The Black Line On Nail: Is It Splinter Hemorrhages?

Have you ever noticed a small vertical black line on nails and wondered what could be the reason? Could it be something serious? Most of the time the black lines on nails do not indicate any serious underlying issues. However, it’s still a good idea to get it looked at if the problem persists for more than a few days, a week at most. In a few cases, it could indicate an underlying condition. Is it a splinter hemorrhage? Let’s explore the article to get the answer. 

Glance at the topic: 

• Linear melanonychia, which can appear as black lines on nails, is commonly found among people of African descent. In populations with darker skin tones, this condition is often a benign variation in nail pigmentation​.

• Melanonychia is more common in certain ethnic groups, affecting up to 20% of the Japanese population. Nearly all individuals of Afro-Caribbean descent by age 50.

• Vitamin B12 or folate deficiency can lead to changes in nail color. It also causes formation of dark lines, suggesting that dietary factors play a role in this condition​.

Could a Black Line on Nail Mean Splinter Hemorrhages?

Yes, a vertical black line on nails can indicate a splinter hemorrhage. It could indicate that the area in which these spots appeared has suffered some sort of trauma. Basically, the primary cause of the splinter hemorrhage is damage to blood vessels present under your nail bed. These are thin black lines on the nails which can be nearly 1 to 3 mm long. When splinter hemorrhages first develop in the nail, they appear purple or reddish. However, within some days, they turn black or brown. Moreover, they actually move with the growing nail. Also, they do not change their look even on the application of the pressure on the nail. 

What are Splinter Hemorrhages and Their Symptoms?

The following are the possible symptoms of splinter hemorrhages: 

• Discoloration of the nails due to bleeding blood vessels below the nail.

• Appearance of blemishes or dark spots on nails.

• The presence of dark vertical lines on nails

• Typically, no discomfort in the area of occurrence unless associated with injury or trauma.

• No change in appearance or discomfort when applying pressure on the nail.

Splinter hemorrhages can appear without any noticeable cause in some cases. Hence, it's essential to monitor for any changes or expansion of the discoloration. If associated with other symptoms, a medical evaluation may be necessary. 

Causes of Splinter Hemorrhages

There are two main possibilities under which black Splinter hemorrhages can occur. One is due to some external factors such as injuries. The second case can be due to some underlying medical condition. 

Let's take a look at the top seven underlying causes of splinter hemorrhages.

1. Trauma To The Nail

The most common cause of splinter hemorrhage is trauma suffered to the nails which exhibit black lines. A trauma to the nail can be a painful experience but is certainly not a matter of much concern. The black lines on nails due to accidental striking of the toe on something usually go away within a few days of the trauma suffered. Also, it recovers back to its normal color.

2. Fungal Infections

A fungal infection comes in the acute spectrum of diseases. It can still be one of the underlying conditions that cause black lines on nails. The likely causes of fungal infections are as follows:

• If you have come in contact with someone with the condition.

• If you are actively participating in sports that necessitate wearing shoes for a prolonged period. Those sports are basketball, football, or tennis.

• Or, if you have suffered any injuries to the nail.

3. Bacterial Endocarditis

Bacterial Endocarditis is also known as Infective Endocarditis or IE. It is a condition wherein bacteria starts accumulating in the lining of the heart. Bacteria accumulation in the heart lining can leak and circulate to other body parts such as the nails. In turn, it causes splinter hemorrhages and the appearance of a faint black line on the nail. 

4. Vasculitis

Another health condition that can be the underlying cause of splinter hemorrhages and thus the black line on the nail is vasculitis. Typically, vasculitis is a disease that causes alterations to the blood vessels. Either the vessels can grow thick, weak, or narrow and hinder blood flow through the body. The hindered flow of blood can contribute to a blemish or black line on the nail, in some cases. This can indicate the symptom of splinter hemorrhages.

5. Diabetes

Diabetes, as mentioned previously can also be the underlying cause of splinter hemorrhages. There are a total of four types of diabetes but we only need to be concerned about Type 2 Diabetes. Diabetes is a medical condition in which the body is not able to control or process glucose to convert it into energy. Since high amounts of glucose and sugar remain unprocessed, they start damaging the blood vessels. This can result in splinter hemorrhages in the form of a black line on nails.

6. High Cholesterol Levels

Cholesterol is a biosynthetic component, constituting the structural walls of the cellular membranes. High cholesterol levels are usually caused because of unhealthy eating habits. High cholesterol means unwanted fats in the blood vessels. This can thicken the blood vessels in a way that causes problems with the blood flow. These blood flow problems can result in very serious conditions such as coronary heart disease, heart attacks, and strokes. The problem with the blood flow also results in splinter hemorrhages in some cases.

7. Melanoma

A study suggests subungual melanoma can also cause a black line on the nail. It may indicate a serious form of skin cancer. Melanoma is one of the most life-threatening types of cancer in which abnormal developments can occur on the skin caused by some sort of ultraviolet radiation such as too much exposure to sunlight. It can usually develop anywhere around the torso or legs and form some deformity like a red or a black spot. In dark-skinned people, the occurrence of melanoma is very rare. However, in those rare cases, it usually occurs in the form of a black line on the nails of the toes or fingers.

What Kind of Diagnosis is Recommended for Splinter Hemorrhages?

The necessity for a diagnosis is to determine if the splinter occurred due to any injuries to the nails or the general area around it. If such is the case then a consultation with a doctor is rarely recommended. On the off chance that there was no history of injury or trauma to the nails then one should immediately seek medical help. If doctors determine that injury or trauma is the cause, then they might suggest the following tests:

• Blood Culture: A blood culture, in this case, will help check the presence of fungi in the blood.

• Erythrocyte Sedimentation: This test determines if your body is suffering from any inflammation.

• Chest X-ray and Echocardiogram: Doctors recommend these tests if they suspect the hemorrhages are occurring due to bacterial endocarditis.

• Biopsy: Finally, providers advise biopsy when there is a possibility that the underlying cause could be melanoma.

Is Splinter Hemorrhages Treatable?

In most cases, you can get rid of the black line on the nail without any treatment. The line can heal on its own over time. However, in other rare cases, doctors recommend medication. For instance:

• In case of injuries and traumas, the best treatment is to just let the nail grow out and heal on its own.

• In case of hemorrhage due to a fungal infection, doctors may recommend some antifungal medications.

• If some underlying medical conditions cause hemorrhage, then it is bound to go away once that condition has been treated.

Seeking medical advice on how to get rid of black lines on nails can help in managing symptoms and underlying causes. Doctors recommend regular check-ups for individuals with heart conditions to prevent endocarditis.

Prevention Strategies 

Splinter hemorrhages are tiny lines that appear under the nails and often look like small splinters of wood. They can be a sign of minor injuries or indicate more serious health issues. To avoid getting these black lines, it's important to follow some basic health and safety guidelines. Below are strategies to prevent splinter hemorrhages and keep your nails healthy:

Final Thoughts 

The black line on nails is usually caused due to splinter hemorrhages which depending on the underlying cause can be treated and rarely pose any fatal threats. Usually, this is a harmless health condition but can be a sign of a serious problem too. Generally, it grows if you face any nail trauma. But if you experience such a symptom without any traumatic condition, you should possibly see a doctor for a thorough diagnosis. If you experience any problem related to skin or nails, get in touch with the Best Dermatologist.