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splinter hemorrhage (flame-shaped splinter hemorrhage)

Red or brown streaks in the nail*. Etiology: 1) endocarditis (generally arising in the midportion of the nail bed) - microemboli 2) psoriasis 3) lichen planus 4) pityriasis rubra pilaris 5) chronic renal failure 6) autoimmune connective tissue disease - vasculitis [5] - systemic lupus erythematosus 7) trichinosis [5] 8) onychomycosis [5] 9) trauma [2] Pathology: - nail bed capillary injury Clinical manifestations: - red-brown short fine lines in the nail bed * images [3,4,5] * flame-shaped splinter hemorrhages are also seen in the retina in patients with ischemic optic neuropathy.

General

nail disease sign/symptom

References

  1. Color Atlas & Synopsis of Clinical Dermatology, Common & Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY, 1997, pg 500
  2. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
  3. Family Practice Notebook (images) Nail Splinter Hemorrhage. http://www.fpnotebook.com/derm/Nails/NlSplntrHmrhg.htm
  4. Rashid RM, Barros BS (image) Hidden Heart Disease: 19 Dermatologic Clues You Should Know. Medscape. June 13, 2017. http://reference.medscape.com/slideshow/hidden-heart-disease-6004452
  5. Brady MP Fingernail and Toenail Abnormalities: Nail the Diagnosis. Medscape March 17, 2021 https://reference.medscape.com/slideshow/fingernail-abnormalities-6002456