Isla Bennett
Red streaks in your nails can be a sign of splinter haemorrhages, which are tiny blood clots deep in the nail bed. They can also be a symptom of Darier disease, which causes alternating red and white longitudinal streaks, known as 'candy-cane' nails. If you have red streaks in more than one nail, it could indicate an underlying regional or systemic disease.
| Characteristics | Values |
|---|---|
| Name | Longitudinal erythronychia |
| Description | One or more linear red bands in the nail unit |
| Localisation | Can be localised (involving only one nail) or polydactylous (involving more than one nail) |
| Cause | The localized form is usually due to a neoplastic process, whereas involvement of more than one nail may indicate an underlying regional or systemic disease |
| Appearance | Linear, pink-red streaks extending from the proximal nail fold to the distal free edge of the nail plate |
| Width | Typically ranges from less than 1 mm to 3 mm |
| Other features | Splinter hemorrhages (tiny blood clots rooted deep in the nail bed), semitransparent distal matrix, distal V-shaped chipping, splitting, onycholysis of the nail plate, reactive distal nail bed and hyponychial hyperkeratosis |
| Associated with | Darier disease (nails with alternating red and white longitudinal streaks, described as “candy-cane”) |
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What You'll Learn
Longitudinal erythronychia
Red streaks in your nails can be caused by a condition called longitudinal erythronychia, which is the presence of one or more linear red bands in the nail unit. This can be localized, involving only one nail, or polydactylous, involving more than one nail. The localized form is usually due to a neoplastic process, whereas involvement of more than one nail may indicate an underlying regional or systemic disease. Clinical examination reveals one or more linear, pink-red streaks extending from the proximal nail fold to the distal free edge of the nail plate. The width of the band typically ranges from less than 1 mm to 3 mm. Other features may include splinter haemorrhages within a red band, a semitransparent distal matrix, distal V-shaped chipping, splitting, onycholysis of the nail plate, and reactive distal nail bed and hyponychial hyperkeratosis.
Splinter haemorrhages are another potential cause of red streaks in the nails. They are characterised by red, splinter-like streaks under the nails, resembling a splinter underneath the nail. They occur when blood leaks or swells from small blood vessels that run up and down the nail bed. Tiny blood clots known as microemboli in the capillaries can also cause splinter haemorrhages. One of the most common causes of splinter haemorrhages is trauma to the nails. However, they can sometimes indicate an underlying disease.
In rare cases, red and white longitudinal streaks in the nails, described as "candy-cane", can be a symptom of Darier disease, which is caused by mutations of the ATP2C1 gene. This condition is reported in 92% to 95% of patients with Darier disease.
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Splinter hemorrhages
Red streaks in your nails can be a sign of splinter hemorrhages. These are tiny blood clots rooted deep in the nail bed. They are called splinter hemorrhages because they look like a splinter, but they cannot be removed by buffing, cutting or excising. Splinter hemorrhages can be a symptom of Darier disease, which is characterised by alternating red and white longitudinal streaks in the nails, described as 'candy-cane'. They can also be a sign of an underlying regional or systemic disease.
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Darier disease
Red streaks in the nails can be caused by splinter haemorrhages, which occur when blood leaks or swells from small blood vessels that run up and down the nail bed. They are called splinter haemorrhages because they resemble having a splinter underneath the nail. They are usually caused by trauma to the nails, but they can also be an indicator of an underlying disease.
Red and white streaks in the nails can be a symptom of Darier disease, which is caused by mutations of the ATP2C1 gene. This disease is characterised by alternating red and white longitudinal streaks in the nails, described as "candy-cane". This nail abnormality is reported in 92-95% of patients with Darier disease. Patients with Darier disease may also have wedge-shaped distal subungual keratosis accompanied by flat keratotic papules on the proximal nail fold.
The skin findings in Darier disease are characterised by keratotic papules and plaques, which are predominantly found in seborrheic areas such as the scalp, face, neck, upper chest, and back. These skin lesions can be very itchy and may become infected if scratched. They often worsen in hot and humid weather and with emotional stress.
There is no cure for Darier disease, but treatments are available to help manage the symptoms. These include topical medications such as retinoids and calcineurin inhibitors, which can help to reduce the scaling and inflammation of the skin. Oral medications such as acitretin and isotretinoin may also be prescribed in more severe cases. Phototherapy, which uses ultraviolet light to treat the skin, can also be effective in improving the appearance of the skin lesions.
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Reactive distal nail bed
Red streaks in nails are called longitudinal erythronychia and are caused by splinter haemorrhages. Splinter haemorrhages are characterised by red, splinter-like streaks under the nails. They are caused by bleeding of the nail bed capillaries into the longitudinal ridges of the nail. They are usually asymptomatic and migrate distally with the nail growth. They can be caused by trauma, such as a sports injury, or by physical factors, including drugs, dermatological diseases, systemic diseases, and idiopathic conditions.
Splinter haemorrhages are most frequently found on the distal third of the nail plate, but they may be seen at any level. They appear as multiple, longitudinal, tiny, purple-to-brown streaks. They are usually seen in the fingernails, but can also occur in the toenails. The red line moves distally with time (weeks to months).
The presence of longitudinal erythronychia can be localized (involving only one nail) or polydactylous (involving more than one nail). The localized form is usually due to a neoplastic process, whereas involvement of more than one nail may indicate an underlying regional or systemic disease. Clinical examination reveals one or more linear, pink-red streaks extending from the proximal nail fold to the distal free edge of the nail plate. The width of the band typically ranges from less than 1 mm to 3 mm.
Splinter haemorrhages are a frequent but not specific clinical finding. They are fine, nonblanchable, red-brown to black longitudinal streaks of 1 to 3 mm visible through the plate. They are caused by the extravasation of blood from the longitudinally oriented vessels of the nail bed. The blood attaches itself to the underlying nail plate and moves distally. Occasionally, splinter haemorrhages may appear to remain stationary, probably because of attachment to the nail bed rather than to the plate.
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Hyponychial hyperkeratosis
Red streaks in the nails are called splinter hemorrhages. They are caused by trauma to the nails, or by an underlying disease.
Dermoscopic examinations can reveal hyperkeratosis in the hyponychium. This may be accompanied by longitudinal grey regular lines on a grey background, and true leukonychia.
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Frequently asked questions
Red streaks in your nails are called longitudinal erythronychia. They can be localized, involving only one nail, or polydactylous, involving more than one nail.
Red streaks in your nails are caused by splinter hemorrhages, which occur when blood leaks or swells from small blood vessels that run up and down the nail bed. They can be caused by trauma to the nails or by tiny blood clots known as microemboli in the capillaries.
While red streaks in your nails can sometimes indicate an underlying regional or systemic disease, they are sometimes just another harmless abnormality that can occur in the body.
