed are damaged and burst. The nail bed is the skin underneath the nail.

Small amounts of blood from the damaged blood vessel become visible through the nail. The bleeding creates a splinter-like line in the direction of nail growth. Splinter hemorrhages can occur on your toenails or fingernails.

The primary symptom of a splinter hemorrhage is a small amount of bleeding underneath a nail. You may notice a dark red or brown line along your nail groove. The dark streak closely resembles a splinter.

A splinter hemorrhage doesn’t usually cause physical pain. In fact, you may not immediately notice the hemorrhage. The exception is when a splinter hemorrhage occurs from an injury, such as hitting your toe or finger. In this case, you may have swelling, inflammation, and pain along with a small amount of blood.

Splinter hemorrhages can develop after an injury or trauma to a fingernail or toenail. Stubbing a toe or injuring a finger can damage blood vessels along the nail bed on the affected digit and trigger bleeding underneath the nail.

Splinter hemorrhages caused by injury aren’t a reason for concern. The nail will clear up as the injury heals. But sometimes a splinter hemorrhage indicates an underlying disease or disorder.

If you didn’t injure your toe or finger, the hemorrhage may result from conditions that can damage blood vessels. Underlying conditions may include:

• Bacterial endocarditis: Bacterial in the blood stream travels to the heart valve.
• Vasculitis: Blood vessel damage caused by inflammation.
• Systemic diseases: These cause inflammation in blood vessels, such as rheumatoid arthritis, nail psoriasis, lupus, scleroderma, peptic ulcer, malignancies.
• Fungal infection of the nail: Infections can trigger thinning of the nail bed and possible blood vessel damage.
• Diabetes: High glucose levels can damage blood vessels.
• Raynaud’s disease: Toes and fingers become oversensitive to coldness, which can damage capillaries in the nail bed.
• Cholesterol: Accumulation of this substance in the blood vessels of the fingernails can result in damage.

Splinter hemorrhages can also occur as a side effect of certain medications, such as nonsteroidal anti-inflammatory drugs. These medications can cause bleeding when taken in high doses.

If you experience minor bleeding from a splinter hemorrhage caused by an injury, there’s no reason to see a doctor. On the other hand, if a splinter hemorrhage occurs for an unknown reason, or if you have bleeding in more than one nail, see a doctor for further evaluation.

Your doctor may ask about your medical history and family medical history. Laboratory tests used to determine the cause of splinter hemorrhages include:

• blood culture (detects bacteria or fungi in your blood)
• complete blood count
• erythrocyte sedimentation rate (detects inflammation in your body)

Your doctor may also order imaging tests to look for abnormalities. These include a chest X-ray and an echocardiogram, which takes pictures of your heart.

Sometimes a hemorrhage under the nail is a sign of melanoma, a type of cancer. If your doctor suspects a malignancy, they’ll recommend a biopsy to determine whether the dark spot is cancerous or benign.

Treatments depend on the underlying cause.

Treatments for splinter hemorrhages caused by trauma

No treatment is necessary for splinter hemorrhages caused by trauma. Depending on the severity of the injury, the hemorrhage may clear up within a couple of days or slowly disappear as your nail grows out. Because nails grow at a slow pace, it may take several months for the splinter-like mark to completely disappear.

If you have pain following an injury to your fingernail or toenail, apply a cold compress to the area to reduce swelling and inflammation, or take over-the-counter pain medication as directed.

Treatments for other causes

Splinter hemorrhages caused by a disease or disorder may clear up after treating or curing the underlying cause.

Treatment for these types of hemorrhages vary. For example, your doctor may prescribe medication or recommend an over-the-counter antifungal for splinter hemorrhages caused by a fungal infection. Or you may receive a prescription corticosteroid or immunosuppressant if the underlying cause is a systemic disease like rheumatoid arthritis or nail psoriasis.

If testing determines that you have bacterial endocarditis, your doctor may prescribe an antibiotic or recommend surgery to repair your heart valves.

When splinter hemorrhages are a side effect of medication, the hemorrhage may disappear once you stop taking the medication.

The outlook for splinter hemorrhages is often positive. When caused by trauma, the nail slowly heals and clears up without medical treatment.

For the best possible outcome for hemorrhages caused by an underlying disease or disorder, listen to your doctor’s recommendations. This may include discontinuing certain medications, as well as taking medications as directed.

What do the spots of different colors on the nails signal – symptoms, treatment and prevention

March 14, 2021

Every woman wants to look great and understands perfectly well that healthy, shiny and well-groomed nails are a manifestation of her beauty. However, nails can tell not only about the good taste of their owner, they also carry valuable information about her health and lifestyle. A change in the structure of the nail plates may indicate the presence of an infection, serious illness or malnutrition. One of the unwanted signs that our body sends is the appearance of spots on the nails. What are they?

Common causes of nail defects

Changes are sometimes harmless. Color, structure, shape change, forming dots, grooves, breaks, discoloration, dents and cracks. If you are concerned about the condition of the nail plates, see a doctor, as in this case it takes more than just looking at your hands to find out about the problem. The nail consists of horny cells – from 100 to 150 layers superimposed on each other. It grows slowly (from 0.5 to 1.2 millimeters per week).

Grooves

Longitudinal grooves are a normal sign of age. In most cases, they are harmless. Transverse depressions indicate abnormal growth of the nail. A clumsily performed manicure injures the growth zone and the entire plate, which can lead to grooves. Other causes may be severe infections, ailments of the gastrointestinal tract, vitamin deficiency or poisoning (thallium, arsenic, as well as barbiturates, cytostatics or anticoagulants).

Warp

If the nail has an enlarged, round-bulging shape, this most often indicates ailments of the lungs or heart. This is where a visit to the doctor is important. If the nail plate is lowered inward, and the edge is bent upwards (in the form of a spoon), this indicates an iron deficiency or exposure to chemicals. Spots and funnel-shaped depressions can be caused by eczema, alopecia, or a fungal infection.

Brittleness

The reason may be frequent contact with detergents and chemicals. Nail polish removers dehydrate your nails, making them brittle. Sometimes the cause is malnutrition (lack of vitamins A, B and iron), malnutrition (anorexia).

Color spots on the nails – yellow, purple-blue… or something else?

The medical term for discoloration of the nail plate is dyschromia. Distortion of a healthy color can occur over the entire plate or in its individual sections. Dyschromia is common in the form of spots of white, yellow, violet-blue, reddish, brown or black. The reasons are different – these are diseases of the liver, kidneys, heart, external factors, the appearance of infections, unbalanced nutrition. Let’s get acquainted with them in more detail, taking into account the colors.

White

May be harmless. They are usually a sign of the normal aging process. Some of them are also inherited. However, white spots can indicate many diseases. The symptom itself is called “leukonychia” – from the Greek words “leuko”, which means white, and “onyx” – “nail”. Leukonychia, depending on its immediate cause and visual defect, is a very variable condition and can signal health problems.

Causes of white spots on the nails:

• Allergy to cosmetics.
• Low red blood cells.
• Liver disease, diabetes, overactive thyroid, heart failure.
• Lack of nutrients in the diet.
• The most common disease-related changes that appear on the nails include fungus and psoriasis. They have very similar characteristics. In both diseases, the horny plate thickens, becomes crumbly, wavy and flaky, in addition, the color of the nail changes to cloudy white.
• Injuries, pinching, wearing uncomfortable shoes.
• Heavy metal poisoning.
• If the nails are deep white with a narrow pink stripe at the tip, this disease is called “Terry’s nails” and is the result of aging.

White spots were previously thought to be a symptom of calcium deficiency. However, on the contrary, leukonychia can occur as a result of excess calcium in the body. This is an important indicator for a careful examination of health by a doctor. Such a seemingly harmless symptom can accompany serious diseases – skin (erythema multiforme, alopecia, psoriasis), Hodgkin’s lymphoma, some types of anemia, kidney failure, infections and injuries.

Red

The cause may be trauma or aggressive manicure. Inept handling of nail clippers also causes damage.

The main causes of redness:

• Infective endocarditis or bacterial damage to the heart valves. The disease allows the formation of microthrombi that clog the capillaries of the nail plate. Fuzzy red stripes form in the form of splinters.
• Cyanosis – occurs when red blood cells cannot carry enough oxygen. Its manifestations can be seen on other parts of the body.
• Gore after injury.
• Psoriasis – sometimes characterized by dark red subungual hemorrhages.

It is better to find out the cause from a doctor (if it is not related to an injury). A blood test and a chest ECG are done to confirm infective endocarditis. For psoriasis – a blood test + examination of the skin and nails. The appearance of red formations on the toenails usually indicates hypertension, pulmonary disorders, or carbon monoxide poisoning (the nail bed becomes cherry red).

Black

Change to black may be caused by injury. A hematoma forms under the nail.

And in the worst case, black spots on the nails can lead to:

• Skin cancer (melanoma). Medicines can discolor nails to brown, blue, or greenish.
• Cardiovascular diseases.
• Diseases of the stomach or duodenum XII.
• Lack of vitamins A, C, B + fatty food.
• Circulatory disorders of the brachial artery.
• Pathology of the liver.
• Onychomycosis (fungus).

A genetic factor may also be the cause of the disorder. Black spots sometimes indicate cyanosis – a lack of oxygen. In this case, medical attention is required.

Yellow

The reasons for their appearance can be not only harmless, but also dangerous. Frequent use of decorative varnishes, work with aggressive chemicals and paints causes yellowing of the nails. The constant use of gel polish when building up acrylic decorative coatings blocks the access of air and causes changes due to harmful substances.

Diseases that cause yellow spots on the nails include:

• Psoriasis. In this case, yellowish spots, similar to drops of oil, sometimes form.
• Fungal infections.
• Diseases of the liver + gallbladder. Stagnation of bile leads to the accumulation of yellow pigments at the site of the nail bed.
• Diabetes.
• Yellowish-brown to grey-green change, induration and hardening of some or all of the nail plates are characteristic of “yellow nail syndrome”. The syndrome is associated with respiratory diseases and lymphedema.
• Consumption of foods rich in carotenoids + poor absorption of vitamin A.

Age changes also cause yellowing of the nails. You can improve their condition with the help of special tools and bleaching compounds.

Brown

Darkening of the nails occurs after contact with chemicals (stain, hair dye, nicotine in smokers).

Also lead to this:

• Addison’s disease (autoimmune or tuberculous destruction of the adrenal glands).
• Large amount of iron in the blood.
• Hormonal abnormalities.
• Fungal infection.
• Long-term use of certain medications.

Changes may occur on or under the nail plate.

Blue

Most often, blue spots appear due to injuries.

In addition, the reasons may be:

• Poor blood circulation, and as a result – insufficient saturation of tissues with oxygen.
• Iron deficiency, together with a lack of vitamin B12, contributes to the development of iron deficiency anemia.
• Glomus tumor of the phalanx. Requires surgical intervention.

Diagnosis of deficiency of any essential substances in the body can be based on a careful analysis of diet and blood. In addition to testing the level of macro- and microelements, tests for the content of heavy metals also need to be carried out. Growth of healthy and shiny nails can be maintained with the right supplements.

Why nails stain and what to do about them – HEROINE

Nail stains are quite common. Of course, you can hide them under a layer of varnish, but do not lose sight of the reasons for their appearance. They can be different: from damage to the nail to health problems.

A change in nail pigmentation is called dyschromia. From this material you will learn why spots appear on the nails, how to deal with them and when you should not put off going to the doctor.

What are the spots on the nails

There are a lot of reasons for the appearance of spots on the nails, as well as their shades. The color of the pigment may indicate diseases or problems that should not be overlooked.

White spots

White spots on the nails are not always a reason to sound the alarm. They can appear with age, and this is quite normal. Or even be hereditary.

But sometimes their appearance is due to other factors that need to be paid attention to. The white spots themselves are called leukochinia, and this symptom can indicate various problems in the body:

• allergic to cosmetics;
• low red blood cells, anemia;
• liver disease;
• diabetes mellitus;
• abnormal functioning of the thyroid gland;
• lack of vitamins and minerals in the diet.

Sometimes the white spots can grow and take up quite a large space on the nail plate. This may be due to fungus and psoriasis. At the same time, the nail plate thickens, peels off, and its color changes to dull white.

Red spots

Red spots on the nails may be the result of injury. They also appear if you carelessly use manicure accessories, such as nail clippers.

But there are other causes of red spots. For example, such spots appear with infective endocarditis or damage to the heart valves. With these diseases, microthrombi are formed, which clog the capillaries under the nail plate. In this case, the spots look like a kind of splinters or blurry stripes.

Cyanosis also causes red spots on the nails. This condition occurs due to insufficient oxygenation of the skin and mucous membranes, which leads to problems with the vessels – their thinning and fragility.

Also, red spots can be one of the manifestations of psoriasis. In this case, they acquire a dark shade, and their cause is hemorrhages under the nail plate.

If you have red spots on your nails that are not related to injury, you should see a doctor to determine the exact cause.

Black spots

Severe injuries can cause hematomas under the nail plate – this is the cause of black spots.

Also, black spots are characteristic of diseases of the stomach and pathologies of the liver. They can appear in diseases of the cardiovascular system and fungi. Also common in people battling skin cancer, drugs to treat the condition can change the color of your nails to dark shades of blue, brown, black, or green.

Also, with cyanosis, which we mentioned earlier, there may be not red, but black spots on the nails.

Yellow spots

Often such spots can be found on the hands of artists and manicure enthusiasts. They appear due to frequent contact with chemicals. Yellowing of the nails is also found in smokers.

Spots resembling drops of oil may appear in psoriasis. Also, yellow pigmentation is common with fungal diseases and poor absorption of vitamin A.

And if yellow color appears in the area of ​​the nail bed, this may indicate diseases of the liver and gallbladder. It is the stagnation of bile in the body that is the cause of this color change.

Find out more about why nails can turn yellow here.

Brown spots

Brown spots on the nails may be the result of exposure to chemicals and smoking. Changes in the nail plate can be both external and internal. Long-term medication can also change nail pigmentation.

It also occurs when there is an excess of iron in the blood. Quite often, brown spots are also found in hormonal failure. You can read about its other symptoms in this material.

Blue spots

Most often, nails acquire this shade due to injuries. In addition, the cause of blue spots can be poor blood circulation, lack of vitamin B12 and iron, anemia.

Another serious cause is a glomus tumor of the nail phalanx. This is a benign formation of the neuromuscular node of the skin. Its most common symptom is burning and pain at the tip of the finger, even with a light touch or exposure to cold. If you notice such a symptom in yourself, you should not postpone going to the doctor. Timely assistance will reduce the risk of complications.

How to deal with pigment spots on nails

The first thing to do when pigment spots appear is to consult a doctor and, if necessary, undergo an additional examination. In many cases, purely cosmetic solutions to problems are not enough.

However, there are some general recommendations that help in the fight against stains on the nails:

• review your diet: include more foods rich in vitamins and minerals, dietary meat in your diet. And spicy, fatty and smoked foods should be discarded;
• avoid stress: they lead to a deterioration in the general condition of the body and chronic diseases, which also appear in spots on the nails;
• take proper care of your nails: do not overdo it with the amount and frequency of application of varnish, use a moisturizer, do baths to strengthen nails;
• give up smoking: age spots associated with it are quite difficult to remove without getting rid of a bad habit;
• wear gloves when working with chemicals: the less your nails come into contact with harmful substances, the better they look.