A Pilot Study: Nailing Indian Elections with the Indelible Ink Mark.

CONTEXT: The indelible ink that's used in our elections was developed by National Physical Laboratories (NPL), Delhi in 1962, and has been used ever since. Though formulated by NPL, it is manufactured by Mysore Paints and Varnish Ltd. owned by the Karnataka Government. Earlier, the ink mark was applied on the cuticle but with effect from February 01, 2006 the ink is applied on the voter's left index fingernail from the distal end proximally until the cuticle using an applicator. This idea of the ink mark applied during elections was used as a simple tool to measure the rate of nail growth in a busy outpatient department of a Tertiary Hospital in South India. AIMS: To assess the feasibility of using the ink mark during elections as a method of obtaining data of nail growth across the spectrum of the entire country. SUBJECTS AND METHODS: In 74 patients presenting to a hospital, the rate of nail growth was measured. The voter's mark on the left index fingernail of patients during the recent elections was used as a marker for measuring the length of the nail.
RESULTS: The average rate of nail growth was 0.113 mm/day. The rate of nail growth was found to be more in females, younger individuals, pregnancy, patients on nutritional supplementation, psoriasis.
CONCLUSION: This study which was conducted on 74 patients using the election ink mark successfully confirmed the possibility of using it as an efficient tool in measuring the rate of nail growth. The findings revealed the slightly higher rate of nail growth as compared to a study done by Rani et al. However, the limited sample size in this study was the major limitation.

What was known?

Rate of nail growth is more in females than in males

Rate of nail growth is more in younger age group than the older

Rate of nail growth is reduced in chronic systemic diseases and chemotherapeutic drugs

Rate of nail growth is increased during pregnancy and psoriasis.

Introduction

The use of an indelible ink mark on the fingernail is a practice during the elections in India. As the fingernail grows, the level of the mark shifts distally. According to the Election Commission of India, 540 million[12] people voted with 23 million[3] belonging to the age group 18–19 years, making the 2014 general election the largest ever election in the world.[4] With these overwhelming statistics, the election period from April to May 2014 was selected as an appropriate time to conduct a study on the rate of nail growth as this indelible mark could be easily used as a simple tool to carry out a large-scale study in a short period of time in our country. In other countries such as Cambodia and Maldives, the voter dips a finger in the ink, whereas in Afghanistan an ink pen is used. Mysore Paints and Varnish Ltd. exports indelible ink to 28 countries, including Turkey, South Africa, Nigeria, Canada, and Malaysia thus making it a possibility to use this indelible ink mark as a universal tool to measure the rate of nail growth not just in our country but worldwide to obtain data across a vast epidemiological and geographical spectrum which will further help to confirm the role of age, gender, race and temperature among other factors affecting the rate of nail growth.

To the best of our knowledge, there has been no such study undertaken in the past to assess the rate of nail growth in the South Indian population.

Aims of this study were

To ascertain whether the indelible ink mark used during elections can be used as a tool to rapidly attain statistics in a large population nationwide, for assessing the rate of nail growth

To assess other demographic and systemic factors affecting the rate of nail growth.

Subjects and Methods

In our study, 74 patients who presented to the outpatient department (OPD) of St. John's Medical College in the month of July 2014 with the voter's ink mark were included in the study. The voter's mark on the left index fingernail of patients during the recent elections was used as a marker for measuring the length of the nail [Figure 1]:

Figure 1

Left index finger with indelible ink mark

The length of the nail was calculated from the center of the proximal nail fold to the proximal end of the voter mark using a magnifying lens, calipers, and measuring scale [Figures 2 and 3]

Figure 2

Measurement with calipers

Figure 3

Calipers with digital scale

The date of voting and the date of recording the length of the nail were noted for each individual

The rate of nail growth was calculated by dividing the length of the nail (in mm rounded up to 3 decimal places) by the number of days

The time period between the election date and the date of the measurement of the rate of nail growth was >60 days.

The following information was obtained from each patient:

Demographic details

Associated systemic diseases

Cutaneous disease

Drug intake

Other factors, e.g. pregnancy, lactation.

The average rate of nail growth was calculated in each of the following groups:

Age (<35 years, >35 years)

Sex

Chronic diseases: Diabetes mellitus, hypertension, anemia, tuberculosis, connective tissue diseases

Dermatological conditions: Psoriasis, pemphigus, leprosy

Nutritional supplements

Immunosuppressive drugs: methotrexate, cyclophosphamide.

Results

The rate of nail growth ranged from 0.072 to 0.141 mm/day. Females had a higher rate of nail growth (0.098–0.141 mm/day) as compared to males (0.072–0.124 mm/day). The rate of nail growth in younger patients (<35 years) was found to be 0.108–0.141 mm/day as compared to older patients (>35 years) which was 0.072–0.120 mm/day [Table 1].

Table 1

Effect of age and sex on the rate of nail growth

Patients with chronic systemic disorders such as diabetes, tuberculosis, hypothyroidism, hypertension and connective tissue disorder had a reduced rate of nail growth as compared to patients without any chronic disorder (0.111–0.122 mm/day) [Table 2].

Table 2

Effect of systemic disease on the rate of nail growth

Patients suffering from psoriasis had an increased rate of nail growth (0.118–0.124 mm/day) whereas patients with other dermatological conditions such as pemphigus and leprosy had a lower rate of nail growth [Table 3].

Table 3

Effect of cutaneous diseases on the rate of nail growth

Patients who were on nutritional supplements such as Vitamin D and calcium had an increased rate of nail growth. Patients on anti-tubercular therapy and immunosuppressants such as methotrexate and cyclophosphamide were found to have a slower rate of nail growth [Table 4].

Table 4

Effect of drugs on the rate of nail growth

The median number of days for which the rate of nail growth was measured for our entire study sample was 111 days. The median number of days for which rate of nail growth was measured for the remaining subclassifications has been mentioned below.

Discussion

The average rate of nail growth in our study was found to be 0.113 mm/day. This coincided with the average rate of nail growth in a study done by Bean[5] which was found to be 0.119 mm/day. However in a study done by Rani et al.[6] in Bhopal, the average rate of nail growth of the left index finger, was found to be lower (0.086 mm/day). The rate of nail growth depends on the age, with it being higher in a younger age group that is, <35 years which is consistent with a study conducted by Peter.[7] The rate of nail growth is more in females than males which are consistent with a study conducted by Rani et al.[6] in 2000.

The rate of nail growth was retarded in patients with connective tissue disease (0.106 mm/day) as compared to the healthy individuals (0.118 mm/day). In a study done by Hamilton[8] patients with rheumatoid arthritis had a lower rate of nail growth (0.085 mm/day) as compared to healthy individuals (0.09 mm/day). This study also showed that the nail grows slower in patients on steroids as compared to healthy individuals which were consistent with our study.

The rate of nail growth was reduced in patients with anemia, hypothyroidism, infections such as tuberculosis and drugs like methotrexate and was increased in pregnancy and psoriasis which was consistent with the findings in a study by Orentreich et al.[9] However, our study showed an increased rate of nail growth in patients on nutritional supplements as compared to the same study which showed no effect on the rate of nail growth.

As far as adverse effects related to indelible voter's ink is concerned none of our patients reported the above, however there have been reports in literature about the fatal irritant potential of this ink resulting in chemical burns.[10]

Conclusion

This study conducted on 74 patients included 38 males and 36 females who during the month of April to May 2014 participated in the general election and presented to our OPD in the month of July. The findings revealed the slightly higher rate of nail growth as compared to literature by Rani et al.[6] The rate of nail growth was found to be higher in females, the younger age group which was consistent with that of Rani et al.[6] It was also found to be higher in pregnancy, patients with psoriasis and patients on nutritional supplements. However, reduced rate of nail growth was found in patients with chronic diseases such as connective tissue disorders, diabetes, hypertension, hypothyroidism, and patients on steroids and methotrexate. This study helped highlight a simple observation like the indelible ink mark which can be successfully used to rapidly assess the rate of nail growth within a short span of time over the entire spectrum of a country around the time of an election. And as this study was found to be successful in relation to correlation of data with other studies, this method can also be used across other countries to obtain much wider and varied demographic details to study various other factors affecting nail growth. However, the limited sample size was found to be a limitation of the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

What is new?

This study depicts how a simple observation like the indelible ink mark can be used to rapidly assess the rate of nail growth within a short span of time over the entire spectrum of a country around the time of an election.

This method can be used as a simple tool across not just our country but also other nations to obtain demographic details across a wider cross section of the society. This information can be extrapolated to obtain factors affecting rate of nail growth across a more variable epidemiological society.