Aust. 1. Ment. Ret.

(1972) 2: 51-53

THE DOWN’S SYNDROME DERMATOGRAM -

A CLINICAL EVALUATION
S. G . PURVIS-SMITH’
J Intellect Dev Dis Downloaded from informahealthcare.com by Nyu Medical Center on 01/11/15

SYNOPSIS
A dermatoglyphic nomogram (derrnatogram) which was recently devised to asist the
clinical diagnosis of Down’s syndrome, has been evaluated on 103 patients and 51 normal
controls. The dermatogram clarsified 79% of the patients as having Down’s syndrome, and
ascessment of the normal controls produced no false positives . This study confirms the
usefulness of the dermatogram as an aid to diagnosis of Down’s syndrome esFecially where
other clinical signs are cquivocal

Several dermatoglyphic indices have been The four dermatoglyphic parameters which
designed to aid in the diagnosis of Down’s constitute the dermatogram (dermal ridge
syndrome, and of these, the best known is pattern on the right hallux; size of the right
For personal use only.

probably that of Walker (1957). Recently
Reed et a1 (1970) devised a simple derma-
toglyphic nomogram based on the four der-
matoglyphic features which best discriminate
between individuals with Down’s syndrome
and normal subjects. They called this nomo-
gram the Down’s syndrome dermatogram
(figure
This report evaluates the ability of the der-
matogram to correctly classify known Down’s
syndrome patients and normal subjects.
SUBJECTS AND METHODS
The hand and footprints of 103 patients
(52 males and 51 females) with Down’s syn-
drome werc recorded at the Lorna Hodgkin-
son Sunshine Home, Sydney, Australia, using
an inkless technique described previously
(Purvis-Smith, 1969). Five patients were
known to have karyotypes with trisomy 2 1 ;
diagnosis in the remainder had been made on
clinical grounds. Ages of the patients ranged
from 5 to 62 years. Controls consisted of
5 1 normal subjects (27 males and 24 females).
Both patients and controls were of Caucasian
origin.
1. Research Assistant, Children’s Medical Research Founda-
tion Royal Alexandra Hosnital for Children Camperdown,
N.S:W. 2050, Australia. (Address for Reprinis)
2. Copies of the Down‘s syndrome dermatogram may be
obtained from the Indiana University Foundation Indiana
University ,School of Medicine, 1100 West Michigin Street,
Indianapolis. Indiana. 46202, U.S.A.
atd angle; dermal ridge pattern on the index
finger of each hand) were assessed for each
individual, and the patients and controls then
classified by the dermatogram. The use of
the dermatogram is illustrated in Figure 2:
Line I connects the pattern type on the right
hallux with the measured atd angle on the
right hand. Line IT connects the pattern types
observed on the right and left index fingers.
Line 111 connects the intersection of lines I
and A with the intersection of lines TI and B,
and its intersection with the diagnostic index
line classifies the subject as Down’s syndrome,
intermediate or normal.
RESULTS
The classification of the 103 patients and
51 controls according to the Down’s syndrome
dermatogram is shown in the table; Reed’s
figures for 250 proven trisomic mongols and
332 karyotyped normal controls are also shown
for comparison. Eighty-one of the present
patients, including the five with proven trisomy,
fell within the Down’s syndrome range. No
patient fell within the normal range and no
normal control fell within the Down’s syn-
drome range.
DISCUSSION
In this study, 79% of mongo1 patients were
classified as having Down’s syndrome, and no
patient fell within the normal range; a result
comparable with that of Reed. In the con-
 52 AUSTRALIANJOURNALOF MENTAL RETARDATION

DOWN‘S S Y N D R O M E D E R M A T O G R A M

RIGHT HALLUCAL PATTERNS

INDEX FINGER
RIGHT ATD PATTERNS

0
ANGLE PATIENT
TIBIAL ARCH
LINEA f 110
H W P I T A L NUMBER

100 -- LOOP

--
A
SMALL DISTAL 90
MOP DIAGNOSTIC
80.- MDEX
LINE LINE B

--
J Intellect Dev Dis Downloaded from informahealthcare.com by Nyu Medical Center on 01/11/15

lLEFT
70 RIGHT ARCH
INDEX FINGER INDEX FINGER
--
fl
LAAGE DISTAL 00
LOOP
-- 50
DOWN’S
SYNDROME

WHORL
40

ao
--
--
--
30

I o w
- A
a
o
TA
RL
O U L
TA
RL
0

o
UL

A
w
WHORL

4
For personal use only.

T t N T E I ) AI(CI1
FIIIULAR LOOP

k-’ OTHER
@ 1970 Indiana llniversity Foundxliw
( a l l rights reserved )

Figure 1. The Down’s syndrome dermatogram.

TABLE 1
Classification of Patients and Normal Subjects by the Down’s Syndrome Dmatogram
~

PATIENTS CONTROLS

Classification

Down’s Syndrome
Prezent Study
(103)
81
Reed’s Study
(250)
81 %
Present Study
(51)
0
I Reed’s Study
(332)

(79%)
Intermediate
~~

22
(21 % )
- 18%
I 11
(22%)
32%

< 1%
Ncrmal 0
I 40
(78%) I 67 %

trols, however, 78% fell within the normal
range, the remaining 22% being classified as
intermediate; in comparison with Reed’s, these
results show somewhat better separation of
patients and controls (Table 1). The value
of the Down’s syndrome dermatogram in
making a rapid, objective and reasonably
accurate assessment from simple dermato-
glyphic data is thus confirmed. In both
accuracy and ease of use, the dermatogram
supersedes earlier methods such as that of
Walker.
The dermatogram will be of considerable
value as an aid to clinical diagnosis of Down’s
syndrome prior to confirmation by karyo-
typing. Its principal value, however, will be
in screening patients with atypical Down’s
syndrome, as an indication to the clinician of
the need for more definitive chromosome
analysis.
 AUSTRALIAN
JOURNAL OF MENTALRETARDATION 53

DOWN'S SYNDROME DERMATOGRAM

RIGHT HALLUCAL PATTERNS

INDEX FINGER
RIGHT ATD PATTERNS
ANGLE PATIENT .
TIBIAL ARCH
HOSPITAL NUMBER
LINE A
110

LOOP

SMALL DISTAL
LOOP
80
90
DIAGNOSTIC
INDEX
LlNE LINE B C'I
J Intellect Dev Dis Downloaded from informahealthcare.com by Nyu Medical Center on 01/11/15

RIGHT LEFT ARCH

INDEX FINGER INDEX FINGER
LARGE DISTAL
LOOP

WHORL R WHORL
For personal use only.

TENTED ARCH

@ 1970 Indiana University Foundation

( a l l rights r e s e r v e d )

Flgure 2. Use of the Down's syndrome dermatogram.

ACKNOWLEDGEMENTS REFERENCES