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splinter hemorrhage (flame-shaped splinter hemorrhage)
Red or brown streaks in the nail*.
Etiology:
1) endocarditis
- 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) scurvy [2]
10) trauma (most common cause) [2]
Pathology:
- nail bed capillary injury
- generally arising in the midportion of the nail bed
Clinical manifestations:
- red-brown short fine lines in the nail bed
- subungual linear pigmented streaks following the long axis of the nail
- color changes from purple to brown or black as they age.
* 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
- Color Atlas & Synopsis of Clinical Dermatology, Common
& Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY,
1997, pg 500
- Medical Knowledge Self Assessment Program (MKSAP) 17,
American College of Physicians, Philadelphia 2015
- Medical Knowledge Self Assessment Program (MKSAP) 20
American College of Physicians, Philadelphia 2025
- Family Practice Notebook (images)
Nail Splinter Hemorrhage.
http://www.fpnotebook.com/derm/Nails/NlSplntrHmrhg.htm
- 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
- Brady MP
Fingernail and Toenail Abnormalities: Nail the Diagnosis.
Medscape March 17, 2021
https://reference.medscape.com/slideshow/fingernail-abnormalities-6002456