What Is A Splinter Hemorrhage?

An Area of Blood Beneath the Nails Resembling a Splinter

A splinter hemorrhage is a small area of bleeding (hemorrhaging) that happens under the fingernails or toenails. It resembles a splinter, which is what it's named after. Oftentimes, splinter hemorrhages are caused by minor injuries, like biting your nails or stubbing your toe. However, they can also be a sign of serious disease, including endocarditis, an infection of the heart.

Continue reading to learn more about splinter hemorrhages, including what causes splinter hemorrhages and when they are serious and require further medical evaluation.

Types of Splinter Hemorrhage

A splinter hemorrhage is any bleeding that occurs under the fingernail or toenails. However, where the hemorrhage appears can give you important information about its causes and whether it is serious. The types of splinter hemorrhage are:

• Distal splinter hemorrhages occur around the base of the nail. They’re often caused by trauma and occur only in a few nails.

• Proximal splinters happen in the center of the nail. These are more serious since they can be a sign of heart infection. These splinters often occur in many nails at once.

Splinter Hemorrhage Symptoms

The only symptom of splinter hemorrhages is their appearance. They look like a spot that:

• Is red, brown, purple, or black in appearance

• Runs longitudinally, up and down the nail, rather than across it

• Can appear in one nail or many

Other than the appearance of a streak under the nail, splinter hemorrhages don’t have symptoms. However, the conditions that cause splinter hemorrhages, including infections, can have other symptoms that you might experience simultaneously.

Causes

Tiny blood clots cause splinter hemorrhages under the nail. These clots damage the capillaries, which are types of blood vessels, leading to a splinter-like appearance. Splinter hemorrhages are often caused by minor nail trauma, such as biting the nails or stubbing a toe.

However, splinter hemorrhages can also be caused by health conditions, including:

• Psoriasis (skin cells build up, forming patches of itchy, dry skin and scales)

• Fungal nail infection

• Medication side effects

• Endocarditis (infection of the heart valves)

• Vasculitis (inflammation of blood vessels)

Since splinter hemorrhages can be a sign of serious health conditions, you should see a healthcare provider if you experience splinter hemorrhages on multiple nails or have them often.

Diagnosis

A physical exam can diagnose splinter hemorrhages. Diagnosing splinter hemorrhages is less important than diagnosing the condition causing them, especially if you have proximal splinter hemorrhages that appear around the center of more than one nail.

If you see your healthcare provider about splinter hemorrhages, they might ask you about other symptoms you’re experiencing. Usually, splinter hemorrhages are not the first symptom people experience with other conditions. Still, they can be an important clue about underlying health concerns.

To diagnose the health conditions that might be contributing to splinter hemorrhages, your healthcare provider may order additional testing, including:

• Blood cultures

• Complete blood count (CBC)

• Erythrocyte sedimentation rate (ESR or sed rate), a type of blood test that measures markers of inflammation

• A chest X-ray

• An electrocardiogram (ECG or EKG)

• An echocardiogram

Treatment

Splinter hemorrhages don’t require treatment. They’ll disappear over time. However, if they are caused by another underlying condition you’ll need to work with a healthcare provider to treat that condition.

Are Splinter Hemorrhages Serious?

Sometimes, but not always, splinter hemorrhages can be serious. They are more likely to be a sign or serious disease if:

• They appear on many nails at once.

• They’re in the middle of the nail bed, rather than close to the base.

• You’re experiencing other symptoms, including fever, chest pain, or shortness of breath.

• You haven’t had recent trauma to the nails and don’t use a walking aid that could explain the hemorrhages.

When in doubt, it’s always best to talk with your healthcare provider to determine whether your splinter hemorrhages are cause for concern.

Summary

Splinter hemorrhages are small bleeds that can occur under the fingernails or toenails. They’re often red or brown in appearance and run along the length of the nail rather than across it. Most often, they are caused by trauma like bumping your nail and are not cause for concern.

However, splinter hemorrhages that appear without a clear cause, that are in the middle of the nail bed, or that happen on many nails at once may be a sign of serious illness, including an infection of the heart. When in doubt, talk to your healthcare provider about splinter hemorrhages.