What are Red or Black Spots on Nails?
A splinter hemorrhage is a narrow black line that forms vertically under a nail, caused by small blood vessel damage.
While often harmless, it can sometimes signal a more serious health issue. In some cases, such as with endocarditis, it may appear as a red spot resembling a wood splinter under the nail.
- It is black or reddish-brown
- It does not change appearance when you apply pressure to the nail
- Appears in one or more places under the nail
- It can also be skin cancer such as melanoma or squamous cell cancer
The thickest lines that create a horizontal stripe on the nail are called Beau's lines. They are usually not harmful, but they can be a symptom of cancer called subungual melanoma.
Causes of Red or Black Spots on Nails
Splinter hemorrhages can develop after injury or trauma to a fingernail or toenail. Bumping a toe or injuring a toe can damage blood vessels along the nail bed in the affected toe and cause bleeding under the nail.
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Get A Second OpinionIf you did not hurt your toe or finger, the bleeding may result from conditions that can damage blood vessels. The underlying conditions can include:
- Bacterial endocarditis: Bacteria in the bloodstream travel to the heart valve
- Vasculitis: Damage to the blood vessels caused by inflammation
- Systemic diseases: Systemic diseases cause inflammation in blood vessels, such as rheumatoid arthritis, nail psoriasis, lupus,scleroderma,peptic ulcer, malignant neoplasms
- Fungal Nail Infection: Infections can lead to thinning of the nail bed and possible damage to blood vessels
- Diabetes: High glucose levels can damage blood vessels
- Raynaud's disease: Fingers and toes become over-sensitive to cold, which can damage the capillaries in the nail bed.
- Cholesterol: The accumulation of this substance in the blood vessels of the nails can cause damage.
Splinter bleeds can also occur as a side effect of certain medications, such as nonsteroidal anti-inflammatory drugs. These drugs can cause bleeding when taken in high doses.
Diagnosis of Red or Black Spots on Nails
Your doctor may ask about your medical history and your family medical history. To determine the cause of splinter hemorrhages, laboratory procedures used include:
- blood culture (detects bacteria or fungi in your blood)
- complete blood count
- erythrocyte sedimentation rate (detects inflammation in your body)
- Your doctor may also order imaging tests to look for abnormalities. These include a chest X-ray and an echocardiogram, which takes pictures of your heart
A hemorrhage under the nail is often a symptom of cancer called melanoma. If your doctor suspects a malignancy, he or she will recommend a biopsy to determine if the dark spot is cancerous or benign.
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Book an AppointmentTreatment of Red or Black Spots on Nails
Treatment for splinter hemorrhage will vary depending on the underlying cause of the condition. Sometimes, you may not need any treatment, and the splinter hemorrhage will grow with the nail.
If a splinter hemorrhage indicates another medical issue, consult your doctor for treatment. Conditions like endocarditis may require antibiotics and surgery. Chronic conditions such as psoriasis may need various topical and oral treatments for management and prevention.
When to visit a Doctor?
It is especially important to see a doctor if a person has a painful, bleeding nail or changes with no known cause. Besides any of the following symptoms:
- fever
- petechiae, which are pin-sized red "spots" on the skin
- joint pain
A person should consult their doctor if they notice changes in the quality of the nail, such as thinning, cracking, or differences in shape.
