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] It is probably prudent to consider Frank's Sign alongside other clinical markers of physiological ageing, rather than utilising it as a stand-alone sign in the identification of coronary artery disease.^[10]

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.^[11]

Notable individuals with Frank's sign

• Dick Van Dyke^[12]
• George W. Bush^[13]
• Mel Gibson^[14]
• Steven Spielberg^[13]