Palm Reading Perspectives

Multi-Perspective Palm Reading: About Hands & how to make a Hand-Diagnosis

Nailfold Blood Vessels reveal a Biological Marker for Schizophrenia!

with 13 comments

Visibility of the nailfold blood vessels plexus has been known for a long time as a biological marker in schizophrenia.

In an earlier post is described that schizophrenia became known for a high occurence of minor physical anomalies (MPA’s). Another example of a developmental abnormality that has been studied as a hand marker for schizophrenia, but which lies outside the scope of the traditional MPA construct, is the occurence of visibility of the blood vessels in the proximal nailfold – a.k.a. ‘nailfold plexus visibility’ (NPV – which requires the use of a microscope for proper assessment). A high level of nailfold plexus visibility is rare in the general population (occurring in 3-7% of healthy adults) while the rate of high NPV ranges from 20-70% in populations with schizophrenia (Curtis et al., 1999).

Interestingly, over the years studies have suggested this hand characteristic is specificly related to the so-called ‘negative symptoms’ in schizophrenia (which are associated with deficits of normal emotional responses or of other thought processes). And EEG studies have revealed that this nail fold blood vessel condition may mark a process associated with abnormal brain development leading to schizophrenia – including: an inverse relationship between plexus visibility and lateral ventricle size in the brain. The PVS is reliably determined and stable over time. Interrater reliabilities for PVS reportedly range from .83 to .99 (Buchanan and Jones 1969; Maricq 1966).

Taken together, researchers have concluded that findings on MPAs indicate that these minor anomalies appear to be part of some schizophrenia syndromes, representing a stable systemic or physical set of manifestations of the underlying neurodevelopmental processes that lead to the illness. This might explain why in the DSM-V the term ‘schizophrenia’ may be get replaced by the name ‘psychosis risk syndrome‘.


 The skin has a profuse blood supply, which is important in temperature regulation. The subcutaneous arteries form a network in the subcutaneous tissue, and from this is derived a subpapillary plexus in the dermis. Capillary loops in the dermal papillae arise from the subpapillary plexus, and from these loops the avascular epidermis is bathed in tissue fluid. A subpapillary plexus of venules gives the skin its pink color: the vessels become dilated when the skin is heated, and thereby make it look red.


Just like is seen in the perspective of minor physical anomalies, nailfold plexia visibility is much more common in schizophrenia than in any other form of psychopathology. Studies have revealed that nailfold plexia visibility in schizophrenia is (much) more common than in other psychotic- & mood disorders – but these other disorders also show higher occurence than seen in the general population.

Studies have also shown that that patients with schizophrenia with a highly visible plexus have greater oculomotor dysfunction, negative symptoms, symptom severity, chronic course, and neuropsychological dysfunction. Furthermore, nailfold plexus visibility appears to be at least moderately heritable.


Other studies have revealed that nail fold plexus visibility has also been linked with hand markers in rheumatoid arthritis & hand markers in psoriasis. The pronounced subpapillary plexus visibility, greater number of vessels and their elongation are indicative of rheumatoid arthritis, while shorter, fewer capillaries and especially characteristic psoriatic capillaries, when present, suggest psoriatic arthritis.

Changes of nailfold capillary patterns have been described in certain patients with systemic sclerosis, dermatomyositis, mixed connective tissue disease, and Raynaud’s syndrome.

NOTICE: The nail tutor demonstrates how other nail fold characteristics can be associated with specific medical problems. More details about how to recognize various stages/variants of proximal nailfold blood vessels visibility in a palm reading, are presented in the picture below.

A phantom picture for the hand in schizophrenia is available here:

Nailfold plexus examples.

Nailfold plexus changes are characterized by loss of (drop-out) nailfold capillary loops that surround the remaining, enlarged dilated capillaries. Upper left, A normal nailfold capillary pattern shows the uniform morphology and homogeneous disitribution of the small capillary loops just below the cuticle. Upper right, Capillaroscopy in a patient with systemic sclerosis illustrates dilatation of isolated capillary loops, with loss of surrounding loop structures. Lower right, The abnormal pattern is from a patient with childhood dermatomyositis. Dilated capillary loops are present, as well as areas of arborized clusters of capillary loops. Lower left, Distortion of the normal capillary loop architecture is seen in a patient with adult dermatomyositis. Note the loss of normal homogeneous distribution of the capillaries and the alterations in the morphology of the vessels, including the dilated and enlarged “giant” capillary loops.


Written by martijnvanmensvoort

June 11, 2011 at 2:13 am

13 Responses

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  1. The people posting these pictures as significant of shizophrenia are the crazy ones! These enlarged loops are significant, instead, for autoimmune diseases such as dermatomyositis, and scleroderma, particularly the latter. Now it’s also possible for scleroderma to affect the nerves, but the primary cause here would be the autoimmune disease, and particular attention should be paid to that FIRST!


    June 17, 2011 at 1:50 am

  2. P.S. The lower set of photos was apparently copied from , where they were being used properly to illustrate the effects of scleroderma and dermatomyositis, not schizophrenia.

    Of course, anyone who believes in palm-reading is loony anyway.


    June 17, 2011 at 2:03 am

    • Daisy, the photos only serve as an illustration of how various stages of ‘nailfold plexus visibility’ can be recognized – and the second picture is featured with a description which confirms the significance of your knowledge… but not your conclusions!

      PS. In line with my earlier response, here is for example a 2008 document (which includes a rate of the stage of NPV-severity):

      The ABSTRACT e.g. reports:

      “Twenty-four individuals with schizophrenia and 28 of their first-degree biological relatives were studied using clinical scales, functional ratings, and neuropsychological tests. An assessment of Nailfold Plexus Visibility (NPV) was also performed on these individuals. In keeping with the literature, we found an increased prevalence of high NPV in our schizophrenia subjects relative to controls and community norms, and also found that high NPV patients had significantly more negative symptoms and poorer social functioning. Measures of negative symptoms indicative of the deficit syndrome did a better job of distinguishing high from low NPV subjects than did more broadly defined negative symptom indices. As predicted, the prevalence of high NPV in first-degree relatives of high NPV schizophrenia subjects was increased compared to relatives of low NPV schizophrenia subjects. These two relative groups did not differ on overall level of schizotypy symptoms or on negative symptom schizotypy indices. However, relatives of low NPV patients scored significantly higher on scales of positive symptom schizotypy. Overall, these results support the hypothesis that high NPV is a marker of risk for a distinct subtype of schizophrenia.”


      June 17, 2011 at 2:41 am

  3. Your first photograph, I’m sure I’ve seen somewhere else before.

    Your second photograph is stolen from an article at concerning scleroderma, and then slightly cropped.

    Your third photograph is also stolen from at article at figure 3, a photo illustrating nail fold capillary microscopy, an another patient with scleroderma.

    How about if I inform the owners of these pictures of the theft and misuse of them to “represent” something other than what they really represent. I’m sure they’d be livid.


    July 16, 2011 at 7:03 pm

    • Hello Hallie,

      You obviously missed my 2nd response to DaisyDo where I mentioned:

      “… the photos only serve as an illustration of how various stages of ‘nailfold plexus visibility’ can be recognized.”


      July 16, 2011 at 7:36 pm

  4. You have stolen photographs that show this disorder of capillaries is associated with scleroderma, not schizophrenia. Furthermore the author, Dr. Vuchetich, of the study you cite has since published another study which as nearly as I can tell by the title, retracts the findings of his first one. See . Deficit schizophrenia is synonymous with negative symptoms schizophrenia.

    Here’s a definition of the latter: Negative symptoms represent a withdrawal or lack of function that you would usually expect to see in a healthy person. For example, people with schizophrenia often appear emotionless, flat and apathetic.

    Now I can understand why some patients with scleroderma may have that aspect. The disease is hopeless, debilitating, incurable, ultimately fatal, and it can take many many years to get diagnosed. It took from 1985 until 2010 before I was finally diagnosed, and all the while was made to feel like doctors were not taking my pain seriously. It finally required going to the doctor who 2 weeks later was named 2010 Doctor of the Year by the Scleroderma Foundation. Articles like this one add insult to injury from what is actually an autoimmune disease process.

    What this doctor SHOULD have done as soon as he saw the nailfold changes is to check the antinuclear antibodies, and then also check to see if such scleroderma-associated antibodies as SCL-70 and anticentromere were present. But he didn’t do that, did he!!!!


    July 19, 2011 at 10:24 pm

  5. Hello Hallie,

    Thank you for your additional comment.

    Sorry, but your comment appears to suggest that ‘nail fold plexus’ can only be observed in patients who have scleroderma. But that is not how ‘body markers’ work at all… for, ‘nail fold plexus’ can sometimes even be observed in healthy individuals!

    Actually, in 2010 another (innovative) study was published which has confirmed the link between ;’nail fold plexus’ and schizophrenia via a ”reliable digital photomicroscopic method”, see:

    Again, my report does NOT DENY the link between ‘nail fold plexus’ and scleroderma (which you correctly described, but was also mentioned in my report above under the last pictures!!). However, my report focusses on the fact that the same characteristic has also been linked with in schizophrena (especially the negative symptoms).

    This is another report (published in 1999) where photos of ‘nail fold plexus’ are presented in the perspective of schizophrenia, reporting that nail fold plexus was observed in about 22% of schizophrenics (against 7.4% in unipolar depression disorder, 7.6% in bipolar depression patients, and 7.6% in non-psychiatric controls):

    And of course, it is completely unlikely that in all those positive cases ‘nail fold plexus’ can be attributed to scleroderma – because that is actually a rare disorder (observed in about 1 in 1000 persons, see:

    PS. I don’t want to dismiss the significance of the other 2010 report that you mentioned, but since there is plenty of evidence for the link with schizophrenia… one should not draw any conclusions from the title alone.

    Unfortunately there is not an abstract available, I have no info about how many schizophrenic patients were involved in that study… but in general: it is always possible that a well established link is not confirmed by a sample due to the size of the small sample, etc.

    I hope my report now will make sense for you as well.


    July 20, 2011 at 1:29 pm

  6. PS. Hallie, this study focussed on ‘nailfold plexus’ and connective tissue diseases confirms that nail fold plexus featured with giant capillaries is much more often seen in those connective tissue patients patients (44%) than in controls (0%).

    However, the fundamental relatively small differences between both groups is illustrated by the fact that the average number of enlarged cappilaries was only about 3 times higher in connective tissue patients than in controls (see the sentence below marked with **


    OBJECTIVE: To describe and quantify the morphological characteristics of nailfold capillaries that distinguish different forms of connective tissue disease from healthy controls. METHODS: A CCD video microscope with fibreoptic illumination and PC based image processing was used to visualise nailfold capillaries and to quantify findings in 23 patients with systemic sclerosis (SSc), 22 patients with systemic lupus erythematosus (SLE), 21 patients with undifferentiated connective tissue disease (UCTD), and 38 healthy controls. RESULTS: Capillary density was reduced in SSc (5.2 (SD 1.3) capillaries/mm) compared with other patient groups and controls. **The average number of enlarged capillaries/finger was high in all disease groups (5.5-6.6) compared with controls (2).** However, giant capillaries were most frequent in SSc (43%) and were not present in controls. Mild and moderate avascular areas were present in all groups (35%-68%), but severe avascularity was most frequent in SSc (44%) compared with other patients (18%-19%) and controls (0%). The greatest frequency of extensive haemorrhage was in SSc (35%). CONCLUSIONS: There is a range of abnormal capillary findings in patients with connective tissue disease and healthy controls. However, certain abnormalities such as a reduced number of capillaries, severe avascularity, giant capillaries, and haemorrhage are most commonly associated with SSc. Videomicroscopy with image processing offers many technical advantages that can be exploited in further studies of nailfold capillaries."

    (I hope this will help you to become aware that the schizophrenia studies were probably focussed on counting 'enlarged capillaries', instead of counting 'giant capillaries')


    July 20, 2011 at 1:50 pm

  7. My scleroderma specialist says I have definite scleroderma, even though my capillary loops are only “mildly enlarged.” So I still maintain that these doctors should have been running rheumatologic tests on all of these patients found to have enlarged loops.

    The problem is this: the ACR criteria for diagnosis that were set up in 1980 were designed not for early diagnosis, but rather as a guide for selection of the most obviously sclerodermic patients for purposes of research studies. Therefore it does not adequately diagnose people with limited systemic scleroderma or sine scleroderma who may not yet have developed skin effects, or who in fact (in the case of sine scleroderma) may NEVER develop the skin hardening, even though they DO develop all the same internal fibrosis of scleroderma. So there may be a huge reservoir of undiagnosed people. Dr. Thomas Medsger who has authored over 180 articles and research studies on slceroderma has probably done more research on this than anyone else in the world. It was he who in 2001 before a worldwide symposium of scleroderma specialists proposed that the ACR criteria should be modified to allow diagnosis of early, limited, and sine scleroderma. What he proposed was that nailfold capillaroscopy results, scleroderma-associated antibodies, and Raynaud’s be added to the ACR criteria in order to identify these early cases. Europe, Canada, and Brazil are adopting his modified criteria. Unfortunately the U.S. is slow to do so, because here there is at least one very influential but backward researcher who is opposed to the modifications.

    For a further discussion of this, you may go to the scleroderma forum which is administered by the Scleroderma Foundation.


    July 21, 2011 at 12:34 am

    • Thank you Hallie,

      By the way, in my approach I always check multiple features of the hand (on multiple dimensions) before considering the possibility of a diagnosis.
      Which implicates that the presence of a single hand feature nearly always means nothing. And if ‘nailfold plexus’ is present in a schizophrenia case and a scleroderma case, one will observe other characteristics in the rest of the hand: in scleroderma one can expect skin & vascular problems (such as pitted scars, thickened & hardened patches, Raynaud’s phenomenon), in schizophrenia the features are much more diverse (which may include: motoric problems and various inborn abnormalities).

      So it will not be hard to discriminate a group of schizophrenics from a group of scleroderma patients if all individuals in both groups would have ‘nailfold plexus’.

      Finally, while you have the ‘nailfold plexus visibility’ yourself, I do hope that you are aware that it concerns just one of the less common characteristics in scleroderma, see:

      Thank you again for your detailed input!! 🙂


      July 21, 2011 at 1:56 pm

  8. … Two more recommendations for further reading (schizophrenia & scleroderma are discussed in both): (2011 article)


    July 21, 2011 at 2:48 pm

  9. One more thought:

    Regarding the issue about how to discriminate nail fold plexus visibility in sceroderma from schizophrenia, one can focuss on the skin of the hand:
    – in scleroderma one will typically observe nail fold plexus visibility COMBINED with skin problems (e.g. sclerodactly = thickening of the dorsal skin of the fingers);
    – while in schizophrenia skin problems are usually not present at all!

    This example should illlustrate once again the importance of finding MULTI-PERSPECTIVE combinations in order to find a specific hand-diagnosis.


    August 23, 2011 at 6:56 pm

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