Advances in Human Biology

ORIGINAL ARTICLE
Year
: 2016  |  Volume : 6  |  Issue : 3  |  Page : 136--141

Role of Digital and Palmar Dermatoglyphics in Early Detection of Oral Leukoplakia, Oral Submucous Fibrosis and Oral Squamous Cell Carcinoma Patients


N Lakshmana1, A Ravikiran2, Y Samatha2, Abhishek Singh Nayya3, Pavani B Vamsi1, B Kartheeki3,  
1 Department of Oral Medicine and Radiology, Sri Sai Dental College and Hospital, Srikakulam, India
2 Department of Oral Medicine and Radiology, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India
3 Department of Oral Medicine and Radiology, Saraswati Dhanwantari Dental College and Hospital and Post-Graduate Research Institute, Parbhani, Maharashtra, India

Correspondence Address:
Abhishek Singh Nayya
44, Behind Singla Nursing Home, New Friends«SQ» Colony, Model Town, Panipat - 132 103, Haryana
India

Abstract

Background and Objectives: Unusual dermatoglyphics may indicate genetic or chromosomal aberrations consistent with numerous diseases. The aim of the present study was to relate dermatoglyphic patterns in oral leucoplakia, oral submucous fibrosis (OSMF) and oral squamous cell carcinoma (OSCC) patients. Aim: The aim of the present study was to analyse the qualitative and quantitative variations in digital and palmar dermatoglyphics amongst the patients diagnosed with oral leucoplakia, OSMF and OSCC. Materials and Methods: A cross-sectional study comprising 225 patients, of which 75 patients were diagnosed with oral leucoplakia and OSMF, 75 patients were diagnosed with OSCC whereas 75 high-risk individuals with habits but without active lesions, was carried out. Finger and palmar prints were collected and analysed qualitatively and quantitatively. Results: In oral leucoplakia, OSMF and OSCC patients, loops were found to be the predominant finger ridge patterns whereas whorls were predominant in the control group. Conclusion: The study concluded that dermatoglyphics might serve as a potential tool in the early detection of the various oral pre-malignant and malignant lesions.



How to cite this article:
Lakshmana N, Ravikiran A, Samatha Y, Nayya AS, Vamsi PB, Kartheeki B. Role of Digital and Palmar Dermatoglyphics in Early Detection of Oral Leukoplakia, Oral Submucous Fibrosis and Oral Squamous Cell Carcinoma Patients.Adv Hum Biol 2016;6:136-141


How to cite this URL:
Lakshmana N, Ravikiran A, Samatha Y, Nayya AS, Vamsi PB, Kartheeki B. Role of Digital and Palmar Dermatoglyphics in Early Detection of Oral Leukoplakia, Oral Submucous Fibrosis and Oral Squamous Cell Carcinoma Patients. Adv Hum Biol [serial online] 2016 [cited 2019 Dec 13 ];6:136-141
Available from: http://www.aihbonline.com/text.asp?2016/6/3/136/195320


Full Text

 Introduction



Dermatoglyphics deals with the study of the epidermal ridges and their configurations on the fingers, palms and soles. [1] The word dermatoglyphics is derived from the Greek word derma meaning skin and glyphics meaning carvings. [2] Cummins and Midlo coined the term dermatoglyphics for the scientific study of ridges. [3],[4] Unusual ridge configurations have been shown to exist not only in the individuals affected with chromosomal defects but also in the ones with single gene disorders and in whom the genetic basis of the disorder is still unclear. [4] The development of dermatoglyphic patterns begins with the appearance of foetal pads in the 6 th week of gestation and reaches a maximum size between the 12 th and 13 th weeks while becoming full-grown in the 24 th week of gestation. [5] From this stage onwards, they are largely unaffected by the extraneous factors, and this explains their unique role as an ideal marker for individual identification and the study of populations, as well as in the detection of defects due to intrauterine irregularities in the early stages of gestation. Although dermatoglyphics is assumed to have a genetic basis for its development, the exact mechanism of inheritance is still unknown. Carter and Matsunaga have postulated that abnormalities in dermal ridges can only appear when a combination of hereditary and environmental factors exceeds a certain level and leads to changes in the local environment including an inadequate blood/oxygen supply and alterations in the epithelial growth patterns. [6],[7] These finger and palmar prints are permanent variables and inherited, differ amongst parents and their children, siblings and even in monozygotic twins. Because of these characteristics, these dermal ridges also play a crucial role in the personal identification of an individual for forensic purposes. [8] Since the discovery of dermatoglyphics in 1926, it has been used in the study of several genetic abnormalities. [9] The dermatoglyphic patterns of children with Down's syndrome were first studied by Harold Cummins in 1936. [10] Since most of the investigations required to confirm the diagnosis in hereditary disorders are complex and expensive, dermatoglyphics can be efficiently employed as an adjuvant to other clinical signs as a screening procedure. The question, now, is to test the predictive possibilities of dermatoglyphics in search of the various oral pre-malignant and malignant lesions. The present study was planned to analyse the qualitative and quantitative variations in digital and palmar dermatoglyphic patterns in oral leucoplakia, oral submucous fibrosis (OSMF) and oral squamous cell carcinoma (OSCC) patients.

 Materials and Methods



The present study was a cross-sectional study carried out between 1 st May 2012 and 15 th September 2013 comprising 225 patients, of which 75 patients were diagnosed with oral leucoplakia and OSMF, 75 patients were diagnosed with OSCC whereas 75 high-risk individuals with habits but without active lesions were included in the study. Finger and palmar prints were collected and analysed qualitatively and quantitatively. The permission to conduct the study was obtained from the Institutional Ethics Committee. The study sample was divided into three groups.

Group 1

This study group consisted of 75 patients clinically diagnosed with malignant oral ulcers/ulceroproliferative growths [Figure 1].{Figure 1}

Inclusion criteria

Patients with a positive history of tobacco and alcohol useWith the presence of malignant oral ulcers in oral cavity with associated problems that were consistent with the diagnosis of oral cancers.

Exclusion criteria

Patients with oral cancers without habits were excluded from the study.

Group 2

This study group consisted of 75 patients diagnosed with oral leucoplakia and OSMF.

Inclusion criteria

Patients with a positive history of tobacco and alcohol useOut of 75 patients, 34 patients were diagnosed with oral leucoplakia [Figure 2] and 41 were diagnosed with OSMF [Figure 3].{Figure 2}{Figure 3}

Exclusion criteria

Patients without a history of any deleterious habit were excluded from the study.

Group 3 (control group)

This group consisted of 75 high-risk individuals with habits but without active lesions in the oral cavity.

Inclusion criteria

Individuals with a positive history of tobacco and alcohol use but without active lesions in the oral cavity were included in the study.

Exclusion criteria

Patients with other oral soft tissue lesionsWithout a history of any deleterious habit.

Patients and individuals with dermatological diseases which could have affected the dermatoglyphic patterns were excluded from the study, in general.

After taking a thorough history of each patient, clinical examination was carried out, and the findings were recorded in a specially prepared pro forma. Clinical diagnosis was made in patients who showed characteristic clinical features consistent with the diagnosis of oral leucoplakia, OSMF and malignant oral ulcers. The patients who were diagnosed clinically with malignant oral ulcers were biopsied to get a confirmatory diagnosis of OSCC.

Sample collection for digital and palmar prints: Before taking the photographs of finger and palmar print patterns, the patients were asked to wash the ridged areas with soap and water followed by air-drying to remove sweat, oil and dirt from the skin to enhance the quality of dermatoglyphic prints. Each patient was then asked to place the fingers and palm of each hand one after the other in a custom-made standardised equipment whereas photographs of finger and palmar patterns were taken with a digital camera [Figure 4]a and b. The distance between camera and palm was standardised to be 8 inches to get optimum image quality and this was accomplished by the wooden standardised equipment. A 16 megapixel camera, without magnification, was used for acquiring the images. The images were previewed in the camera for optimum quality. Thus, images of fingers and palms of both the hands were acquired for each study sample [Figure 5]a-c, [Figure 6]a, b and [Figure 7]a, b. The images were then stored by optimally labelling the study groups and patient details.{Figure 4}{Figure 5}{Figure 6}{Figure 7}

Sample analysis

Each parameter of the finger and palmar prints was analysed qualitatively and quantitatively and the results obtained were subjected to statistical analysis.

Statistical analysis

Statistical analysis was done using SPSS version 20 software. For qualitative analysis, Chi-square test was used to find the P values. For quantitative analysis, mean and standard deviations were estimated in the sample for each study group. Mean values were compared using one-way ANOVA. P < 0.05 was considered statistically significant.

 Results



The aim of the present study was to analyse the qualitative and quantitative variations in digital and palmar dermatoglyphics amongst the patients diagnosed with oral leucoplakia, OSMF and OSCC. [Table 1] shows the frequency of fingerprint patterns in different study groups. On analysing the data, loops [Figure 5]a were found to be the predominant fingerprint patterns with a frequency of 59.73% followed by whorls [Figure 5]b, 34.14% and arches [Figure 5]c, 6.13% in OSCC (Group 1) whereas loops were found to be the predominant fingerprint patterns with a frequency of 61.2% followed by whorls, 32% and arches, 6.8% in oral leucoplakia and OSMF (Group 2). As far as the control group (Group 3) was concerned, whorls were the predominant fingerprint patterns in this group with a frequency of 50.27% followed by loops, 44% and arches, 5.73%. When arches were compared between the three groups, Group 3 had less frequency (5.73%) when compared to Group 1 (6.13%) and Group 2 (6.8%). In case of loops, Group 3 had less frequency (44%) of loops when compared to Group 1 (59.73%) and Group 2 (61.2%). When whorls were compared, Group 3 had a lesser frequency (5.73%) when compared to Group 1 (6.13%) and Group 2 (6.8%). The results were found to be statistically significant with P < 0.001. The predominant patterns observed in hypothenar area of both hands in all the three groups were the arches. [Table 2] compares the frequency of hypothenar area patterns in both the right and left hands. The predominant patterns observed in thenar areas of both hands in all the three groups were found to be loops. [Table 3] compares the thenar area/I1 patterns in all the three groups in both the right and left hands. The predominant pattern observed in I2 , I3 and I4 areas of both hands in all the three groups were the loops. [Table 4] compares the I2 , I3 and I4 area patterns in all the three study groups in both the right and left hands. [Table 5] reveals the total finger ridge count [Figure 6]a in all the three study groups. In Group 1, the mean was 141.19 as against a mean of 144.81 for Group 2 and 152.04 for Group 3. On intergroup comparison, the P value came out to be 0.978 between Group 1 and Group 2, 0.294 between Group 2 and Group 3 and 0.208 between Group 1 and Group 3. [Table 6] shows comparison of AB ridge count [Figure 6]bin the right hand in all the three study groups with a mean of 29.68 for Group 1, 31.04 for Group 2 whereas 31.04 for Group 3. On intergroup comparison, the P value came out to be 0.328 between Group 1 and Group 2, 0.998 between Group 2 and Group 3 and 0.363 between Group 1 and Group 3. [Table 7] shows the comparison of AB ridge count in the left hand in all the three study groups. In Group 1, the mean was 30.77 with 32.61 in Group 2 and 32.92 in case of Group 3. On intergroup comparison, the P value came out to be 0.26 between Group 1 and Group 2, 0.93 between Group 2 and Group 3 and 0.10 between Group 1 and Group 3. [Table 8] shows comparison of ATD angle [Figure 7]a and b in the right hand in all the three study groups. In Group 1, the mean was 41.10 with a mean of 39.42 in Group 2 and 39.32 in Group 3. On intergroup comparison, the P value came out to be 0.06 between Group 1 and Group 2, 0.99 between Group 2 and Group 3 and 0.07 between Group 1 and Group 3. [Table 9] shows comparison of ATD angle in the left hand in all the three study groups. In Group 1, the mean was 41.83 with a mean of 39.74 in Group 2 and 39.74 in case of Group 3. On intergroup comparison, the P value came out to be 0.6 between Group 1 and Group 2, 1.0 between Group 2 and Group 3 and 0.62 between Group 1 and Group 3.{Table 1}{Table 2}{Table 3}{Table 4}{Table 5}{Table 6}{Table 7}{Table 8}{Table 9}

 Discussion



It was in 1926 that Cummins introduced the term dermatolgyphics. [3],[11] According to Pour-Jafari, dermatoglyphics is the study of the patterns of the ridged skin of palms and soles. [8] Dermatoglyphics was first used in India for personal identification by Herschel. [12],[13] Fingerprints are a multifactorial trait. A large number of genes interplay with environmental influences in forming these distinct fingerprints. [14] Galton conducted an extensive research on the significance of skin ridge patterns not only to demonstrate their permanence but also their use as a means of personal identification. He demonstrated the hereditary significance of fingerprints and the biological variations of different fingerprint patterns amongst different racial groups. [14],[15] Ramani et al. observed the genetic component for various fingertip patterns. [16] Once formed, they are age and environment stable, becoming a reliable indicator, of a genetic damage. [8] At present, researchers claim that the study of dermatoglyphics is an important diagnostic tool for some diseases, especially the ones with obscure aetiology and mysterious pathogenesis. The diagnosis of a plethora of diseases genetically or non-genetically determined can be aided by dermatoglyphic analysis. [17],[18] Oral leucoplakia and OSMF are the prime lesions to be considered in this regard as most of the OSCCs are preceded by either of these two precancerous lesions and/or conditions. [15] There has been a relative dearth of research into this area, wherein dermatoglyphics has been used in the prediction in an individual for the susceptibility towards the development of such lesions as well as frank OSCCs. In examining dermatoglyphics and cancer patients, in general, one of the studies has noted an increase in whorls and a decrease in radial loops in cancer patients. [19] Another study with different cancers also found more whorls to be present. [20] A decreased ridge count in patients with cancers was also found in yet another study. [21] Another study found an increased proportion of ulnar loops in cancer patients. [22] Substantial evidence suggests that the carcinogenic process is driven by the interaction between exposure to exogenous carcinogens and an inherent genetic susceptibility. In response to environmental exposures, genetic damage accumulates more quickly in individuals with genetic susceptibility to DNA damages than in those without such instability but with a similar exposure. Consequently, individuals with genetic instability might be at a greater risk for developing these lesions. [18],[23] Very few studies, till date, actually have been carried out to assess dermatoglyphic patterns in patients who developed OSCCs. Venkatesh et al. performed a study on palmar dermatoglyphics in patients with oral leucoplakia and OSCC and observed a significant increase in the frequency of arches in such patients. [1] A study conducted by Gupta and Karjodkar also showed promising results by observing an increased frequency of arches and ulnar loop patterns on fingertips with a decreased frequency of simple whorl patterns on fingertips and a decreased frequency of palmar accessory triradii on the right and left hands in OSCC patients. Significant findings in OSMF patients included an increase in the frequency of arches and ulnar loop pattern, decrease in frequency of simple whorl patterns on fingertips, decrease in ATD angle on the right hand and a decrease in the frequency of palmar accessory triradii on the right hand. [24] A study by Tamgire et al. showed a highly significant decrease in simple whorl pattern on the left little finger in OSMF patients. [17] In oral cancers, dermatoglyphic patterns grossly have shown an increased frequency of arch pattern on the fingertips. [25] The study conducted by Venkatesh et al. showed 70% whorls and 6.30% loop type of fingerprints in oral leucoplakia and OSCC patients, respectively. In another study on OSCC patients, 70% loops, 32.30% whorls and 7.0% arch pattern of fingerprints were found. [1] The study conducted by Gupta and Karjodkar reported an increased percentage of loops in the OSMF group. [24] Tamgire et al., however, reported that there was no statistically significant difference in different patterns amongst the gutkha chewers with and without OSMF and that on digit-wise comparison, there was a significant increase of whorl pattern in the right and left thumbs of gutkha chewers with OSMF. [17] The study conducted by Ganvir and Gajbhiye found that whorl type of fingerprint pattern was predominant in significantly higher number of individuals affected with OSMF and OSCC as against the control group, wherein loop was the predominant fingerprint pattern. [26] Furthermore, the study conducted by Kumar et al. showed that there was a significant decrease of tented arches and ulnar and radial loops and an increase of simple whorls in OSMF patients as against the controls. [27] The variations seen in studies conducted so far contradicting the role of dermatoglyphics might be reasoned out due to geographic variations. Segura-Wang and Barrantes also reported that there is a significant interpopulation variation in dermatoglyphic patterns which should be kept in mind before arriving at a definite conclusion. [28]

 Conclusion



In the present study, loops were more common in the malignant and pre-malignant groups with significant P values. Whorls, on the other hand, were more predominant in the normal/control group. The relevance of dermatoglyphics is not only for diagnosis but also for prevention by predicting a disease. It is not only for defining an existing disease but also it is for identification of people with a genetic predisposition to develop the disease.

Acknowledgement

To all the patients who contributed in the study without whom this study would not have been feasible.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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