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Year : 2018  |  Volume : 7  |  Issue : 3  |  Page : 118-119

Frank's sign: Cutaneous marker of cardiovascular disease

Department of Cardiology, IPGME&R and SSKM Hospital, Kolkata, West Bengal, India

Date of Web Publication10-Jul-2018

Correspondence Address:
Dr. Rakesh Agarwal
243, G.T. Road (N), Laxmi Niketan, Flat-2E, Liluah, Howrah - 711 204, West Bengal
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JCPC.JCPC_3_18

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How to cite this article:
Agarwal R. Frank's sign: Cutaneous marker of cardiovascular disease. J Clin Prev Cardiol 2018;7:118-9

How to cite this URL:
Agarwal R. Frank's sign: Cutaneous marker of cardiovascular disease. J Clin Prev Cardiol [serial online] 2018 [cited 2023 Jun 8];7:118-9. Available from: https://www.jcpconline.org/text.asp?2018/7/3/118/236328

A 60-year-old man with long-standing hypertension on irregular drug intake presented with right-sided hemiplegia, nausea, and vomiting. Clinical examination was consistent with a left-sided cerebrovascular accident and imaging corroborated the clinical findings. The patient was initially managed in the Intensive Care Unit and later in the ward conservatively. He was noted to have bilateral Frank's sign on general examination [Figure 1], [Figure 2], [Figure 3].
Figure 1: Left-sided Frank's sign

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Figure 2: Right-sided Frank's sign

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Figure 3: Computed tomography image showing left basal ganglia hemorrhage

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Frank's sign is described as “a prominent crease in a lobule portion of the auricle.”[1] This diagonal ear lobe crease has been considered to be a cutaneous marker of coronary and carotid atherosclerosis.[2] It is said to be a dermatological indicator of premature aging and loss of dermal and vascular fibers.[3] However, genetics, anatomic peculiarity, or a result of a particular way of sleeping have also been postulated to lead to Frank's sign.[4] In fact, the sign was mentioned by Petrakis in some of the Greco-Roman sculptures in the museums of Rome.[1],[4] Several cases associate Frank's sign with ischemic heart disease and ischemic strokes, but this is probably the first case where it has been noticed in a patient with hypertensive hemorrhagic cerebrovascular event.[3],[5]

Frank's sign should alert the clinicians toward an underlying cardio-cerebrovascular disease, and an evaluation directed at it should be done in patients presenting with the same.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Petrakis NL. Diagonal earlobe creases, type A behavior and the death of Emperor Hadrian. West J Med 1980;132:87-91.  Back to cited text no. 1
Friedlander 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.  Back to cited text no. 2
Griffing G. Images in clinical medicine. Frank's sign. N Engl J Med 2014;370:e15.  Back to cited text no. 3
Guţiu IA, Galeţescu E, Guţiu LI, Răducu L. Diagonal earlobe crease: A coronary risk factor, a genetic marker of coronary heart disease, or a mere wrinkle. Ancient Greco-Roman evidence. Rom J Intern Med 1996;34:271-8.  Back to cited text no. 4
Fareedy SB, Pathak R, Salman A, Alweis R. Frank's sign: A potential predictor of cardiovascular disease. J Community Hosp Intern Med Perspect 2015;5:26885.  Back to cited text no. 5


  [Figure 1], [Figure 2], [Figure 3]


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