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Published on: 8/20/2026

What are the underlying causes of splinter hemorrhages in nails?

Splinter hemorrhages are thin, dark red or brown lines that appear under the fingernails or toenails. They occur when tiny blood vessels (capillaries) beneath the nail burst, leaving small streaks of blood trapped under the nail plate.

Common causes of splinter hemorrhages include:

  • Nail trauma or injury
  • Fungal or bacterial nail infections
  • Endocarditis (infection of the heart's inner lining)
  • Vasculitis or autoimmune conditions like lupus
  • Psoriasis or eczema affecting the nails
  • Certain medications, such as blood thinners

While minor cases often resolve on their own, splinter hemorrhages can sometimes signal a more serious underlying condition, especially when they appear on multiple nails without any injury. Because the causes range from harmless to serious, understanding what's behind your symptoms is essential. Take a free, instant, online symptom check to get personalized insights and clear guidance on your next steps.

Reviewed for medical accuracy: 07/15/2026

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Explanation

Splinter hemorrhages appear as thin, dark lines under the nails and are caused by bleeding under the nail bed. This can happen when tiny blood vessels, called capillaries, get damaged or when small blood clots form.

Causes:

  1. Injury: One common cause is trauma to the nail, such as hitting your finger, which can damage the blood vessels.
  2. Infections: Some infections, like endocarditis, an infection of the heart valves, can lead to splinter hemorrhages.
  3. Health Conditions: Other conditions, such as psoriasis or certain blood disorders, can also cause these nail changes.

Splinter hemorrhages are usually not serious if they result from minor injuries. However, if you notice many of them or if they appear without any known injury, it could be a sign of a more serious health issue. You can use a free symptom checker to help assess your symptoms and determine whether you should seek medical attention. A healthcare provider will be able to determine if an underlying condition needs attention.

(References)

  • Haber R, Khoury R, Kechichian E, & Tomb R. (2016). Splinter hemorrhages of the nails: a systematic review .... International journal of dermatology, 27420914.

  • Tully AS, Trayes KP, & Studdiford JS. (2012). Evaluation of Nail Abnormalities. American family physician, 22534387.

  • Fawcett RS, Linford S, & Stulberg DL. (2004). Nail abnormalities: clues to systemic disease. American family physician, 15053406.

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