Nail Splinter Hemorrhage

Aka: Nail Splinter Hemorrhage, Splinter Hemorrhage

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II. Pathophysiology

  1. Capillary leak at epidermal ridge

III. Signs

  1. Red or brown Nail Longitudinal Band 1-3 mm long
    1. Typically start as red and then transition to brown or black
  2. Involves nail bed (not nail plate)
  3. Lines persist despite pressure applied to the nail
    1. Lines are due to blood that has leaked from the vasculature

IV. Causes

  1. See Longitudinal Melanonychia
  2. See Nail Longitudinal Band
  3. Subacute Bacterial Endocarditis (classic)
    1. Only occurs in 15% of endocarditis cases
  4. Local Trauma (common cause)
  5. Psoriasis
  6. Onychomycosis
  7. Trichinosis
  8. Other conditions include renal, pulmonary and endocrine conditions

V. Differential Diagnosis (cause similar appearing lesions)

  1. Rheumatoid Arthritis
  2. Systemic Lupus Erythematosus
  3. Dermatomyositis
  4. Scleroderma
  5. Antiphospholipid Syndrome
  6. Peptic Ulcer Disease
  7. Oral Contraceptive use or pregnancy

VI. References

  1. Degowin (1987) Diagnostic Exam, Macmillan, p. 697
  2. Tully (2012) Am Fam Physician 85(8): 779-87 [PubMed]

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