Splinter Hemorrhages

Splinter hemorrhages are small, linear, and red or brown lines that occur beneath the nails of the fingers or toes. They are usually less than 1 cm in length and can be a sign of underlying medical conditions, including serious ones like endocarditis and bacterial infections.

There are several types of splinter hemorrhages, each with different causes and implications.

1. Traumatic Splinter Hemorrhages: These are the most common type of splinter hemorrhages and are caused by physical trauma to the nail. This can occur from things like slamming your finger in a door or hitting your finger with a hammer. The injury can cause small blood vessels to break under the nail and result in a splinter hemorrhage. Traumatic splinter hemorrhages are typically harmless and will clear up on their own with time.
2. Endocarditis-Associated Splinter Hemorrhages: Endocarditis is an infection of the inner lining of the heart, and it can cause splinter hemorrhages to occur. The splinter hemorrhages in this case are caused by small clumps of bacteria that break off from the infected heart valve and travel through the bloodstream to the nails. Endocarditis-associated splinter hemorrhages are usually found in conjunction with other symptoms of endocarditis, such as fever, fatigue, and joint pain.
3. Rheumatoid Arthritis-Associated Splinter Hemorrhages: Rheumatoid arthritis is an autoimmune disease that can cause inflammation in the joints and other parts of the body. People with rheumatoid arthritis are at increased risk for developing splinter hemorrhages, which are caused by the inflammation and irritation of the small blood vessels beneath the nails.
4. Systemic Lupus Erythematosus-Associated Splinter Hemorrhages: Systemic lupus erythematosus (SLE) is another autoimmune disease that can cause splinter hemorrhages. SLE can cause inflammation and damage to the blood vessels, including the small blood vessels beneath the nails, which can result in splinter hemorrhages.
5. Raynaud’s Disease-Associated Splinter Hemorrhages: Raynaud’s disease is a condition that affects the blood vessels in the fingers and toes and causes them to narrow in response to cold temperatures or stress. People with Raynaud’s disease are at increased risk for developing splinter hemorrhages, which are caused by the reduced blood flow to the nails.

Causes

These can be a sign of underlying medical conditions and can be caused by a variety of factors. Some of the most common causes of splinter hemorrhages include:

1. Endocarditis: Endocarditis is an infection of the inner lining of the heart, specifically the endocardium. This condition can cause small clumps of infected material to break off and travel through the bloodstream, leading to splinter hemorrhages.
2. Vasculitis: Vasculitis is a group of disorders that cause inflammation of the blood vessels. This inflammation can cause the blood vessels to become narrow or even blocked, leading to the formation of small clots, such as splinter hemorrhages.
3. Trauma: Physical trauma to the nails, such as from bumping or hitting them, can cause splinter hemorrhages.
4. Raynaud’s disease: Raynaud’s disease is a condition that affects blood flow to the fingers and toes. It can cause the blood vessels to narrow and become blocked, leading to the formation of splinter hemorrhages.
5. Thrombophilia: Thrombophilia is a condition that causes a person’s blood to form clots more easily than normal. This can lead to the formation of splinter hemorrhages.
6. Connective tissue disorders: Connective tissue disorders, such as lupus and rheumatoid arthritis, can cause inflammation in the small blood vessels, leading to the formation of splinter hemorrhages.
7. Septicemia: Septicemia is a serious infection that occurs when bacteria enter the bloodstream and spread throughout the body. This can cause small clumps of infected material to break off and travel through the bloodstream, leading to splinter hemorrhages.
8. Nicotine and other vasoconstrictors: Nicotine and other vasoconstrictors, such as caffeine and certain medications, can cause the blood vessels to narrow and become blocked, leading to the formation of splinter hemorrhages.
9. Hypertension: High blood pressure can cause damage to the blood vessels, leading to the formation of splinter hemorrhages.
10. Sickle cell anemia: Sickle cell anemia is a genetic condition in which the red blood cells are shaped like crescents, instead of the normal round shape. This can cause the blood cells to become stuck in the small blood vessels, leading to the formation of splinter hemorrhages.
11. Chronic obstructive pulmonary disease (COPD): COPD is a group of lung diseases that cause breathing difficulties. It can cause damage to the small blood vessels in the fingers and toes, leading to the formation of splinter hemorrhages.
12. HIV/AIDS: HIV/AIDS weakens the immune system, making it easier for infections to occur. This can cause small clumps of infected material to break off and travel through the bloodstream, leading to splinter hemorrhages.
13. Systemic lupus erythematosus (SLE): SLE is a type of autoimmune disorder that causes inflammation in various parts of the body, including the blood vessels. This can cause the formation of splinter hemorrhages.
14. Behcet’s disease: Behcet’s disease is a rare autoimmune disorder that causes inflammation in various parts of the body, including the blood vessels. This can cause the formation of splinter hemorrhages.
15. Rickettsial infections: Rickettsial infections are caused by bacteria that are spread by ticks and other insects. They can cause small clumps of

Symptoms

The following are the main symptoms associated with splinter hemorrhages:

1. Pain: Pain or tenderness may be felt at the site of the splinter hemorrhage, especially if the affected nail has been traumatized.
2. Discoloration: The affected nail will typically appear red or brown in color due to the presence of blood under the nail.
3. Nail Bed Inflammation: Inflammation of the nail bed may occur, causing swelling and redness in the area.
4. Nail Bed Drainage: Drainage of fluid or pus from the nail bed may occur, which can indicate the presence of an infection.
5. Nail Bed Deformity: The affected nail may become deformed, causing it to become raised or have a curved appearance.
6. Nail Bed Separation: The nail may separate from the nail bed, which can cause pain and tenderness.
7. Nail Bed Ulceration: An ulcer may form on the nail bed, which can be painful and may drain fluid or pus.
8. Nail Bed Discoloration: The nail bed may become discolored, appearing yellow, green, or brown in color.
9. Nail Bed Thickening: The nail bed may become thickened, causing the affected nail to become raised or have a distorted appearance.
10. Nail Bed Splitting: The nail may split or crack, causing pain and tenderness.
11. Nail Bed Bruising: Bruising of the nail bed may occur, causing the affected area to appear black and blue in color.
12. Nail Bed Tenderness: The affected area may be tender to the touch, causing discomfort or pain when pressure is applied.
13. Nail Bed Warmth: The affected area may feel warm to the touch, indicating inflammation and the presence of an infection.
14. Nail Bed Swelling: Swelling may occur in the affected area, causing the nail to become raised or distorted in appearance.
15. Nail Bed Drainage: Drainage of fluid or pus from the nail bed may occur, which can indicate the presence of an infection.

It is important to seek medical attention if you experience any of these symptoms, as they may indicate a more serious underlying condition. Some of the common causes of splinter hemorrhages include trauma to the nail, infections, systemic diseases, and certain medications.

Diagnosis

There are several types of diagnoses and tests that can be performed to determine the cause of splinter hemorrhages. Here are 15 of the most common:

1. Physical examination: A physical examination of the nails can help to determine the presence of splinter hemorrhages. This examination may involve looking for other signs of illness, such as changes in the color or texture of the skin, nail bed, or surrounding tissue.
2. Blood tests: Blood tests can be used to check for underlying medical conditions that may be causing splinter hemorrhages. This may include tests for infections, such as streptococcal infections, or tests for autoimmune diseases, such as lupus.
3. Fungal culture: If a fungal infection is suspected as the cause of splinter hemorrhages, a fungal culture may be performed. This test involves taking a sample of the affected nail and growing it in a laboratory to determine the type of fungus that may be causing the infection.
4. Biopsy: If other tests do not reveal the cause of splinter hemorrhages, a biopsy may be performed. This involves removing a small piece of the affected nail and examining it under a microscope to determine the underlying cause.
5. Endocarditis blood culture: Endocarditis is an infection of the heart valves that can cause splinter hemorrhages. A blood culture can be performed to check for the presence of the bacteria that cause endocarditis.
6. Antinuclear antibody (ANA) test: The ANA test is used to check for autoimmune diseases, such as lupus, that may be causing splinter hemorrhages.
7. Rheumatoid factor (RF) test: The RF test is used to check for rheumatoid arthritis, an autoimmune disease that can cause splinter hemorrhages.
8. Erythrocyte sedimentation rate (ESR) test: The ESR test is used to check for inflammation in the body, which may be causing splinter hemorrhages.
9. C-reactive protein (CRP) test: The CRP test is used to check for inflammation in the body, which may be causing splinter hemorrhages.
10. Antiphospholipid antibody (APA) test: The APA test is used to check for antiphospholipid syndrome, an autoimmune disorder that can cause splinter hemorrhages.
11. Homocysteine level test: High levels of homocysteine in the blood have been linked to an increased risk of splinter hemorrhages. A homocysteine level test can be performed to check for elevated levels.
12. Prothrombin time (PT) test: The PT test is used to check for blood clotting disorders, such as deep vein thrombosis (DVT), which can cause splinter hemorrhages.
13. Activated partial thromboplastin time (aPTT) test: The aPTT test is used to check for blood clotting disorders, such as DVT, which can cause splinter hemorrhages.
14. D-dimer test: The D-dimer test is used to check for blood clots, such as DVT, which can cause splinter hemorrhages.
15. Echocardiogram: An echocardiogram is a test that uses ultrasound to visualize the heart and check for endocarditis, which can cause splinter hemorrhages.

Treatment

Different types of treatments for splinter hemorrhages:

1. Antibiotics: If a bacterial infection is causing the splinter hemorrhage, antibiotics may be prescribed to clear the infection.
2. Antifungal medication: Fungal infections of the nails can also cause splinter hemorrhages. In such cases, antifungal medication may be prescribed to clear the infection.
3. Blood thinners: Blood thinners such as warfarin, heparin, or dabigatran may be prescribed if splinter hemorrhages are caused by a clotting disorder.
4. Corticosteroids: Corticosteroids may be prescribed to reduce inflammation and swelling. They can also help to improve circulation and prevent the formation of blood clots.
5. Vitamin and mineral supplements: Vitamin and mineral deficiencies can contribute to the formation of splinter hemorrhages. Taking vitamin and mineral supplements may help to prevent these markings from forming.
6. Lifestyle changes: Making lifestyle changes, such as quitting smoking and reducing alcohol consumption, can help to improve circulation and prevent the formation of splinter hemorrhages.
7. Exercise: Regular exercise can help to improve circulation and prevent the formation of splinter hemorrhages.
8. Hot or cold compresses: Applying hot or cold compresses to the affected area may help to reduce pain and swelling.
9. Nail care: Proper nail care, such as avoiding rough or sharp objects and keeping nails trimmed, can help to prevent the formation of splinter hemorrhages.
10. Topical creams: Topical creams, such as those containing vitamin E or tea tree oil, may help to improve circulation and reduce inflammation.
11. Surgery: In severe cases, surgery may be necessary to remove the affected nail and repair any underlying damage.
12. Biopsy: A biopsy may be performed to determine the underlying cause of the splinter hemorrhages.
13. Blood tests: Blood tests may be performed to determine if a clotting disorder or other medical condition is causing the splinter hemorrhages.
14. Imaging tests: Imaging tests, such as X-rays or MRI scans, may be performed to determine if there is any underlying damage or disease causing the splinter hemorrhages.
15. Nail reconstruction: In severe cases, nail reconstruction may be necessary to repair the affected nail and prevent future splinter hemorrhages from forming.

It is important to note that the treatment for splinter hemorrhages will depend on the underlying cause of the markings. A healthcare provider can provide a personalized treatment plan based on the individual’s specific medical history and the underlying cause of the splinter hemorrhages.

References