Have you ever noticed small red lines appearing on your nails? These little red streaks on the nails are called splinter hemorrhages which may arise due to trauma to the nail. However, if you cannot recall ever injuring your nails, then the presence of these red streaks may signal an underlying medical condition.
What are Splinter Hemorrhages?
As mentioned, splinter hemorrhages are small red longitudinal streaks that appear under the nails. These occur due to blood leaking or swelling from the blood vessels running up and down one’s nails. Microemboli, which are small blood clots, that form in the capillaries is also a likely cause of a splinter hemorrhage.
The splinter hemorrhage is approximately 1 to 3 millimeters long, whereas the streaks may appear reddish-brown or red. These streaks are rarely painful. However, if the pain is associated with the splinter hemorrhage, then it may likely be linked to systemic disease. In individuals with systemic diseases, the splinter hemorrhage may reoccur in different locations of the nail.
Women are less likely to experience a splinter hemorrhage than men. Also, individuals of darker complexions are at higher risk of getting a splinter hemorrhage than fair-skinned individuals.
Trauma to the nails is the usual cause of splinter hemorrhages, which account for approximately 20 percent based on a study by the American Academy of Family Physicians. Such instances of trauma to the nails include hitting the fingernails against something hard, getting the nails stuck in cramped or tight spaces, or dropping something hard on the nails.
However, if an individual fails to identify the reason for the splinter hemorrhage to have appeared, then it may signal an underlying condition. Various causes of a splinter hemorrhage include the following.
1. Antiphospholipid Syndrome
When blood clots form in the veins and arteries, the nail beds may also manifest such clots. This may signal antiphospholipid syndrome which can be due to another condition like lupus.
2. IV Drug Abuse
Heroin is an illegal drug often abused by some individuals. Consistent use of such an illegal drug not only causes splinter hemorrhages but puts an individual at a higher risk of getting infectious diseases.
3. Infectious Endocarditis
Infectious endocarditis may occur when an individual is diagnosed with an underlying medical condition like strep. Other than strep, individuals who continuously use IV drugs are at a higher risk of getting infectious endocarditis. Splinter hemorrhages are one of the later symptoms of this condition.
4. Rheumatic Heart Disease
Strep throat, when left untreated during childhood, may develop to a severe infection. This places the child at a greater risk of developing rheumatic heart disease during adulthood.
5. Systemic Lupus Erythematosus
This condition is an autoimmune disorder that causes changes in the circulation in the fingers, blood clotting, and joint pain. However, on rare occasions, a splinter hemorrhage may be a result of consuming medications such as warfarin, aspirin, or chemotherapy drugs like ganciclovir or tetracycline.
6. Nail Psoriasis
Another autoimmune disorder is nail psoriasis which leads to an overgrowth of skin cells on the nails. This leads to nail pitting. However, nails may also separate or split from the bed of the nails.
7. Idiopathic Splinter Hemorrhaging
In cases where the reason for the splinter hemorrhage cannot be identified, it is diagnosed as an idiopathic splinter hemorrhage.
This autoimmune rheumatic disorder causes skin hardening and splinter hemorrhages. A dermatologist and a rheumatologist conduct numerous specific tests to diagnose an individual with this condition. Since it is much like other autoimmune disorders, scleroderma is complicated to diagnose. Depending on the organ it affects, this disease affecting chronic connective tissues may be mild or extremely fatal.
This condition causes damage to the blood vessels due to inflammation.
10. Raynaud’s Disease
In this medical condition, the fingers and toes become sensitive to cold which may lead to damage in the capillaries, particularly in the nails.
Various causes for a splinter hemorrhage not mentioned above may also include peptic ulcer disease, oral contraceptive use, mitral stenosis, internal malignancy, or pregnancy. High levels of cholesterol and blood sugar, particularly diabetes, can cause damage to blood vessels and may lead to splinter hemorrhages. A fungal infection of the nail bed could also lead to blood vessel damage.
Splinter hemorrhages that are caused by trauma do not require treatment. These streaks subside over time as the nails grow, which takes approximately three to four months.
Individuals may prevent splinter hemorrhages due to trauma by making the nails strong. Such methods include drinking more than eight glasses of water a day and adding zinc and vitamin B to the diet. A diet high in these minerals and vitamins help support the strong growth of the fingernails.
In cases where the splinter hemorrhage is due to a medical condition, the treatment depends on the diagnosed disease. In endocarditis, surgery is recommended to replace the damaged valves causing the bleeding.
For streaks on the nails related to medications, an individual should consult with their primary caregiver regarding alternative medicines to take.
When to Seek Medical Attention
A splinter hemorrhage that is painful and is not caused by trauma or injury should be brought to the doctor for an evaluation. Other than pain associated with the splinter hemorrhages, an individual should seek medical attention if he or she manifests the following.
- Joint Pain
- Petechiae (Red Dots on Skin)
What to Expect at Visit?
During an evaluation, the healthcare provider asks questions to determine the cause of a splinter hemorrhage. Such questions include the following.
- Have you experienced recent injury or trauma to the nails?
- When did the streaks first appear or when did you first notice them?
- Have you experienced other symptoms such as muscle aches, fever, or shortness of breath?
- Have you been diagnosed with endocarditis?
Apart from a quick medical history, a physical examination is done which includes tests such as blood cultures, erythrocyte sedimentation rate, or a complete blood count. Further tests that may be ordered by the healthcare provider also include an echocardiogram, an ECG, or a chest x-ray.
In rare instances, a splinter hemorrhage may be a symptom of cancer, specifically melanoma. The healthcare provider may suggest a biopsy, especially if he or she suspects malignancy. A biopsy determines if the dark spots are benign or cancerous.