By Medicover Hospitals / 26 Feb 2021
A narrow black line that has formed vertically under the nail is called a splinter hemorrhage. It occurs for a variety of reasons and perhaps harmless or a sign of a more serious health condition.
- What are Red or black spots on the nails?
- When to visit a Doctor?
What are Red or black spots on the nails?
The red or black spots may be splinter hemorrhages associated with endocarditis. It can look like a splinter of wood under the nail. The condition is caused by small damaged blood vessels under the nail. Features include:
The thickest lines that create a horizontal stripe on the nail are called Beau's lines. They are usually not harmful, but they can be a symptom of cancer called subungual melanoma.
- It is black or reddish-brown
- Does not change appearance when you apply pressure to the nail
- Appears in one or more places under the nail
- It can also be skin cancer such as melanoma or squamous cell cancer
Splinter hemorrhages can develop after injury or trauma to a fingernail or toenail. Bumping a toe or injuring a toe can damage blood vessels along the nail bed in the affected toe and cause bleeding under the nail.
If you did not hurt your toe or finger, the bleeding may result from conditions that can damage blood vessels. The underlying conditions can include:
Splinter bleeds can also occur as a side effect of certain medications, such as nonsteroidal anti-inflammatory drugs. These drugs can cause bleeding when taken in high doses.
- Bacterial endocarditis: Bacteria in the bloodstream travel to the heart valve
- Vasculitis: Damage to the blood vessels caused by inflammation
- Systemic diseases: Systemic diseases cause inflammation in blood vessels, such as rheumatoid arthritis, nail psoriasis, lupus, scleroderma, peptic ulcer, malignant neoplasms
- Fungal Nail Infection: Infections can lead to thinning of the nail bed and possible damage to blood vessels
- Diabetes: High glucose levels can damage blood vessels
- Raynaud's disease: Fingers and toes become over-sensitive to cold, which can damage the capillaries in the nail bed.
- Cholesterol: The accumulation of this substance in the blood vessels of the nails can cause damage.
Your doctor may ask about your medical history and your family medical history. To determine the cause of splinter hemorrhages, laboratory procedures used include:
A hemorrhage under the nail is often a symptom of cancer called melanoma. If your doctor suspects a malignancy, he or she will recommend a biopsy to determine if the dark spot is cancerous or benign.
- blood culture (detects bacteria or fungi in your blood)
- complete blood count
- erythrocyte sedimentation rate (detects inflammation in your body)
- Your doctor may also order imaging tests to look for abnormalities. These include a chest X-ray and an echocardiogram, which takes pictures of your heart
Treatment for splinter hemorrhage will vary depending on the underlying cause of the condition. Sometimes, you may not need any treatment and the splinter hemorrhage will grow with the nail.
If the splinter hemorrhage is a sign of another medical condition, see your doctor for treatment. You can visit the doctor for help if the splinter hemorrhage is a symptom of some medical problems that are quite different, so there is no standard treatment to improve the nail condition Endocarditis, for instance, involves antibiotics and probably surgery. Psoriasis is a chronic disease that requires multiple topical and oral medications, and prevention methods.
When to visit a Doctor?
It is especially important to see a doctor if a person has a painful, bleeding nail or changes with no known cause. Besides any of the following symptoms:
A person should consult their doctor if they notice changes in the quality of the nail, such as thinning, cracking, or differences in shape.
- petechiae, which are pin-sized red "spots" on the skin
- joint pain
Frequently Asked Questions:
Splinter hemorrhages are usually a harmless event that can temporarily alter the nail beds.
Splinter hemorrhages have also been observed in association with anemia, trichinosis, chronic glomerulonephritis, vasculitis, psoriasis, scurvy, juvenile cirrhosis, high altitudes, eczematous eruptions, fungal nail infections, rheumatoid arthritis, mitral stenosis, septicemia, malignant tumors dialysis.
For example, even a fungal infection of the nail (onychomycosis) can lead to small splinter hemorrhages in the nail bed. Another common condition that can cause splinter hemorrhages from the nail bed is nail psoriasis.
Movement of your body can cause a splinter to "pop open." The action of immune cells that migrate to the area also achieves this result, although this can cause localized pain.
Never squeeze a splinter as this can cause it to break into smaller pieces that are more difficult to remove. Use a small needle to remove the splinter. You may use a small needle to extract it if the whole splinter is lodged under the surface. First, sterilize the needle and a pair of tweezers with isopropyl alcohol.
JAMA Network - https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/571583
Science Direct - https://www.sciencedirect.com/science/article/abs/pii/S0190962203032778
Wiley's Online Library - https://onlinelibrary.wiley.com/doi/abs/10.1111/ijd.13347