Frank's sign

Frank's sign is a diagonal crease in the ear lobe extending from the tragus across the lobule to the rear edge of the auricle.[1] The sign is named after Sanders T. Frank.[1]

Normal Ear Anatomy
Earlobe creases seen in a Japanese angina patient

It has been hypothesised that Frank's sign is indicative of cardiovascular disease[2][3] and/or diabetes.[4] Some studies have described Frank's sign as a marker of cardiovascular disease but not linked to the severity of the condition.[5] In contrast, other studies have rebutted any association between Frank's sign and coronary artery disease in diabetics.[6] There have also been reported cases of Frank's sign being a predictor of cerebral infarctions.[7] A link between Frank's sign and premature aging and the loss of dermal and vascular fibers has also been hypothesized.[8] Some studies have focused on association between bilateral earlobe crease and coronary artery disease.[9]

Severity
  • Grade 3 – A deep crease across the whole of the earlobe.
  • Grade 2b – Creased more than halfway across the earlobe.
  • Grade 2a – A superficial crease across the earlobe.
  • Grade 1 – A small amount of wrinkling on the earlobe.[10]

Notable individuals with Franks' sign

References
  1. Frank ST (August 1973). "Aural sign of coronary-artery disease". N. Engl. J. Med. 289 (6): 327–8. doi:10.1056/NEJM197308092890622. PMID 4718047.
  2. Mallinson, Tom; Brooke, David (2017). "Frank's Sign as a clinical marker of cardiovascular disease". Journal of Paramedic Practice. 9 (1): 8–10. doi:10.12968/jpar.2017.9.1.8.
  3. Miot, H.A., Molina de Medeiros, M. etal (2006). Association between coronary artery disease and the diagonal earlobe an preauricular creases in men. Anais Brasileiros de Dermatologia. vol.81 no.1
  4. Mustafa Ahmed, M.D. (13 August 2014). "Earlobe Crease And Heart Disease – Fact Or Myth?". Abel Healthcare. Retrieved 8 February 2015.
  5. Lesbre JP, Castier B, Tribouilloy C, Labeille B, Isorni C (January 1987). "[Frank's sign and coronary disease]". Ann Cardiol Angeiol (Paris) (in French). 36 (1): 37–41. PMID 3827155.
  6. Davis TM, Balme M, Jackson D, Stuccio G, Bruce DG (October 2000). "The diagonal ear lobe crease (Frank's sign) is not associated with coronary artery disease or retinopathy in type 2 diabetes: the Fremantle Diabetes Study". Aust N Z J Med. 30 (5): 573–7. doi:10.1111/j.1445-5994.2000.tb00858.x. PMID 11108067.
  7. Nazzal, Saleh; Hijazi, Basem; Khalila, Luai; Blum, Arnon (April 28, 2017). "Diagonal Earlobe Crease (Frank's Sign): A Predictor of Cerebral Vascular Events". The American Journal of Medicine. doi:10.1016/j.amjmed.2017.03.059. PMID 28460854.
  8. George Griffing, M.D. (March 2014). "Frank's Sign". The New England Journal of Medicine. 370 (15): e15. doi:10.1056/NEJMicm1213868. PMID 24597888.
  9. Evrengül H, Dursunoğlu D, Kaftan A, et al. (2004). "Bilateral diagonal earlobe crease and coronary artery disease: a significant association". Dermatology. 209 (4): 271–5. doi:10.1159/000080847. PMID 15539887. S2CID 26858693.
  10. "Frank's Sign – Diagonal earlobe crease (DELC)". Stanford Medicine. July 2, 2015. Retrieved January 1, 2021.
  11. Livingston, David (November 29, 2018). "Dick Van Dyke (age 92), Premiere Of Disney's 'Mary Poppins Returns' - Arrivals". gettyimages.com. Getty Images. Retrieved November 30, 2018.
  12. Lindsay, Jessica (March 27, 2018). "If you have this mark on your ear, it could be a warning you have heart disease". Metro. Retrieved January 1, 2021.
  13. Wachs, Daliah (August 29, 2018). "Deep Forehead Wrinkles May Suggest Heart Disease Risk". KDWN. Retrieved January 1, 2021.
  14. Miller-Rinaldi, Maria (June 10, 2019). "How to See 8 Heart Attack Signs in Dental Patients". Relaxation Dentistry Chaska. Retrieved January 1, 2021.
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