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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)

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