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A diagonal earlobe crease

Published:January 10, 2022DOI:https://doi.org/10.1016/j.ejim.2022.01.017

      Highlights

      • Frank's sign is a diagonal earlobe crease running backward from the tragus at a 45⁰ angle across the lobule to the rear edge of the auricle.
      • Frank's sign is thought to result from loss of dermal and vascular elastic fibers.
      • Frank's sign is an easily detectable predictor of coronary artery disease.

      Keywords

      1. Case description

      A 67-year-old man had a medical history of type 2 diabetes mellitus, dyslipidemia, hypertension, and alcohol-related liver disease. His vital signs were normal, and he had no symptoms. On physical examination, he had bilateral diagonal earlobe creases running backward from the tragus at a 45⁰ angle across the lobule to the rear edge of the auricle (Fig. 1). What is the clinical significance of this sign?
      Fig 1
      Fig. 1Bilateral diagonal earlobe creases running backward from the tragus at a 45⁰ angle across the lobule to the rear edge of the auricle (arrows).

      2. Discussion section

      A diagonal earlobe crease, also known as Frank's sign, was first described to be a potential predictor of coronary artery disease (CAD) in 1973 [
      • Frank S.T.
      Aural sign of coronary-artery disease.
      ]. Frank's sign is thought to result from loss of dermal and vascular elastic fibers [
      • Griffing G.
      Frank's sign.
      ]. Earlobe ceases occur more frequently with increasing age; however, a large prospective population study demonstrated that the presence of an earlobe crease is associated with increased risks of ischemic heart disease and myocardial infarction independent of age and other well-known cardiovascular risk factors [
      • Christoffersen M.
      • Frikke-Schmidt R.
      • Schnohr P.
      • Jensen G.B.
      • Nordestgaard B.G.
      • Tybjærg-Hansen A.
      Visible age-related signs and risk of ischemic heart disease in the general population: a prospective cohort study.
      ]. In the present case, further questioning of the patient revealed that he underwent percutaneous coronary intervention for acute myocardial infarction at 40 years old. Frank's sign is an easily detectable predictor of CAD. Routine inspection of the earlobes may inform physicians on the patients’ backgrounds and clinical conditions.

      Declaration of Competing Interest

      None declared.

      References

        • Frank S.T.
        Aural sign of coronary-artery disease.
        N Engl J Med. 1973; 289: 327-328
        • Griffing G.
        Frank's sign.
        N Engl J Med. 2014; 370: e15
        • Christoffersen M.
        • Frikke-Schmidt R.
        • Schnohr P.
        • Jensen G.B.
        • Nordestgaard B.G.
        • Tybjærg-Hansen A.
        Visible age-related signs and risk of ischemic heart disease in the general population: a prospective cohort study.
        Circulation. 2014; 129: 990-998