Splinter Hemorrhage

What is a splinter hemorrhage?

Splinter hemorrhages are small areas of bleeding (hemorrhaging) under your nails. They can affect your fingernails or toenails. They look like thin, red or reddish-brown lines below your nails. They run vertically in the direction of your nail growth. Splinter hemorrhages get their name because they look like wood splinters under your nail.

Splinter hemorrhages occur when small blood vessels called capillaries under the skin beneath your nail (nail bed) burst due to damage. The leaking blood becomes visible through your nail. Splinter hemorrhages most often occur after you injure your nail, but sometimes they are a sign of a health condition.

Who do splinter hemorrhages affect?

Splinter hemorrhages can affect anyone, but they’re more common in males than females. They’re also more common in people with darker skin tones than in people with lighter skin tones.

What does a splinter hemorrhage look like?

Splinter hemorrhages resemble wood splinters under your nail. They look like tiny lines or streaks under your nail plate that run in the direction of your nail growth. They’re usually 1 to 3 millimeters long. They normally appear closer to the end of your nails, but any part of your nail may be affected.

When they first form, splinter hemorrhages appear reddish or purple, but they’ll darken to brown or black within a few days. They’ll usually move with your nail as it grows.

Splinter hemorrhages occur more often in fingernails than toenails. They usually only affect one nail in otherwise healthy people. It may be a sign of an underlying condition if you have the condition in more than one nail.

What causes splinter hemorrhages?

When blood vessels under your nail bed sustain damage, splinter hemorrhages can occur. They can happen after you injure yourself. Trauma to your nail is the most common cause of the condition. Stubbing your toe or getting acrylic nails put on can cause splinter hemorrhages. If you have a splinter hemorrhage due to trauma or an injury, it will go away on its own and not cause any concern.

In some cases, splinter hemorrhages may be a sign of a medical condition that can damage your blood vessels. Infections, diseases and conditions that can cause the condition may include:

Skin conditions

Splinter hemorrhages are commonly seen in conditions such as nail psoriasis and lichen planus. Nail psoriasis is an autoimmune disorder that causes skin cells to collect on your nails. Lichen planus is an inflammatory skin condition that often results in an itchy rash. Up to 35% of people with lichen planus reported having splinter hemorrhages.

Vasculitis and systemic diseases

Splinter hemorrhages may be due to inflammation of your blood vessels (vasculitis). Several diseases such as antiphospholipid syndrome and lupus can cause vasculitis.

Infectious diseases

Bacterial infections such as endocarditis may cause splinter hemorrhages. Endocarditis is an infection of your heart valves. Studies show that 15% to 33% of people with endocarditis have splinter hemorrhages. People with chronic kidney disease also report them. This may be due to hemodialysis or a kidney transplant.

Drug reactions

Splinter hemorrhages are found in 60% to 70% of people taking kinase inhibitors such as sunitinib and sorafenib. Kinase inhibitors are cancer medications that stop cancer cells from growing. Splinter hemorrhages are also more common in people taking blood thinners such as aspirin, warfarin, apixaban or rivaroxaban.

Other causes

There are various other causes of splinter hemorrhages. They can occur because of a rare benign (noncancerous) tumor of your nail called onychomatricoma. They can look similar to a type of skin cancer called subungual melanoma.

How is a splinter hemorrhage diagnosed?

Your healthcare provider will perform a physical examination. They’ll also ask you about your symptoms and medical history. They may ask you:

• When you first noticed the splinter hemorrhage.
• If you’ve injured yourself recently or had an acrylic nail application.
• If the condition is affecting more than one nail.
• If you have other symptoms.
• About any other health conditions you have.
• If you’re taking any prescription or over-the-counter medications.

What tests will be done to diagnose a splinter hemorrhage?

Your healthcare provider may request a test called a dermoscopy. Using a dermoscope, a dermatologist can clearly see the splinter hemorrhage in order to help diagnose it.

How do you treat splinter hemorrhages?

Most splinter hemorrhages don’t require any treatment. If an injury caused the condition, it should go away on its own as the nail grows out.

If you don’t remember injuring yourself or you have splinter hemorrhages affecting more than one nail, contact your healthcare provider. They will determine treatment based on the underlying cause of the condition.

Your healthcare provider may prescribe you a medication or recommend an over-the-counter option if you have a disease such as nail psoriasis.

How can I reduce my risk of splinter hemorrhages?

You can reduce your risk of developing splinter hemorrhages due to injury or trauma by keeping your nails strong. Eat healthy foods rich in vitamin B and zinc to help support nail growth. In addition, drink plenty of water.

You can prevent splinter hemorrhages caused by certain drugs by stopping or reducing the medication. Be sure to talk to your healthcare provider before making any changes to your medication.

Other causes of splinter hemorrhages can’t always be prevented. They are typically a symptom of an underlying condition.

What can I expect if I have splinter hemorrhages?

Splinter hemorrhages are harmless if caused by an injury or other trauma. They may look unpleasant but they’ll go away within a few days or when your nail grows out.

If you haven’t sustained an injury, a splinter hemorrhage may be a sign of a more serious condition. Contact your healthcare provider to determine the underlying cause of the condition. Your outlook (prognosis) will depend on the cause of the condition and treatment.

When should I see my healthcare provider?

Many splinter hemorrhages are due to trauma or injury and will clear up on their own. However, there are certain reasons you should contact your healthcare provider about the condition. These reasons include:

• If you don’t remember injuring yourself or sustaining any trauma.
• If the splinter hemorrhage doesn’t go away within a few days or when your nail grows out.
• If you keep getting splinter hemorrhages.
• If the condition is affecting more than one nail.

A note from Cleveland Clinic

A splinter hemorrhage is a common nail condition that may have several different causes. The most common cause of the condition is trauma to your nail, but underlying health conditions can cause the disorder as well. If you’re worried about the condition, see your healthcare provider. They can help determine what may be causing it and how to treat it.