Frank sign and its significance

Frank sign- Diagonal ear lobe crease (DELC) sign

• The Frank's sign is a diagonal crease in the earlobe that runs backward from the tragus at a 45-degree angle across the lobule to the rear edge of the auricle and may be a predictor of coronary artery disease.

• Frank sign is indicative of coronary artery disease (CAD).
• Frank's sign is thought to indicate premature aging and loss of dermal and vascular elastic fibers. 
• Although it has limited sensitivity, the sign is more useful diagnostically in persons younger than 60 years of age than in older persons.
• Sensitivity of 43% and specificity of 70%
• Pathophysiology: Microvascular disease of ear lobe which is end artery territory

• Grading system for severity of CAD

               • Unilateral incomplete – least severe
               • Unilateral complete
               • Bilateral complete – most severe

               Other classifications systems exist, but without the association with                                  increased cardiovascular events:

               • Grade 1 – wrinkling
               • Grade 2a – superficial crease (floor of sulcus visible)
               • Grade 2b – crease more than 50% across earlobe
               • Grade 3 – deep cleft across whole earlobe (floor of sulcus not visible)