Splinter haemorrhages

Splinter hemorrhages are thin red or brown lines that run in the direction of the nail. This is caused by bleeding under the nail bed, typically due to small blood vessel damage or trauma.. They are harmless on their own and may indicate minor conditions but they can be a sign of more advanced conditions like infective endocarditis, psoriasis and mitral stenosis.

• vascular

  Septic emboli/thrombophlebitis

  Mitral stenosis (1)

• infection

  Infective endocarditis

  Meningococcal disease (1)

• neoplasm

  Potential malignancies (benign tumour) (1)

• drugs

  Tyrosine kinase inhibitors (users of sunitinib and sorafenib)

  Nitrofurantoin

  Ganciclovir

  Terbinafine

  Tetracyclines (1)

• iatrogenic

  Valvular or pacemaker vegetation

  Infected thrombus from indwelling vascular catheter or graft (2)

• congenital

  Hereditary Hemorrhagic Telangiectasia

  Congenital heart diseases

  Koilonychia (3)

• autoimmune

  Psoriasis

  Systemic lupus erythematosus

  Antiphospholipid syndrome (1)

• trauma

  Use of walking aids causing nail trauma (3)

• endocrine/metabolic

  Diabetes mellitus (1)

Source: DermNetNZ.org [1]

Splinter haemorrhages

Wooden-splinter shaped line under the bail with a brown discolouration

Source: ResearchGate [4]

Splinter haemorrhages

Brown streaks on fingernails, caused by bacterial endocarditis

[1] https://dermnetnz.org/topics/splinter-haemorrhage

[2]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9421492/#:~:text=Splinter%20hemorrhages%20in%20endocarditis%20develop,catheter%20or%20graft%20(1)

[3] https://www.sciencedirect.com/topics/medicine-and-dentistry/splinter-hemorrhage

[4] https://www.researchgate.net/figure/Splinter-hemorrhage-with-bacterial-endocarditis_fig1_274262439