ISSN: 0975 -8542
Journal of Global Pharma Technology
Available Online at: www.jgpt.co.in
©2009-2019, JGPT. All Rights Reserved 349
Dermatoglyphics and Type 2 Diabetes Mellitus: Review
Mohammed Majid 1, 2, Falah S. Al-Fartusie2* Dheaa Sh. Zgeer3
1. Directorate of Forensic Investigations, Ministry of Interior, Baghdad, Iraq.
2. Chemistry Department, College of Science, Mustansiriyah University, Baghdad, Iraq.
3. Forensic DNA centre for research and training, Al-Nahrain University, Baghdad, Iraq.
*Corresponding Author: Falah S. Al-Fartusie
Study of epidermal ridges on the skin covers the palmar and plantar surface of hands and soles, and is
known as Dermatoglyphics (also known as fingerprints). Dermatoglyphics patterns are genetically
determined and are affected by environmental factors in the uterus. After their formation, they remain
stable, unchanged, and are not affected by postnatal environment or age. Dermatoglyphics can serve as a
reliable marker of individual identification, as they can be a morphological trait, and a mirror to explain
genetic and environmental factors in the first trimester of pregnancy. Diabetes is a chronic disease with
serious complications if not managed well. In fact, 90% of diabetics are type 2 diabetes mellitus,
multifactorial metabolic syndrome. T2DM will not be diagnosed until the long-term complications. Early
diagnosis and treatment are very important to prevent long-term complications of the disease (such as
retinopathy, neuropathy, nephropathy), and predicting people with high risk of T2DM can be useful in
preventing disease and complications. In this review, we will discuss dermatoglyphics, and the main
results of researchers who studied Dermatoglyphics for T2DM patients.
Keywords: Dermatoglyphics, T2DM, Arch, Loop, Whorl, Ridge count.
Dermatoglyphics (Fingerprints) refers to the
study of all features of ridged skin .
Cummins and Midlo first formulated this
term in 1943, derived from the Greek words
"dermato" which means skin and "glyphics"
means carvings . The ridged skin (also
known as the friction ridges skin) is located
on the digit and palmar surface of the hands
(known as fingerprints and palm prints) and
on the plantar surface and the toe of the feet.
It is believed that the mechanical function of
these ridges conveys a firmer grip and
prevents slippage , and is also believed to
enhance the sense of touch .
Diabetes is a serious and chronic disease that
occurs, either when the pancreas cannot
produce enough insulin, or when the body
cannot use insulin effectively . It is
characterized by high levels of glucose in the
blood, which may lead to progressive damage
in most tissues and organs of the body such
as heart, blood vessels, eyes, kidneys, skin,
According to the international Diabetes
Federation, in 2017 there were 425 million
people with diabetes, and there are expected
to be more than 629 million patients by 2045
. There are two types of diabetes mellitus;
type 1 and type 2 (formerly known as insulin
and non-insulin diabetes mellitus). The most
common type of diabetes is type 2 diabetes
(T2DM) (about 90% of diabetics). It was
previously called non-insulin-dependent or
adult-onset diabetes. Symptoms of T2DM are
often less obvious or absent. Therefore, the
disease may not be diagnosed for several
years, until the complications have already
Early diagnosis and treatment are very
important to prevent long-term complications
of the disease (eg retinopathy, neuropathy,
and nephropathy). The prediction of people
with high risk of developing T2DM is useful
not only for disease prevention, but also to
prevent the disease complications.
Falah S. Al-Fartusie et. al. | Journal of Global Pharma Technology|2019| Vol. 11| Issue 05 (Suppl.) |349-357
©2009-2019, JGPT. All Rights Reserved 350
Historical Review and Pioneers of
Fingerprints and Dermatoglyphics
Ancient civilizations such as Mesopotamia,
Indus, Chinese and Egyptians were all
familiar with the uniqueness of individual
fingerprints. Fingerprints were used as a sort
of stamp or brand mark on pottery or as seals
to give authenticity to important documents.
Clay tablets containing fingerprints
belonging to ancient Assyria were found, and
are now found in the British Museum . In
1684, one of the first fingerprint publications
was presented by Dr. Nehemia Gro, a Fellow
of the College of Physicians and Surgeons of
the Royal Society of England.
In 1686 another scientific paper was
published by Marcelo Malphighi, professor of
anatomy at the University of Bologna, Italy.
Later one of the skin layers of skin was
named by his name "the Malphighian layer"
for his magnificent work in this field . In
1823, Dr. Johannes Evangelist Burkinge,
Professor of Physiology at the University of
Breslau, classified fingerprint patterns into
nine standard types. In 1858, Sir William
Herschel, the Hooghly Collector distract in
Bangal under the British government,
recommended using fingerprints on official
contracts instead of signing in order to avoid
any disguises or deceptions in the future. Dr.
Henry Faulds was a Scottish Physician who
spent many years in Japan at Tsukiji
Hospital in Tokyo, in 1880 based on his
experiences and research, suggested using
fingerprints accidentally left by a criminal at
the crime scene to make a positive
identification of the real criminal. After that,
Dr. Henry wrote a textbook on fingerprint
In 1892, Sir Francis Galton, a British
anthropologist, and based on the material
collected by Sir William Herschel, published
his famous book "Fingerprints", which was
the first systematic scientific study of
fingerprints, established the fundamental
principles of fingerprints (the permanents of
the ridged skin, the uniqueness of individuals
fingerprint and the classification of
fingerprints patterns). He also discussed the
anatomy of ridged skin and classified the
fingerprint patterns into three main groups
(Arches, Loops, Whorls), in addition he
described and classified the characteristics of
the ridges (which called Galton details or
Minutia). In 1891, and according to the
Galton book, Dr. Juan Vucetich, an
Argentinian criminologist, developed a
classification system for fingerprints. Dr.
Juan classification system has been refined
over time and is still used in most Latin
American countries. Furthermore, Sir
Edward Richard Henry, an English police
officer stationed in Bangal, India, based on
the work of Galton and with the assistance of
two Bengali officers Khan Bahadur Azizul
Haque and Rai Bahadur Hemachandra Bose
of the Anthropometric Office, developed a
classification and storage system. In Henry
classification fingerprint system, the patterns
were modified into four main groups (Arch,
Loop, Whorl, Composites), and each group
was divided into subgroups.
In 1900, Sir E R Henry published a textbook
(Classification and Uses of Fingerprints), and
later the Henry classification system
transferred an anthropometric system from
Bertilon, which until then had been in use
. Harris Hawthorne Wilder, an American
professor of zoology at Smith College,
Northampton, Massachusetts, USA, was
interested in zoology, human anatomy and
forensic science. He introduced
Dermatoglyphics and the developments in
this field to the American public .In 1926,
Dr. Harold Cummins (a Professor of Anatomy
at Tulane University School of Medicine,
New Orleans, Louisiana, USA) named this
branch of science “Dermatoglyphics”. In 1943,
Professor Cummins with the assistance of his
colleague Charles Medlow, presented his
book "Fingerprints, Palms and Soles
Introduction to Dermatoglyphics" commonly
referred to as Cummins and Midllo .
Professor Cummins found that Mongolian
patients (Down syndrome) showed distinctive
features in the skin and fingers.
He reported that dermatoglyphics were
valuable in the diagnosis of Mongolian. His
findings were the foundation of clinical
dermatoglyphics science . Since then,
many researchers have been interested in
analyzing finger and palmar prints, and their
associations with various syndromes such as
Professor Lionel Sharples Penrose and Dr.
Sarah B. Holt, who were interested in the
inheritance of the dermatoglyphics .
Penrose and Holt were published many
papers that contributed to the progress of
Dermatoglyphics and genetics of dermal
ridges [10-14]. In fact, a positive correlation
between medical disorders and
dermatoglyphics anomalies has been
Falah S. Al-Fartusie et. al. | Journal of Global Pharma Technology|2019| Vol. 11| Issue 05 (Suppl.) |349-357
©2009-2019, JGPT. All Rights Reserved 351
established by many researchers, including
disorders caused by autosomal aberration
such as Down syndrome (Mongolian), or
because of sex chromosomal aberration, and
other Inherited disorders [3, 4].
Dermal ridges differentiation occurs at an
early stage of fetal development starting from
the 3rd month of the intrauterine life and
lasts until the 4th month. Once formed, they
remain permanent and never change during
the life span except in the dimensions that
proportional to the growth factor. The ridges
configurations resulting from genetic factors
are modified by the influence of
environmental factors and growth factors
during the formation period [3, 15].
One of the important characteristics of the
dermal ridges is that they reflect growth
troubles that occur before and during their
development , occurring during early fetal
life, along with major tissue differentiation.
Therefore, any abnormal genetic expression
or environmental factors that may affect
subsequent life may also affect the fingers
and palms ridged skin.
On the digital distal phalange, the dermal
ridges set as patterns, these patterns can be
classified primarily into three types
according to Galton, arch, loop and whorl.
Each pattern located in the middle of the
finger ball. Loops and Whorls patterns
contain an important landmark called
Triradii. A triradius is located at the meeting
point of the three opposing ridge systems.
Triradii is a pattern area, also called delta,
can be determined with the help of the
triradii point, which is also an important
landmark in the ridge counting . The
eminent ridges from the triraduis and enclose
to the pattern area are called Radiant .
The main patterns of the papillary ridges in
the fingerprint area are:
Arch is the simplest pattern in which the
ridges flow directly from side to side, and
may be with a slight elevation in the middle
(Figure 1), it can be sub divided into plane
arch and tented arch . Plane arch or
simple arch composed of ridges flow directly
from one end to the other end without any
recurving. Tented arch consists of ridges that
converge at a point so that its soft sweep is
interrupted . Arch pattern occurs in 5% of
Figure 1: Arch Pattern (a) Simple Arch Pattern (b) Tented Arch Pattern
Loop consists of one triradii, the ridges in
this pattern enter from one side and return to
exit the pattern area from the same side
(Figure 2). It must contain at least one
recurving ridge between the core point of
pattern and the triradii point. If there is no
ridges recurve between the core and triradii,
the pattern will classified as Tented Arch
(Figure 1b). The loop pattern can be
subdivided into Ulnar Loop and Radial Loop.
When the ridges are entering and exiting
from the ulnar side it will called ulnar loop,
and if the ridges enter and exit from the
radial side it would be called a Radial loop
. To determine whether the loop is ulnar
or redial, it depends on which hand is that
finger, ulnar loop on the right hand similar to
a redial loop on the left hand. Loops occur at
about 60-70% of fingerprints . Therefore,
their shape and size may vary greatly, and
they may be a regular ring or double ring.
Sometimes, transitional loops can be found
that look alike whorls or complex patterns
Falah S. Al-Fartusie et. al. | Journal of Global Pharma Technology|2019| Vol. 11| Issue 05 (Suppl.) |349-357
©2009-2019, JGPT. All Rights Reserved 352
Figure 2: Loop Pattern
(a) Radial Loop when found in right hand (Ulnar if in left hand)
(b) Ulnar Loop when found in right hand (Radial if in left hand)
Whorl pattern is the most advanced pattern
(Figure 3), where any pattern that involve
two or more triradii's is considered as whorl.
The whorls pattern occurs at about 25-35%
on the fingerprint, and can be divided into
four types as follows :
Plain whorls: consist of one or more ridges
that form a complete circle with two deltas.
Central pocket loop whorls: consist of at
least one re-curving ridge or obstruction in
the right angles of the flow line, with two
deltas. In this type when the imaginary line
is drawn, no re-curving ridge is cut or
touched within the pattern area.
Double loop whorls: consist of two separate
and distinct loop formations with two
separate and distinct shoulders for each
core, in addition to two deltas and one or
more ridges that form a complete circuit.
Accidental whorl: is a pattern that
contains some requirements for two or
more different types, or a pattern that does
not comply with any of the definitions.
Figure 3: Whorl Pattern
Ridge count is used to indicate the size of
pattern. The counting is done along the
straight line that connects the triradial point
with the point of pattern core in loops and
Whorls. Both ridges containing the core point
and triradial point are excluded from the
count. . In the ridge counting, the Arch
pattern usually has a zero ridge count
because it is without a triradii point. Loops
usually contain only one ridge count because
it contains only one triradii point.
Whorls contain tow triradii points, one near
to the ulnar side and the other is near to the
radial side, so in the Whorl pattern there will
be tow ridge counts. In a double loop whorl,
the counting is done from the triradii to the
core that is nearer the triradii .
Fingerprints can be analyzed qualitatively
and quantitatively. Qualitative analysis
including the fingerprints patterns and their
distribution and frequency on the different
fingers .Quantitative analysis include: the
ridge count on each fingerprint pattern, the
sum of ridge count of all ten fingers is called
(Total Fingers Ridge Counts TFRC). In this
count, only one count is taken to each finger,
in the Whorls pattern the higher ridge count
is taken, TFRC represent the pattern size
. Absolute Fingers Ridge Count (AFRC) is
the total of the ridge count of all fingers.
AFRC reflects intensity and size of the
pattern . Next to TFRC and AFRC there
are other fingerprint indicators, these
Pattern intensity index (PII): [(2 ×%whorl +%
loop) /10] 
arch/whorl index of Dankmeijer‟s; (%
arches÷% whorl) × 100 
whorl/loop index of Furuhata‟s; (% whorl÷ %
of loop) × 100 
©2009-2019, JGPT. All Rights Reserved 353
The palm has been divided into several
anatomically designed areas includes thenar,
four inter-digital zones (1st, 2nd, 3rd, 4th),
and the hypothenar area (Figure 4). Thenar
and first inter-digital area are closely related
anatomically and are considered as one area
. In the distal part of the palm, there are
four triradii (one proximal to each finger
except the thumb), they are named (a, b, c
and d) from index to little finger respectively
. Each of these triradiis consists of two
distal radiants (digital radiants) and a
The proximal radiant is directed towards the
interior palm zone. These proximal radiants
are known as the palmar main lines and are
named corresponding to the digital triradii
(A, B, C and D) and distinguished by using
capital letters . There are also axial
triradii called (t, t', t") depending on their
position . There are also the flexion
creases in the palm zone. Flexion creases are
not components of dermatoglyphics but
represent sites of attachment of the skin to
underlying structures . The main flexion
creases are: (1) the distal transverse crease
(called the line of Heart), (2) the proximal
transverse crease (called the line of Head),
and (3) the radial longitudinal crease (called
the line of Life). These creases can aid in
formulate the formula of the palm main lines
.The qualitative analysis of palmar
dermatoglyphics includes the presence of
patterns in the palm areas (inter digital
patterns) and there frequencies, the presence
of more than one axial triradius, and palmar
main lines tracing.
The palmar quantitative analysis usually
involves the ridge count between the distal
triradii such as (a triradii and b triradii). In
addition, the measurement of the palmar
angles such as the (palmar atd angle) by
drawing a line connecting triradius (a) with
the axial triradius (t), and a line connecting
axial triradius (t) with triradius (d), and
measure the angle between the two lines (atd
angle), Figure 4.
Figure 4: Main Palmar Dermatoglyphics
Dermatoglyphics and Diabetes Mellitus
Study of the dermatoglyphics features can be
a useful tool for diagnosing many diseases; if
caused by chromosomal abnormalities, which
are often accompanied by pattern distortion;
and in other diseases, whether hereditary,
non-hereditary or both.
Many researchers studied dermatoglyphics
and their anomalies presence with different
diseases. In this review, we will include the
research articles that studied
dermatoglyphics in Diabetes Mellitus (DM)
patients in different populations, specifically
Type 2 Diabetes Mellitus (T2DM). Excluded
criteria include a research article that
contains mixed types of DM or any type other
than T2DM. The English-language articles
are included only. Table 1 contains the
articles listed in this review, and presented
important statistical results.
It has been reported by Sachdev  that
Arch fingertip pattern is significantly higher
in T2DM group, for both sexes, compared to
control group. While, it was found by Burute
and Padmini et al. [21, 24] that Arch
fingertip pattern is significantly higher only
in females T2DM patients than control.
©2009-2019, JGPT. All Rights Reserved 354
Table 1: Important statistical results provided by all the studies included in this review
T2DM patients group
In addition, it was found that Loop fingertip
pattern is significantly higher frequency in
T2DM groups, for both sexes, compared to
control . While it was observed
significantly lower frequency in T2DM group,
for both sexes, in Pathan et al. study .
Another study conducted by sharmila et al.
showed that loop pattern was most dominant
fingerprint pattern in both sexes and slightly
more in female diabetic. Further analysis
showed that higher frequency of ulnar-loop
pattern in the T2DM patients group as
compared with control group .
Also, ulnar loop was found with higher levels
in T2DM patients in comparison with the
control group . Furthermore, many
studies have indicated that Whorl fingertip
pattern was significantly higher frequency in
T2DM groups, in both sexes as compared
with the control group [26, 29, 30, 39]. The
same observation was found but only in
T2DM male patients in Ojha et al. study .
On the other hand, other studies have shown
that whorl pattern is much lower in T2DM
patients for both sexes when compared to the
control group [21, 25, 38].
Total Finger Ridge Count (TFRC) and
Absolute Finger Ridge Count (AFRC)
Several studies have been revealed that FRC
is significantly increased in T2DM patients,
and for both sexes [20, 24, 35]. In another
study conducted by Srivatsava et al., TFRC
was found to be higher in both hands of male
and female right hand only .
While Brutue et al. showed that TFRC
significantly decreased only in the female
T2DM patient group . On the other hand,
AFRC was found to be significantly increased
in both sexes of T2DM patients [24, 39].
While was found to be significantly increased
only in female T2DM patient group .
Brutue et al. reported that AFRC was
decreased significantly only in female
diabetic group .
All studies that analyzed the palmar atd
angle are almost consistent in their
observations that the palmar atd angle
increases in the diabetic group when
compared with the control. Several studies
noted a significant increase in the palmar atd
angle for both hands of patients (male and
female) with T2DM compared to the control
group [20, 23, 24, 27, 32, 38]. Similar results
were observed in a study by Ghosh et al.,
which analyzed atd angle in female with
diabetes only . In addition, another study
conducted by Trivedi et al., showed that the
atd angle was much higher in the right hand
of males only .
A previous study conducted by Ojha et al.,
which analyzed of other palm angles such as
dat palm angle, showed an increase in dat
palm angle for T2DM group . Whereas
observed in Mohan et al., that the palm dat
angle decreased significantly in the right
hand only in the T2DM group .
©2009-2019, JGPT. All Rights Reserved 355
Another study conducted by Nazir et al.,
revaeled that dat angle decreased
significantly in both hands of T2DM patients
group . Furthermore, the palmar adt
angle was found significantly reduced in both
hands of the T2DM group of both sexes in
comparison with control group [20, 27, 36].
Ghosh et al., analyzed other palmar angles in
females only. The palmar btd angle was
observed to be significantly increased in both
diabetic female hands, and ctd angle
observed to be significantly decreased in the
female diabetic group in comparison to the
female control .
Palmar a-b Ridge Counts
A previous study conducted by Tarca et al.,
observed that a-b ridge count was
significantly decreased in T2DM female left
hand as compared to female control group
. While another study conducted by
Ghosh et al., showed that a-b ridge count was
significantly decreased in both hands of
female T2DM patients group . Pathan et
al., study observed that a-b ridge count was
also significantly decreased in T2DM
patients group for both male and female .
Palmar Axial triradius (t, t', t")
Several studies have reported the presence of
an extra palmar axial triradii is observed in
high frequency [20, 22, 23, 33]. Moreover,
Tarca study observed that the absence of the
palmar axial triradii was also observed in
T2DM patients group in comparison the
control group .
The statistically significant findings were as
follows: Tarca observed the presence of ulnar
loop pattern in the palmar hypothenar zone
on both hands of both sexes of the patients
group, and the presence of radial arch
pattern in the palmar hypothenar zone on
the right hand of both sexes patients group
. In addition, Dastidar et al., observed the
presence of higher frequency of 4th inter
digital patterns in T2DM patients group in
both hands .
Main C-line Formula
The palmar main lines that can be traced;
can be classified into: Radial, Ulnar,
Proximal, and absent. The significant
observation on the Main C-line pattern is as
follows: the absence of main C-line was found
to be significantly higher frequency on
diabetic patient’s hands for both sexes [22,
26, 34]. While another study conducted by
Ojha et al., was observed to be significantly
lower frequency in T2DM patients compared
with control group . The Proximal C-line
was observed to be significantly decreased
frequency in T2DM group according to the
observations of Pathan et al.; and Dastidar et
al. studies [26, 34]. Furthermore, the Radial
C-line was found to be significantly higher
frequency in T2DM patients group compared
with the control group according to Ojha et
al.; and Dastidar et al. studies [20, 34].
Meta-analysis and Cohort Studies
A meta-analysis study conducted by
Yohannes  concluded that
dermatoglyphics in the T2DM group showed
a significant reduction in Loop pattern along
with an increase in non-loop patterns (Arch
and Whorl), with increased atd angle and
reduced AFRC, these findings support that
there is a distortion in Early pregnancy
among diabetics. In the Dutch Hunger
Winter Families Cohort study by Kahn et al.,
 a Dermatoglyphics marker (MD15)
(Mean Ridge count of 1st digit – Mean Ridge
count of 5th digit ) was used, and correlated
with late onset diabetes (T2DM). It was
found that risk factor of developing diabetes
increased with the increase of MD15 value.
Dermatoglyphics reflect as a marker, the
effect of genetic factors and non-genetic
factors in the first trimester of intrauterine
life, in which any abnormal expression on the
main tissues may be reflected in
dermatoglyphics features. Dermatoglyphics
features are easily accessible and cost-
effective, and can be categorized and
analyzed qualitatively and quantitatively.
When dealing with any medical disorder or
clinical conditions, the control group should
be carefully collected, along with gender and
race differences in dermatoglyphics. In this
review article, it can be concluded that
dermatoglyphics investigations may be used
as an additional screening tool to identify
early risk factors that may help prevent
additional complications of type 2diabetes.
The authors would like to thank
Mustansiriyah University (www.
uomustansiriyah.edu.iq), Baghdad, Iraq, for
its support in the present work.
©2009-2019, JGPT. All Rights Reserved 356
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