Frank's Sign

 

"First described in 1973, Frank’s sign, also known as diagonal earlobe crease (DELC), was observed to be an aural sign of coronary artery disease (CAD). Since then, there has been much interest in examining this unique association. This may occur as a result of age- or disease-related weakening of dermal and elastic fibers in the ear lobes, making it a dermatological predictor of an underlying coronary vessel insufficiency. Over the years, more insights were gained from studies showing the association of DELC with significantly increased prevalence, extent and severity of CAD, independent of traditional CAD risk factors, with good sensitivity and positive predictive value. Recent studies have also demonstrated DELC’s independent association with increased carotid intima-media thickness as well as cardiovascular events (CVE) comprising not only coronary, but ischemic cerebrovascular and peripheral vascular diseases, suggesting that DELC may be a marker of generalized atherosclerotic disease. Wong et al. in a study of 558 consecutive patients (445 patients had CAD on coronary angiography), found that the presence of DELC is independently associated with 5-fold higher risk of CAD. Of note, there has been proposed classification of DELC based on the characteristics of length, depth, bilateralism and inclination of the crease. Although bilateralism has been shown to have good specificity for CVE association, the significance of the characteristics needs to be further studied."

Full text:
KG Lee. Frank's sign - A dermatological link to coronary artery disease? Med J Malaysia 2017; 72:195-6.