Reliability of cheiloscopy and dermatoglyphics in hypertension and diabetes. A comparative study.

Background: Both dermatoglyphic and cheiloscopic patterns are genetically determined. These patterns are known to be associated with type II diabetes or diabetes mellitus and hypertension which are also considered to have genetic influence due to their familial occurrence. Hence, the aim of this study was to compare reliability of both cheiloscopy and dermatoglyphics with hypertension and type II diabetes. Materials and
Methods: This was a prospective study conducted on 300 study participants. Both cheiloscopic and dermatoglyphic patterns were recorded using validated techniques. Obtained patterns were analyzed and assessed for statistical analysis using the SPSS version 21.0 statistical software. The Chi-square test was used for analyzing the obtained data.
Results: In the present study, no statistical correlation was obtained between either dermatoglyphic or cheiloscopic patterns and type II diabetes or hypertension.
Conclusion: The present study showed that cheiloscopy or dermatoglyphics cannot be used as a predictive tool for assessing a subject's risk of developing type II diabetes or hypertension. These are contradictory findings, thus emphasizing more research in this area so that these noninvasive techniques can be used as predictive tools for developing essential hypertension or type II diabetes.

INTRODUCTION

The terminology “Dermatoglyphics” has been derived from Greek “derma” meaning skin and “glyph” which means “carving.”[1] Cummins and Midlo coined the terminology “dermatoglyphics” in 1943. The ridged or friction ridges on the skin are present on palmar and digital surfaces (palmar and digital prints). Functionally, these ridges impart a firm grip to prevent slipping and also enhance touch sensation.[2]

Fingerprints or fingertip patterns are formed by epidermal ridges which form around 6–8 weeks following conception. These appear as volar pads which undergo recession at approximately 10–12 weeks. Skin ridges appear at the 13th week. These patterns get completed at 21 weeks. Once formed, these ridge patterns do not undergo any change.[3]

The term “cheiloscopy” has been derived from Greek “cheilos” which means lips and “skopein” which means “to see.”[4] Fisher in 1902 was the first person to describe lip print patterns, while Edmond Locard was the first individual to recommend cheiloscopic analysis for identification of humans.[5]

The lip patterns or cheiloscopic patterns are constituted by furrows and lines present on the vermillion border of lips. These have patterns identical to those of fingerprint patterns.[6] These patterns are characteristic fissure patterns or sulci labiorum which present as depressions along with elevations. These patterns remain unchanged in climate, minor trauma, inflammatory, and herpetic ulcerations.[7]

As per Suzuki and Tsuchihashi classification, lip prints can be categorized into (a) Type I: incompletely vertical lip print patterns; (b) Type I’: incompletely vertical lip print patterns; (c) Type II or “Y” or branching pattern; (d) Type III or criss-cross pattern; (e) Type IV or reticular lip pattern; and (f) Type V pattern: These lip prints are unique to an individual as they do not correspond to any of the lip patterns.[6]

These patterns form an important component of Forensic Sciences, especially Forensic Odontology.[8] The fingerprint patterns or dermatoglyphic patterns are genetically regulated. The study of these patterns is also useful for diagnosis of diseases such as type II diabetes or diabetes mellitus. There are three kinds of dermatoglyphic or fingerprint patterns: (a) loop pattern; (b) whorl pattern; and (c) arch pattern. These patterns on fingertips start forming around 13 weeks in intra-uterine life.[9] Whorls can be classified as (a) simple whorls: these are formed by sequential concentric rings or whorls; (b) spiral or double whorl: this pattern is constituted by ridge patterns in a clockwise or anticlockwise direction; (c) central pocket loop pattern: this pattern comprises a loop within a smaller whorl, whereas in the “arch” pattern, the epidermal ridges cross from one edge to another edge of the digit.[1]

Arch form of fingerprint pattern: This fingerprint pattern can be classified as (i) plane and (ii) tented arch forms. The plane or simple arch form presents as ridges which flow from one end to another end without any recurving, while the tented arch form is comprised ridges converging at a point

Loop fingerprint pattern: The loop fingerprint pattern is comprised a triradii wherein the ridge pattern enters and exits the pattern on the same side. There is at least a single recurving ridge between the core and triradii point. No ridge recurving between triradii and core is classified as (i) ulnar and (ii) radial loop pattern. If the ridges are entering and exiting toward the ulnar aspect, they are termed as “ulnar loop;” however, if the ridges enter and exit toward the radial aspect, it is termed as “radial loop.” These may be regular or double ring shaped.[2]

Whorl pattern: This pattern involves two or more numbers of triradii. It can be subdivided into four types of patterns (i) plain whorl pattern: this pattern comprises one or greater number of ridge patterns which form complete circle containing the delta shapes; (ii) central pocket-looped whorl pattern: this pattern comprises a minimum of one recurving ridge or obstruction with two delta pattern; and (iii) double loop whorl pattern: this pattern comprises two distinctly separated shoulders in each pattern core, additional to two deltas and may be one or more than one ridge forming complete circuits; and (iv) accidental whorl pattern: this pattern is comprised mixed patterns that do not comply with any of the patterns. A “triradii” is also called “delta.”[2] A whorl demonstrates a difference from loop pattern with respect to concentric ridge arrangement with two or more triradii in a loop pattern.[10]

The loop pattern has a prevalence in 60%–65% subjects, whereas the whorl and arch patterns are usually found to be prevalent in 30%–35% and 5% of studied subjects.[11] Dermatoglyphics has been associated with a variety of systemic conditions such as hypertension, diabetes mellitus, epilepsy, and congenital heart disease. Genes responsible for various dermatoglyphic patterns cause a significant predisposition toward familial disorders, most particularly diabetes mellitus. Furthermore, abnormalities in dermatoglyphic patterns have been noticed in cases with genetic aberrations.[12]

Diabetes is a chronic disorder of metabolism with multiple etiological factors. It is characterized by a chronic hyperglycemic condition which is associated with metabolic disturbances of carbohydrates, protein, and fat. Diabetes is constituted by two types: (a) Type I and (b) Type II. The Type I form is characterized by T-cell-mediated destruction of beta-cells of the pancreas, while the Type II variety is characterized by numerous lifestyle and dietary factors. The Type II form is more commonly seen in the general population. Different fingerprint patterns show a good correlation with genetic diseases. Thus, both the dermatoglyphic patterns and diabetes mellitus demonstrate genetic control and polygenic inheritance.[13] Hypertension is a major reason for mortality all over the world with 9.4 million deaths. This disease puts a burden of overall health care; hence, analysis of biological parameters is required for predicting the disease outcome. There is evidence that hypertension is associated with dermatoglyphic patterns.[14]

Thus, the aim of the study was to test the reliability of cheiloscopy and dermatoglyphics in patients of hypertension and type II diabetes (Diabetes mellitus).

MATERIALS AND METHODS

This prospective study involved 300 subjects (100 males and 200 females) for the analysis of cheiloscopic and dermatoglyphic patterns within the age range of 30–65 years who visited the outpatient department of dental institute for regular checkup. Institutional ethical committee clearance was obtained. Written informed consent was obtained from the study participants after explaining the study purpose to them in a language which was native and easy to understand. Inclusion criteria for the study participants were (1) those with a history of diabetes mellitus for more than 2 years; (2) those diagnosed with hypertension; and (3) those who willingly provided consent. Exclusion criteria of the study were (1) those with genetic deformities; (2) juvenile diabetes mellitus patients (3) those with mental disorders such as autism; (3) those with neuromuscular disorders; (4) subjects who had known allergic or hypersensitivity response toward lipstick and/or lamp black carbon pigment; (5) those who subjects who were not willing to give informed consent for study participation; and (6) subjects with any allergies especially contact dermatitis and rhinitis.

Both cheiloscopic and dermatoglyphic patterns were analyzed after obtaining their print patterns using a magnifying glass for better visualization as described below:

Technique used for obtaining lip print or cheiloscopic patterns:[9]

The patients were instructed to sit in an upright position. After this, a dark pigmented lipstick was applied using a lipbrush in a single stroke. After application of the lipstick, the subjects were asked to rub their lips gently for even spreading. After 2 months of application, cellophane tape was pasted using the glued portion on the subject's lips. Following this, the tape was removed and pasted over an A4-size white bond paper without any smudging. Lip print patterns were studied as per the Suzuki and Tsuchihashi classification: (a) Type I: clear-cut vertical grooves running across entire lips; (b) Type I’: similar to Type I but not covering lip thickness; (c) Type II: branching of grooves; (d) Type III: intersection of grooves; (e) Type IV: reticulated groove pattern; and (f) Type V: groove patterns which do not fall into any of the above types and could not be differentiated, i. e., undetermined.

Technique for obtaining fingerprint or dermatoglyphic patterns:[11]

A kymographic paper was evenly spread up on a flat cardboard followed by the application of facial cream. Lampblack fine powder was applied to fingertips using a brush. The marked hands were then pressed upon A4-sized white paper sheet and fingerprint patterns were recorded. Dermatoglyphic patterns observed were classified as per the Henry's system of classification which classifies fingertip patterns as (a) loops, (b) whorls, and (c) arches.

Statistical analysis

Study observations were entered into Microsoft Excel worksheets and the obtained data were analyzed using the Statistical Package for the Social Sciences version XXI (IBM Business Corporation, Chicago, IL, USA) statistical software. A Chi-square test was employed for statistical analysis. On analyzing the data, P < 0.05 was considered to have statistical significance.

RESULTS AND OBSERVATIONS

Analysis of lip print patterns:

Lip print patterns among diabetics and controls were divided intoTypes I, II, III, IV, and V. Percentage distributions of each of the lip print pattern types in individuals diagnosed with diabetes mellitus were Type I (8%), Type II (17%), Type III (6%), Type IV (16%), and Type V (3%), while in hypertensive subjects, they were Type I (33%), Type II (7%), Type III (3%), Type IV (4%), and Type V (3%) [Graph 1]. The Types II and IV lip print patterns were found to be predominant in diabetic individuals, while Type I lip print pattern was found to be predominant in hypertensive subjects. The statistical difference was found to be statistically significant (Chi-square value = 24.501a, degree of freedom = 3, P = 0.000). Gender-based analysis of the lip print and fingerprint patterns did not show any statistical significance [Table 1].

Graph 1

Graph showing cheiloscopic pattern distribution among diabetics and hypertensive patients

Table 1

Cheiloscopic pattern distribution among diabetics and hypertensive subjects

Lip print pattern distribution	Diabetics (%)	Hypertensives (%)	P
Type I	8	33	0.124
Type II	17	7
Type III	6	3
Type IV	16	4
Type V	3	3

Analysis of dermatoglyphic or fingerprint patterns:

Fingerprint patterns were analyzed for both the hands which included analysis of thumb to little fingertip print patterns. Percent distributions of obtained patterns were analyzed and assessed. In addition, differences in fingerprint patterns were also analyzed. Whorl pattern, loop pattern, and arch pattern were found to have percentage distributions of 24%, 13%, and 5% in diabetic subjects while a distribution of 23%, 12%, and 3% in hypertensive individuals [Graph 2]. Differences obtained were found to have no statistical significance for both hands (P = 0.224 for left hand and P = 0.124 for right hand). Here also, no gender-based statistical difference was observed [Table 2].

Graph 2

Graph showing dermatoglyphic pattern distribution among diabetics and hypertensive patients

Table 2

Dermatoglyphic pattern distribution among diabetics and hypertensive subjects

Dermatoglyphic pattern distribution	Diabetics (%)	Hypertensives (%)	P
Whorl pattern	24	23	0.000
Loop pattern	13	12
Arch pattern	5	3

DISCUSSION

Every human being bears a distinct and easily discernible trait due to which they present with distinct patterns or characteristics of which both dermatoglyphic and cheiloscopic patterns are important features. Dermatoglyphic analysis involves the study of epidermal ridges present on surfaces of palms, fingers, soles as well as toes, whereas cheiloscopic analysis involves the study of patterns of grooves or furrows present on the vermilion border of lips of humans. Both the fingerprint and lip print patterns are known to be useful genetic markers in a variety of congenital and genetic diseases which manifest clinically.

The present study demonstrated no statistical correlation between dermatoglyphic and lip print patterns among diabetic (P = 0.000) and hypertensive (P = 0.124) subjects. The whorl pattern was found to be in highest prevalence among both diabetic and hypertensive subjects. These findings have been supported by Sathawane et al. in 2019 in their study findings on diabetic individuals demonstrated whorl pattern more frequently than the arch pattern in dermatoglyphic analysis, while the reticular variety of cheiloscopic pattern was higher among diabetic subjects when compared with normal subjects.[15]

Kakkeri et al. in 2018 in their study reported that 67% of type II diabetic patients demonstrated whorl pattern, 20% had loop pattern, while 5% demonstrated arch pattern.[11] Similarly, Patahn and Gosavi in 2011 demonstrated a significant increase in the whorl pattern and a significant reduction in the loop pattern.[16]

In the present study, Types II and IV lip print patterns were found to be present in higher numbers among type II diabetics. Similar findings have been reported by Manjusha et al. in 2017 who demonstrated that Type IV lip patterns were more prevalent in diabetic patients.[17] Tandon et al. in 2017 reported a correlation between lip print patterns and fingerprint patterns.[18] Similar supportive findings were reported by Metgud et al. in 2016.[19] However, Murugan and Karikalan demonstrated no correlation between dermatoglyphic and cheiloscopic patterns.[20]

Umana et al. in their study conducted in Nigeria demonstrated significantly high number of loop and whorl patterns in both hands of hypertensive patients.[21]

Lahiri et al. in 2013 in their study conducted in West Bengal, India, showed that hypertensives show higher double loop and arch patterns compared to whorl, ulnar, and radial loops.[22]

Sant et al. in 1983 showed an increase in frequencies of whorl pattern and decrease in loop patern in both male and female diabetic subjects.[23]

However, Rashad and Mi in 1975 in their study on the American and Japanese population of Hawaii islands showed no statistically significant difference in fingerprint patterns.[24]

However, no statistically significant difference in genders was observed on either dermatoglyphic or cheiloscopic analysis.

CONCLUSION

Both lip print and fingerprint patterns are genetically regulated and form a unique pattern for each subject. It has been proposed that both dermatoglyphics and cheiloscopy may play significant roles in identifying various systemic conditions according to various preliminary studies as they have a noninvasive nature. However, in the present study, no such findings were obtained, thus indicating more research in determining if both of these techniques can be used as predictive tools for risk of developing these diseases in future.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.