Journal of the Practice of Cardiovascular Sciences

: 2016  |  Volume : 2  |  Issue : 1  |  Page : 67-

Diagonal earlobe crease: Frank's sign in metabolic syndrome

Krishnarpan Chatterjee, Anirban Ghosh, Rimi Som Sengupta 
 Department of Medicine, ESI-PGIMSR and ESI Medical College, WBUHS, Kolkata, West Bengal, India

Correspondence Address:
Krishnarpan Chatterjee
B-7/11, Diamond Park, Diamond Harbour Road, Joka, Kolkata - 700 104, West Bengal

How to cite this article:
Chatterjee K, Ghosh A, Sengupta RS. Diagonal earlobe crease: Frank's sign in metabolic syndrome.J Pract Cardiovasc Sci 2016;2:67-67

How to cite this URL:
Chatterjee K, Ghosh A, Sengupta RS. Diagonal earlobe crease: Frank's sign in metabolic syndrome. J Pract Cardiovasc Sci [serial online] 2016 [cited 2021 Dec 7 ];2:67-67
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Dear Editor,

We read with interest the editorial in your journal on bedside evaluation in the era of imaging.

[1] The author emphasizes the need of the bedside clinical evaluation to evolve to keep up with the times. Keeping this in mind, we would like to analyze the Frank's sign with an illustrative example.

A 50-year-old female presented with progressive dyspnea and swelling of feet. At presentation, she had dyspnea at rest. She was a known case of diabetes mellitus, hypertension with a history of inferior wall myocardial infarction 5 years back. She was compliant with her medications. On examination, she was obese, her pulse was 110 bpm, blood pressure was 150/100 mmHg, her jugular venous pressure was raised, and she had pedal edema. She had multiple skin tags in the neck region, acanthosis nigricans, a buffalo hump, and bilateral diagonal earlobe crease [Figure 1]. Cardiac examination revealed a gallop rhythm. She was admitted with a diagnosis of metabolic syndrome with heart failure. Electrocardiogram revealed deep pathological Q waves in the inferior leads. Cardiac enzymes were normal. Echo revealed left ventricular ejection fraction of 40% with inferior wall hypokinesia and Grade 1 diastolic dysfunction. She was managed with aggressive antiheart failure therapy and recovered in 5 days.{Figure 1}

Diagonal earlobe was first linked to atherosclerosis by Frank in 1973.[2] Since then, multiple studies have corroborated this association while some studies have shown no correlation.[3] Though the pathophysiology in unproven degeneration of elastin and changed the ratio of elastin and collagen is a possibility. Shrestha et al. have designed an evaluation sheet to make diagnosing a diagonal earlobe crease more objective.[4] Frank's sign has been mentioned as one of the dermatological manifestations of atherosclerosis.[5] The jury is still out on whether Frank's sign has any relevance as a predictor of atherosclerosis in this day and age.

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1Kothari SS. Bedside evaluation in the era of imaging. J Pract Cardiovasc Sci 2015;1:7-8.
2Frank ST. Aural sign of coronary-artery disease. N Engl J Med 1973;289:327-8.
3Friedlander AH, López-López J, Velasco-Ortega E. Diagonal ear lobe crease and atherosclerosis: A review of the medical literature and dental implications. Med Oral Patol Oral Cir Bucal 2012;17:e153-9.
4Shrestha I, Ohtsuki T, Takahashi T, Nomura E, Kohriyama T, Matsumoto M. Diagonal ear-lobe crease is correlated with atherosclerotic changes in carotid arteries. Circ J 2009;73:1945-9.
5Madke B, Nayak C. Eponymous signs in dermatology. Indian Dermatol Online J 2012;3:159-65.