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Splinter Hemorrhage
Medically reviewed by Alana Biggers, MD on July 24, 2017 — Written by Valencia Higuera

Symptoms Causes Diagnosis Treatment Outlook

What is a splinter hemorrhage?

Splinter hemorrhages are tiny blood spots that appear underneath the
nail. They look like splinters and occur when tiny blood vessels
(capillaries) along the nail bed are damaged and burst. The nail bed is the
skin underneath the nail.

Small amounts of blood from the damaged blood vessel become visible
through the nail. The bleeding creates a splinter-like line in the direction
of nail growth. Splinter hemorrhages can occur on your toenails or
fingernails.

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What are the symptoms of a splinter hemorrhage?
The primary symptom of a splinter hemorrhage is a small amount of
bleeding underneath a nail. You may notice a dark red or brown line
along your nail groove. The dark streak closely resembles a splinter.

A splinter hemorrhage doesn’t usually cause physical pain. In fact, you

may not immediately notice the hemorrhage. The exception is when a
splinter hemorrhage occurs from an injury, such as hitting your toe or
finger. In this case, you may have swelling, inflammation, and pain along
with a small amount of blood.

What causes splinter hemorrhages?

Splinter hemorrhages can develop after an injury or trauma to a fingernail
or toenail. Stubbing a toe or injuring a finger can damage blood vessels
along the nail bed on the affected digit and trigger bleeding underneath
the nail.

Splinter hemorrhages caused by injury aren’t a reason for concern. The

nail will clear up as the injury heals. But sometimes a splinter hemorrhage
indicates an underlying disease or disorder.

If you didn’t injure your toe or finger, the hemorrhage may result from
conditions that can damage blood vessels. Underlying conditions may
include:
 Bacterial endocarditis: Bacterial in the blood stream travels to the
heart valve.
Vasculitis: Blood vessel damage caused by inflammation.
Systemic diseases: These cause inflammation in blood vessels, such
as rheumatoid arthritis, nail psoriasis, lupus, scleroderma, peptic
ulcer, malignancies.
Fungal infection of the nail: Infections can trigger thinning of the nail
bed and possible blood vessel damage.
Diabetes: High glucose levels can damage blood vessels.
Raynaud’s disease: Toes and fingers become oversensitive to
coldness, which can damage capillaries in the nail bed.
Cholesterol: Accumulation of this substance in the blood vessels of
the fingernails can result in damage.

Splinter hemorrhages can also occur as a side effect of certain

medications, such as nonsteroidal anti-inflammatory drugs. These
medications can cause bleeding when taken in high doses.
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How is a splinter hemorrhage diagnosed?

If you experience minor bleeding from a splinter hemorrhage caused by
an injury, there’s no reason to see a doctor. On the other hand, if a
splinter hemorrhage occurs for an unknown reason, or if you have
bleeding in more than one nail, see a doctor for further evaluation.
Your doctor may ask about your medical history and family medical
history. Laboratory tests used to determine the cause of splinter
hemorrhages include:

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.

Sometimes a hemorrhage under the nail is a sign of melanoma, a type of

cancer. If your doctor suspects a malignancy, they’ll recommend a biopsy
to determine whether the dark spot is cancerous or benign.

How is a splinter hemorrhage treated?

Treatments depend on the underlying cause.

Treatments for splinter hemorrhages caused by trauma

No treatment is necessary for splinter hemorrhages caused by trauma.

Depending on the severity of the injury, the hemorrhage may clear up
within a couple of days or slowly disappear as your nail grows out.
Because nails grow at a slow pace, it may take several months for the
splinter-like mark to completely disappear.

If you have pain following an injury to your fingernail or toenail, apply a

cold compress to the area to reduce swelling and inflammation, or take
over-the-counter pain medication as directed.

Treatments for other causes

Splinter hemorrhages caused by a disease or disorder may clear up after

treating or curing the underlying cause.
Treatment for these types of hemorrhages vary. For example, your doctor
may prescribe medication or recommend an over-the-counter antifungal
for splinter hemorrhages caused by a fungal infection. Or you may receive
a prescription corticosteroid or immunosuppressant if the underlying
cause is a systemic disease like rheumatoid arthritis or nail psoriasis.

If testing determines that you have bacterial endocarditis, your doctor

may prescribe an antibiotic or recommend surgery to repair your heart
valves.

When splinter hemorrhages are a side effect of medication, the

hemorrhage may disappear once you stop taking the medication.
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Outlook for splinter hemorrhages

The outlook for splinter hemorrhages is often positive. When caused by
trauma, the nail slowly heals and clears up without medical treatment.

For the best possible outcome for hemorrhages caused by an underlying

disease or disorder, listen to your doctor’s recommendations. This may
include discontinuing certain medications, as well as taking medications
as directed.

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