Aust. 1. Ment. Ret.

(1972) 2: 51-53

THE DOWN’S SYNDROME DERMATOGRAM -

A CLINICAL EVALUATION
S. G . PURVIS-SMITH’
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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 atd angle; dermal ridge pattern on the index
Reed et a1 (1970) devised a simple derma- finger of each hand) were assessed for each
toglyphic nomogram based on the four der- individual, and the patients and controls then
matoglyphic features which best discriminate classified by the dermatogram. The use of
between individuals with Down’s syndrome the dermatogram is illustrated in Figure 2:
and normal subjects. They called this nomo- Line I connects the pattern type on the right
gram the Down’s syndrome dermatogram hallux with the measured atd angle on the
(figure right hand. Line IT connects the pattern types
This report evaluates the ability of the der- observed on the right and left index fingers.
matogram to correctly classify known Down’s Line 111 connects the intersection of lines I
syndrome patients and normal subjects. and A with the intersection of lines TI and B,
and its intersection with the diagnostic index
SUBJECTS AND METHODS
line classifies the subject as Down’s syndrome,
intermediate or normal.
The hand and footprints of 103 patients
(52 males and 51 females) with Down’s syn- RESULTS
drome werc recorded at the Lorna Hodgkin- The classification of the 103 patients and
son Sunshine Home, Sydney, Australia, using 51 controls according to the Down’s syndrome
an inkless technique described previously dermatogram is shown in the table; Reed’s
(Purvis-Smith, 1969). Five patients were figures for 250 proven trisomic mongols and
known to have karyotypes with trisomy 2 1 ; 332 karyotyped normal controls are also shown
diagnosis in the remainder had been made on for comparison. Eighty-one of the present
clinical grounds. Ages of the patients ranged patients, including the five with proven trisomy,
from 5 to 62 years. Controls consisted of fell within the Down’s syndrome range. No
5 1 normal subjects (27 males and 24 females). patient fell within the normal range and no
Both patients and controls were of Caucasian normal control fell within the Down’s syn-
origin. drome range.
1. Research Assistant, Children’s Medical Research Founda- DISCUSSION
tion Royal Alexandra Hosnital for Children Camperdown, In this study, 79% of mongo1 patients were
N.S:W. 2050, Australia. (Address for Reprinis)
2. Copies of the Down‘s syndrome dermatogram may be classified as having Down’s syndrome, and no
obtained from the Indiana University Foundation Indiana
University ,School of Medicine, 1100 West Michigin Street,
patient fell within the normal range; a result
Indianapolis. Indiana. 46202, U.S.A. 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 supersedes earlier methods such as that of
range, the remaining 22% being classified as Walker.
intermediate; in comparison with Reed’s, these The dermatogram will be of considerable
results show somewhat better separation of value as an aid to clinical diagnosis of Down’s
patients and controls (Table 1). The value syndrome prior to confirmation by karyo-
of the Down’s syndrome dermatogram in typing. Its principal value, however, will be
making a rapid, objective and reasonably in screening patients with atypical Down’s
accurate assessment from simple dermato- syndrome, as an indication to the clinician of
glyphic data is thus confirmed. In both the need for more definitive chromosome
accuracy and ease of use, the dermatogram 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