Dermatoglyphic patterns in patients with atopic dermatitis

III

IIIIII III

II II

II

III

III

Dermatoglyphic patterns in patients with atopic dermatitis Diane Cusumano, B.A., Brian Berman, M.D., Ph.D., and Susan Bershad, M.D. New York, NY Fingertip dermatoglyphic patterns of forty-five patients with atopic dermatitis were compared to those of sixty nonatopic dermatologic patients, twenty-one of whom had hand dermatitis. The average number of digits in which linear grooves were detected was significantly higher in the atopic group than in the nonatopic controls (p < 0.005). Three or more digits with linear grooves were found in 95.2% of atopic patients with hand dermatitis and in 61.9% of controls with hand dermatitis (p < 0.005). A greater number of digits displaying linear grooves was found in control patients with hand dermatitis than in control patients without hand dermatitis. However, atopic patients with hand dermatitis had, on the average, an even greater number of digits with linear grooves than did control patients with hand dermatitis (p < 0.005). These findings suggest that linear grooves, although associated with hand dermatitis in general, are more commonly found in patients with atopic hand dermatitis. Although a significant increase in the whorl pattern was detected in female, but not in male, atopic patients when compared to sex-matched control groups (p < 0.0025), this increase was significant only in Caucasian females when compared to sex- and race-matched controls (p < 0.0005). (J AM ACADDERMATOL 8:207-210, 1983.)

Dermatoglyphic analysis is being used with increasing frequency by clinicians as an aid to the diagnosis of various medical disorders, including Down's syndrome, 1 Wilson's disease, neuro~ fibromatosis, congenital heart disease, 2 and sickle cell disease, ~ as well as some skin disorders such as psoriasis 4 and dermatitis herpetiformis. ~ Dermatoglyphics are ridge configurations on the digits, palms, and soles which are determined partly by heredity and partly by environmental influences

From The Department of Dermatology, The Mount Sinai School of Medicine. Accepted for publication June 15, 1982. Reprint requests to: Dr. Brian Berman, Department of Dermatology, The Mount Sinai School of Medicine, 1 Gustave L. Levy Place, New York, NY 10029/212-650-8151. 0190-9622/83/020207+04500.40/0

© 1983 Am A c a d Derrnatol

which produce physical stress on the skin. Additional details regarding dermatoglyphic interpretation and clinical application can be found in an excellent review article by Gibbs. 6 Atopic patients often display characteristic skin changes such as an infraorbital crease 7 and increased palmar skin creases. 8 Verbov a noted that the flexor aspects of fingers of atopic patients often display linear grooves which appear as "white lines"9 in fingerprint impressions (Fig. 1). These are shallow epidermal grooves of varying length, width, and direction which cross the papillary ridge pattern. While arches, loops, and whorls in dermatoglyphic patterns are influenced by genetics, there is no evidence that this is true for linear grooves. Linear grooves are easily differentiated from scars by the fact that they do not disrupt the

207

208

Journal of the American Academy of Dermatology

Cusumano et al

A

B

L

C

D

Fig. 1. Dermatoglyphic patterns. A, Whorl; B, arch; C, loop; D, white lines. atopic patients (1) display dermal ridge patterns which differ from those of nonatopic dermatologic patients, (2) differ from controls in the extent of digital involvement with linear grooves, and (3) differ from controls in the frequency of the presence of linear grooves. PATIENTS AND METHODS

Fig. 1. Cont'd. E, Linear grooves. ridge pattern and are not permanent, lasting months to years. 1° The extra transverse digital crease associated with sickle cell disease differs from linear grooves :in that it is a single crease parallel to and just b e y o n d the distal interphalangeal crease, disrupting the local ridge pattern, a while linear grooves are usually multiple and are oriented in various directions over any part of the flexor surface of the distal phalanx. This study was undertaken to determine whether

Forty-five patients with atopic dermatitis were examined for fingertip dermatoglyphics at The Mount Sinai Medical Center dermatology clinic. Requirements for inclusion were a personal or family history of atopy (asthma, hay fever, seasonal rhinitis) and characteristic cutaneous lesions in typical sites of predilection. 'J Patients with historical or physical evidence of disorders which have characteristic dermatoglyphic patterns were excluded; specifically, these disorders were psoriasis, alopecia areata, dermatitis herpetiformis, Down's syndrome, Wilson's disease, neurofibromatosis, congenital heart disease, and sickle cell disease. The patient population was 38% black, 41% Hispanic, and 21% Caucasian, with almost equal rmmbers of males aad females. Ages ranged from 1 to 53 years, and twentyone of these patients had hand dermatitis. The control group consisted of sixty clinic patients with no known personal or family history of atopy, atopic dermatitis, or any of the disorders with charac-

Volume 8 Number 2 February, 1983

Dermatoglyphic patterns in atopic dermatitis

209

Table 1[. Presence of linear grooves in atopic dermatitis and control patients Average number digits affected$

Patient group

n*

Percent patients affected~

Total With hand dermatitis Without hand dermatitis

60 21 39

45.0 61.9 35.8

3.5 (0.4) . . . . . . . . 4.9 (0.8) . . . . . . .

45 2t 24

71.1 95.2 50.0

,,

I I

P§

Control -1-I <0.005 3 ~-----<0.0005

2.7 (0.4) . . . . . .

] ~---
Atopic dermatitis Total With hand dermatitis Without hand dernmtitis

Io:I ....

7.9 " - .... 3.5 (0.7) . . . . .

. 005

J

*Number of dermatologic patients fingerprinted by the Faurot method. tPercentage of patients with three or more digits with linear grooves. :[:Average number of digits with linear grooves(SEM) per patient. §p values determined from comparisonof the averagenumber of digits affected in the indicated patient groups. T a b l e I I , Frequency of dermatoglyphic pattern types on fingertips o f atopic dermatitis patients and control patients Dermato~yphic pattern type(No, of digits involved/total No. of digits)~ i

Patient group*

Whor~ ,

J

Loops

i

Arches

Female Atopic dermatitis Control

82/213 57/218

p < 0.0025

95/213 120/218

NS:~

36/213 41/218

NS

Male Atopic dermatitis Control

43/175 60/220

NS

108/175 126/220

24/175 NS

34/220

NS

*The fingerprintsof 25 female atopic patients, 22 femalecontrol dermatologicpatients, 19 male atopic dermatitis patients, and 22 male control dermatologic patients were analyzed for their dermatoglyphicpattern types. i'Total number of digits displaying a dennatoglyphic pattern type/total numberof digits interpretable. :[:Nonsignificant(p > 0.05). teristic dermatoglyphic patterns mentioned above. This control group included a subgroup of twenty-one patients with hand dermatitides, including dyshidrosis, allergic contact dermatitis, and irritant contact dermatitis. Ages ranged from 8 to 81, with the distribution of ethnic backgrounds and sexes similar to the atopie dermatitis patients. The Faurot inkless printing method was employed; this consists of a solution which does not stain the skin and a treated, sensitized paper. Only fingertips were printed and analyzed for their dermatoglyphic patterns, including whorls, loops, arches, and white lines (linear grooves) (Fig. 1). Analyses of the former three patterns were made in accordance with the guidelines of Schaumann and Alter, t° with digits excluded from the study if the patterns were distorted due to eczematous changes. If linear grooves were detected in three or more digits, the patient was considered to display linear grooves. Only those patients in whom all ten finger-

prints were interpretable were included in the analysis of linear grooves. RESULTS E x t e n t a n d f r e q u e n c y o f l i n e a r g r o o v e s in p a t i e n t s with a t o p i c d e r m a t i t i s a n d in control patients C o m p a r i s o n o f the presence o f linear grooves in forty-five patients with atopic dermatitis and in sixty control d e r m a t o l o g i c patients is s u m m a r i z e d in T a b l e I. The presence of linear grooves was detected more often (p < 0.005) a m o n g atopic dermatitis patients than a m o n g the control group when comparing the total n u m b e r of digits inv o l v e d or when c o m p a r i n g the percent of patients displaying linear grooves. Although the presence of linear g r o o v e s was associated with a variety of hand dermatitides within the control patient group,

Journal of the American Academy of Dermatology

210 Cusumano et al

the number of digits displaying these grooves in atopic dermatitis patients with hand dermatitis was significantly greater than in any other patient subgroup. Frequency of dermatoglyphie pattern types on

digits of patients with atopie dermatitis and control patients Only female patients with atopic dermatitis had an increased frequency of the whorl pattern when compared to female control patients (Table II; 38.5% and 26.1%, respectively). This difference was significant (p < 0.0025), but no significant differences in pattern frequencies were detected between groups of male patients (Table II). When all patients were separated according to ethnic groups, a significant increase in the whorl pattern was detected only in Caucasian female atopic patients when compared to sex- and race-matched controls (p < 0.0005). DISCUSSION Our detection of greater fingertip involvement with linear grooves in atopic patients than in controis supports Verbov's 9 clinical observation. Although the presence of linear grooves was associated with hand dermatitis in general, atopic patients with hand dermatitis displayed a significantly greater number of digits with these grooves than did control patients with hand dermatitis. This does not imply a genetic basis for linear grooves but may only reflect the severity of this form of hand dermatitis. In fact, infraorbital folds in patients with atopic dermatitis were recently found to occur simply as a change secondary to eyelid dermatitis. 11 Unfortunately, those patients were not compared to patients with other skin disorders involving the eyelids. Linear grooves appear to be another cutaneous manifestation of atopy, not solely related to hand dermatitis. Since these grooves may be detected by simple observation, their presence may prove helpful when a diagnosis of atopic dermatitis is in doubt or in predicting its future occurrence. Multiple genes appear to be involved in determining dermal ridge patterns, TM and, although there is a strong hereditary component in the development of atopic dermatitis, its exact mode of inheritance is unknown, la Recognition of an as-

sociation between dermal ridge patterns and atopic dermatitis could prove to be a valuable aid in the diagnosis of this disorder and may further support the concept of genetic and/or intrauterine environmental factors in the etiology of atopic dermatitis. Our detection of an increased frequency of the whorl pattern in Caucasian female atopic patients is not in agreement with Verbov, who found a decrease in this pattern and an increase in the arch pattern in female atopic patients. 9 Two differences in study design may have influenced our respective findings. First, an increase in whorls occurs in asthmatic patients,14 and the majority of the atopic patients we studied gave a personal or family history of asthma. Second, Verbov studied only one homogeneous Caucasian group, and, since there are ethnic variations in dermatoglyphic patterns, ~ this may have influenced his findings.

REFERENCES 1. Walker NF: The use of dermal configurations in the diagnosis of mongolism. J Pediatr 50:19-26, 1957. 2. Shiono H, Kadowaki J: Dermatologic uses of dermatoglyphics. Int J Dermatol 17:134-136, 1978. 3. Zizmor J: The extra transverse digital crease: A skin sign found in sickle cell disease. Cutis 11:447-449, 1973. 4. Laha NN, Nagar KS, Sepaha GC, Sethi NC: Dermatoglyphic patterns in psoriasis. International Symposium on Psoriasis, 2nd, Stanford University, 1976, pp. 342344. 5. Roberts DP, Abdullah N, Marks J, Shuster S: Dermatoglyphics in dermatitis herpetiformis. Br J Dermatol 99: 627-634, 1978. 6. Gibbs RC: Fundamentals of dermatoglyphics. Arch Dermatol 96:721-725, 1967. 7. Morgan DB: A suggestive sign of allergy. Arch Dermatol Syphilol 57:1050, 1948. 8. Verbov J: Atopic dermatitis. Practitioner 223:820-825, 1979. 9. Verbov J: Dermatoglyphie and other findings in atopic dermatitis. Trans St Johns Hosp Dermatol Soc 58:81-88, 1972. 10. Schaumann B, Alter M: Dermatoglyphics in medical disorders. New York, 1976, Springer-Verlag New York Inc., pp. 29-34, 122-126. 11. Uehara M: Infraorbital fold in atopic dermatitis. Arch Dermatol 117:627-629, 1981. 12. Holt S: The genetics of dermal ridges. Springfield, IL, 1968, Charles C Thomas, Publisher, pp. 35-37. 13. Rajka G: Atopic dermatitis. Philadelphia, 1975, W. B. Saunders Co., pp. 46-48. 14. Ozkaragoz K, Atasu M, Saraclor Y: A preliminary study of dermatoglyphies in children with bronchial asthma. J Asthma Res 8:179-182, 1971. 15. Holt S: The genetics of dermal ridges. Springfield, IL, 1968, Charles C Thomas, Publisher, p. 28.