What are the other Names for this Condition (Also known as/Synonyms)

• Fingernail Hemorrhage
• Toenail Hemorrhage

What are Splinter Hemorrhages? (Definition/Background Information)

• Small areas in which bleeding occurs under the fingernails and toenails are termed Splinter Hemorrhages. These are called Splinter Hemorrhages, because they appear similar to a splinter under the nail
• Splinter Hemorrhages are characterized by the appearance of reddish brown lines of blood which runs in a longitudinal direction under the nails. These are caused by tiny blood clots that damage the small capillaries under the nails
• Some reported risk factors for developing Splinter Hemorrhage include injury to the nail, autoimmune conditions, having certain underlying diseases such as vasculitis, endocarditis, and even diabetes, and the use of certain medications
• The most prominent symptom of Splinter Hemorrhage is the appearance of a reddish-brown vertical line under the fingernails or toenails. The diagnosis may require a physical examination and assessment of the underlying cause of the condition. Some blood tests and tests to assess heart function may also be required
• No specific treatment option exists for Splinter Hemorrhages. If an underlying cause is known, management of that condition can help reduce the formation of Splinter Hemorrhages
• Once Splinter Hemorrhage occurs, the individual can help prevent further damage by avoiding further irritation to the affected area. Discontinuing certain medications, known to lead to Splinter Hemorrhages, may also help avoid the condition
• In majority of individuals, the prognosis of Splinter Hemorrhage is excellent. In some, the prognosis depends upon the severity of the underlying condition that caused the Splinter Hemorrhage

Who gets Splinter Hemorrhages? (Age and Sex Distribution)

Splinter Hemorrhages can affect any individual irrespective of age, gender, race and ethnicity.

What are the Risk Factors for Splinter Hemorrhages? (Predisposing Factors)

The following are the risk factors associated with Splinter Hemorrhage:

• Injury to the nail
• The presence of underlying diseases such as:
  • Bacterial endocarditis: Infection of the heart valves caused by bacteria
  • Vasculitis: Damage to the blood vessels caused by a swelling of the blood vessels
• Damage caused to the small capillaries under the nail, due to formation of small clots
• The presence of underlying autoimmune medical conditions such as:
  • Systemic lupus erythematosus (SLE)
  • Scleroderma
  • Rheumatoid  arthritis
  • Nail psoriasis
• Use of certain medications that include:
  • Aspirin
  • Non-steroidal anti inflammatory agents used for headaches, arthritis and other small pains
• Reynaud’s disease: A condition when the fingers and toes become oversensitive to cold
• Diabetes
• Being an athlete (athletes generally have a high risk for Splinter Hemorrhages)
• Living in very cold places
• Onychomycosis-Fungal infection of the nails

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your health care provider.

What are the Causes of Splinter Hemorrhages? (Etiology)

Splinter Hemorrhage is caused by ruptured blood vessels (capillaries) in the nail bed of the fingernails or toenails. The following are the possible causes that may lead to the occurrence of Splinter Hemorrhage:

• Nail injury or trauma: Damage caused to the small capillaries under the nail due to formation of small blood clots
• Accumulation of excess cholesterol in the capillaries of the finger nails
• Endocarditis, which is heart valve infection caused by bacteria
• Vasculitis: Blood vessel damage due to inflammation
• Raynaud’s disease: A condition when the fingers and toes become oversensitive to cold
• Diabetes
• Autoimmune disorders that include:
  • Lupus (or SLE)
  • Scleroderma
  • Rheumatoid arthritis (or RA)
  • Nail psoriasis
• Use of certain medications such as:
  • Aspirin
  • NSAIDs for headaches, arthritis, and other minor aches/pains
• Exposure to extreme cold
• Onychomycosis-fungal infection of the nails

What are the Signs and Symptoms of Splinter Hemorrhages?

• The most prominent symptom manifested by Splinter Hemorrhage is the appearance of thin, reddish-brown lines of blood under the fingernails
• With time, the hemorrhage can turn blue and eventually black

Apart from this, there may be signs and symptoms of the underlying disease or condition.

How are Splinter Hemorrhages Diagnosed?

A healthcare provider may need the following assessments to arrive at an accurate diagnosis of a Splinter Hemorrhage:

• A complete physical examination with special emphasis on heart and blood circulation system
• Evaluation of medical history including history of any underlying diseases or disorders
• Laboratory tests:
  • Blood cultures
  • Complete blood count (CBC)
  • Erythrocyte sedimentation rate (ESR) for checking systemic inflammation
• Other tests to diagnose or monitor underlying diseases may include:
  • Chest X-ray
  • ECG
  • Echocardiogram
• When the hemorrhage is old, it can turn blue and black. This may resemble malignant melanoma (a type of cancer). Hence, a differential diagnosis to rule out melanoma may be undertaken

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Splinter Hemorrhages?

Splinter Hemorrhage typically does not lead to any severe complications.

How are Splinter Hemorrhages Treated?

There is no particular treatment for Splinter Hemorrhage.

• If the condition has been caused by intake of medications, then stopping or discontinuing the medicine may be helpful
• Individuals are generally advised to be careful not to:
  • Increase irritation in the affected area
  • Increase further trauma to the nail

How can Splinter Hemorrhages be Prevented?

It is recommended that those with Splinter Hemorrhages exercise caution and not aggravate the condition through:

• Increased irritation to the affected area
• Increased trauma to the nail

What is the Prognosis of Splinter Hemorrhages? (Outcomes/Resolutions)

• The prognosis of Splinter Hemorrhage is excellent in most cases. however, this may also be dependent upon the severity of the underlying condition (if any)
• In a healthy individual, Splinter Hemorrhage resolves spontaneously within a couple of days without requiring any treatment

Additional and Relevant Useful Information for Splinter Hemorrhages:

• A melanoma is a type of cancer that develops from cells, called melanocytes

The following article links will help you understand melanoma of skin:

http://www.dovemed.com/diseases-conditions/melanoma-of-skin/