{{Short description|Diagonal crease in the earlobe}} thumb|Normal ear anatomy thumb|Earlobe creases seen in a Japanese angina patient '''Frank's sign''' is a diagonal crease in the earlobe extending from the tragus across the lobule to the rear edge of the auricle.<ref name="Frank">{{cite journal |author=Frank ST |title=Aural sign of coronary-artery disease |journal=N. Engl. J. Med. |volume=289 |issue=6 |pages=327–8 |date=August 1973 |pmid=4718047 |doi= 10.1056/NEJM197308092890622}}</ref> The sign is named after Sanders T. Frank.<ref name="Frank"/>
It has been hypothesized that Frank's sign is indicative of cardiovascular disease<ref name="Mall">{{cite journal |last1=Mallinson |first1=Tom |last2=Brooke |first2=David |title=Frank's Sign as a clinical marker of cardiovascular disease |journal=Journal of Paramedic Practice |date=2017 |volume=9 |issue=1 |pages=8–10 |doi=10.12968/jpar.2017.9.1.8 |url=https://www.researchgate.net/publication/312104484}}</ref><ref>Miot, H.A., Molina de Medeiros, M. etal (2006). [http://www.scielo.br/scielo.php?pid=S0365-05962006000100003&script=sci_arttext&tlng=en Association between coronary artery disease and the diagonal earlobe an preauricular creases in men.] Anais Brasileiros de Dermatologia. vol.81 no.1</ref> and/or diabetes.<ref>{{cite web | url=http://myheart.net/articles/earlobe-crease-and-heart-disease-fact-or-myth/ | title=Earlobe Crease And Heart Disease – Fact Or Myth? | publisher=Abel Healthcare | date=13 August 2014 | access-date=8 February 2015 | author=Mustafa Ahmed, M.D.}}</ref> Some studies have described Frank's sign as a marker of cardiovascular disease as a nontraditional risk factor<ref>{{Cite journal |last=Yu |first=Dylan C. |last2=Ahmad |first2=Yaser |last3=Randhawa |first3=Maninder |last4=Rai |first4=Anand S. |last5=Paul |first5=Aritra |last6=Elzalabany |first6=Sara S. |last7=Yu |first7=Ryan |last8=Wasan |first8=Raj |last9=Nanda |first9=Nayna |last10=Nanda |first10=Navin C. |last11=Kalavakunta |first11=Jagadeesh K. |date=2026-01-11 |title=Beyond the Usual Suspects: A Narrative Review of High-Yield Non-Traditional Risk Factors for Atherosclerosis |url=https://www.mdpi.com/2077-0383/15/2/584 |journal=Journal of Clinical Medicine |language=en |volume=15 |issue=2 |pages=584 |doi=10.3390/jcm15020584 |doi-access=free|issn=2077-0383 |pmc=12841846 |pmid=41598522}}</ref> but not linked to the severity of the condition.<ref name="pmid3827155">{{cite journal |vauthors=Lesbre JP, Castier B, Tribouilloy C, Labeille B, Isorni C |title=[Frank's sign and coronary disease] |language=fr |journal=Ann Cardiol Angeiol (Paris) |volume=36 |issue=1 |pages=37–41 |date=January 1987 |pmid=3827155 }}</ref> In contrast, other studies have rebutted any association between Frank's sign and coronary artery disease in diabetics.<ref name="pmid11108067">{{cite journal |vauthors=Davis TM, Balme M, Jackson D, Stuccio G, Bruce DG |title=The diagonal earlobe crease (Frank's sign) is not associated with coronary artery disease or retinopathy in type 2 diabetes: the Fremantle Diabetes Study |journal=Australian and New Zealand Journal of Medicine |volume=30 |issue=5 |pages=573–7 |date=October 2000 |pmid=11108067 |doi= 10.1111/j.1445-5994.2000.tb00858.x}}</ref> There have also been reported cases of Frank's sign being a predictor of cerebral infarctions.<ref>{{cite journal |last1=Nazzal |first1=Saleh |last2=Hijazi |first2=Basem |last3=Khalila |first3=Luai |last4=Blum |first4=Arnon |title=Diagonal Earlobe Crease (Frank's Sign): A Predictor of Cerebral Vascular Events |journal=The American Journal of Medicine |date=April 28, 2017 |volume=130 |issue=11 |pages=1324.e1–1324.e5 |pmid= 28460854 |doi=10.1016/j.amjmed.2017.03.059 |doi-access=free }}</ref> A link between Frank's sign and premature aging and the loss of dermal and vascular fibers has also been hypothesized.<ref>{{cite journal | title=Frank's Sign | author=George Griffing, M.D. | journal=The New England Journal of Medicine |date=March 2014 | volume=370 | issue=15 |pages = e15| doi=10.1056/NEJMicm1213868|pmid = 24597888}}</ref> Some studies have focused on association between bilateral earlobe crease and coronary artery disease.<ref name="pmid15539887">{{cite journal |vauthors=Evrengül H, Dursunoğlu D, Kaftan A, etal |title=Bilateral diagonal earlobe crease and coronary artery disease: a significant association |journal=Dermatology |volume=209 |issue=4 |pages=271–5 |year=2004 |pmid=15539887 |doi=10.1159/000080847 |s2cid=26858693 |url=http://content.karger.com/produktedb/produkte.asp?typ=fulltext&file=DRM2004209004271|url-access=subscription }}</ref> It is probably prudent to consider Frank's Sign alongside other clinical markers of physiological ageing, rather than utilizing it as a stand-alone sign in the identification of coronary artery disease.<ref name="pmid28946988">{{cite journal| author=Mallinson TE, Brooke D| title=Limited Diagnostic Potential of Diagonal Earlobe Crease. | journal=Ann Emerg Med | year= 2017 | volume= 70 | issue= 4 | pages= 602–603 | pmid=28946988 | doi=10.1016/j.annemergmed.2017.06.013 | pmc= | doi-access=free }}</ref>
==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.<ref name="Frank's Sign - Diagonal earlobe crease (DELC) | Stanford Medicine">{{cite web |url=https://stanfordmedicine25.stanford.edu/blog/archive/2015/what-is-the-name-of-this-sign.html |title=Frank's Sign – Diagonal earlobe crease (DELC) |date=July 2, 2015 |work=Stanford Medicine |access-date=January 1, 2021 }}</ref>
==Notable individuals with Frank's sign== *Dick Van Dyke<ref>{{cite web |url=https://www.gettyimages.com/detail/news-photo/dick-van-dyke-attends-the-premiere-of-disneys-mary-poppins-news-photo/1074772874 |title=Dick Van Dyke (age 92), Premiere Of Disney's 'Mary Poppins Returns' - Arrivals |last=Livingston |first=David |date=November 29, 2018 |website=gettyimages.com |publisher=Getty Images |access-date=November 30, 2018}}</ref> *George W. Bush<ref name=metro>{{cite news |url=https://metro.co.uk/2018/03/27/mark-ear-warning-heart-disease-7420573/ |title=If you have this mark on your ear, it could be a warning you have heart disease |date=March 27, 2018 |work=Metro |first=Jessica |last=Lindsay |access-date=January 1, 2021 }}</ref> *Mel Gibson<ref>{{cite news |url=https://kdwn.com/2018/08/28/deep-forehead-wrinkles-may-suggest-heart-disease-risk/ |title= Deep Forehead Wrinkles May Suggest Heart Disease Risk |date=August 29, 2018 |work=KDWN |first=Daliah |last=Wachs |author-link=Daliah Wachs |access-date=January 1, 2021 }}</ref> *Steven Spielberg<ref name="metro" /> *Donald Trump<ref name=“metro />
==References== {{reflist|2}}
==External links== * [https://www.ijocs.org/clinical-journal/franks-sign-diagonal-earlobe-crease.pdf Further image of Frank's Sign]
{{Cardiovascular system symptoms and signs}}
Category:Medical signs