The blackish linear streaks observed earlier in the physical examination were splinter hemorrhages
. In addition, the dermoscopic examination clearly revealed hyperkeratosis in the hyponychium and adherence of the nail bed to the nail plate, raising the suspicion of pterygium inversum unguis (Figure 2).
Prevalence of onycholysis, splinter hemorrhage
, and oil drop were significantly higher in PsA patients in comparison with patients without psoriatic arthritis (Table 3).
(c) Finger changes seen in our patient with subungual inflammation splinter hemorrhages
and inflammation and scaling of several fingertips.
On fundus examination the optic discs of both eyes showed edema, indistinct margins and splinter hemorrhages
extending from the disc to the periphery; intraretinal hemorrhage and cotton-wool exudates were also observed.
Ecchymosis (FIGORE 2) and splinter hemorrhages
are also present.
were seen in 12% and Beau's lines were observed in 14% cases.
* Splinter hemorrhages
. These present as small, linear, longitudinally oriented hemorrhages in the nail bed due to alteration of circulation in small nail bed capillaries.
Many other manifestations result from vessel wall fragility and include splinter hemorrhages
in nails, gum bleeding, painful hemarthroses, subperiosteal hemorrhage, subconjunctival hemorrhage, bleeding within the optic nerve sheath, bleeding into the periorbital area, eyelids, and retrobulbar space, hematuria, hematochezia, melena, and rarely, fatal bleeding into the myocardium and pericardial space.1,2 Rumpel-Leede sign (petechial hemorrhages occurring below the site of tourniquet application) may be elicited.8
Bacterial endocarditis is the most common systemic disease associated with splinter hemorrhages
. These hemorrhages are more common in subacute, rather than acute, infection.