Splinter Hemorrhages of the Nails: a Systematic Review of Clinical Features and Associated Conditions

Splinter hemorrhages (SHs) of the nails represent a frequent although not specific clinical finding that has been associated with conditions of varying severity. However, to date, there is no single report of their characteristics and etiologies. The aim of this study is to guide clinical practice by reviewing all of the data concerning SH of the nails that have become available since the first description of this condition was published in 1923, with particular reference to all clinical features, associated medical conditions, pathogenesis, and necessary workup. PubMed and EMBASE were searched using the keywords "splinter" AND "hemorrhage*"; the only articles excluded were those studying SHs of the retina. Splinter hemorrhage is a frequent nail disorder that may be idiopathic, drug-induced, or a sign of a dermatological disease, such as psoriasis and lichen planus, or a wide range of systemic disorders, the most important of which are infections and vasculitis. Clinicians and dermatologists should be aware of all the clinical features of both SH and associated medical conditions.