A diagonal crease in the earlobe has garnered public attention and medical curiosity as a potential indicator of internal health. This simple fold of skin has been investigated for decades as a potential indicator of health issues. Understanding the nature of this crease and what the science says about its significance can prompt a broader health discussion.
Defining the Diagonal Earlobe Crease
The physical feature is a distinct wrinkle-like line that runs at an oblique angle across the lower part of the earlobe. This mark is formally known as Frank’s Sign, named after Dr. Sanders T. Frank, who first described it in 1973. The crease typically extends backward from the tragus, the small cartilage projection in front of the ear canal, toward the rear edge of the auricle.
Frank’s Sign can appear on only one ear (unilaterally) or both (bilaterally), and its depth and length vary considerably. Researchers classify the crease from a slight wrinkling to a deep fold that extends completely across the earlobe. Although its prevalence increases with age, deep creases have been the focus of medical inquiry since Dr. Frank observed the feature in younger patients with coronary artery blockages.
The Proposed Link to Heart Health
The hypothesis linking the earlobe crease and cardiovascular health centers on microvascular disease. The earlobe is primarily composed of fat and connective tissue, supplied by small vessels known as end arteries. These end arteries lack collateral circulation.
The theory posits that vascular damage affecting small blood vessels throughout the body causes the loss of elastic fibers and collagen in the earlobe. This degeneration and reduced blood flow lead to the characteristic diagonal crease. Since coronary arteries are susceptible to the same microvascular damage, the crease is theorized to mirror the premature aging occurring within the heart’s blood vessels. This shared vulnerability suggests the crease is a visible manifestation of systemic vascular change.
Examining the Scientific Evidence
Since its initial observation, the diagonal earlobe crease has been the subject of numerous investigations attempting to validate its association with coronary artery disease (CAD). Many studies have demonstrated a positive correlation, finding that individuals with the crease, particularly when bilateral, have a statistically higher risk of heart conditions. For example, one large-scale study tracked nearly 11,000 participants over 35 years and found an independent association between the crease and an increased risk of ischemic heart disease.
However, this association does not establish a direct cause-and-effect relationship, and the crease is not considered a perfect predictive tool. Research has indicated a wide range in the sensitivity and specificity of the crease for detecting CAD. The findings are often complicated by confounding factors, as patients with the crease frequently possess other traditional risk factors, such as advanced age, smoking history, hypertension, and diabetes.
The current medical consensus views the earlobe crease as a “soft” sign or a potential marker of accelerated biological aging and atherosclerosis. It is considered insufficient for a definitive diagnosis on its own, as its presence is not a guarantee of heart disease, nor does its absence rule out the condition. The crease is best understood as a nonspecific physical finding that may signal a need for closer evaluation, especially when considered alongside a patient’s established cardiovascular risk profile.
Actionable Steps and Next Consultation
If you notice a diagonal crease on one or both earlobes, use it as an opportunity to review your cardiovascular health. The presence of Frank’s Sign should prompt a consultation with a primary care physician focused on evaluating standard, established risk factors for heart disease.
During the appointment, your physician will likely assess your blood pressure, lipid panel (cholesterol and triglycerides), blood sugar levels, and body mass index. You should also discuss your personal and family medical history, particularly any history of heart disease, stroke, or diabetes. The earlobe crease serves as a visible reminder to ensure that your traditional risk factors are monitored and managed effectively. Taking proactive steps to address these proven risk factors remains the most effective strategy for maintaining long-term heart health.