It has been hypothesised that Frank's sign is indicative of cardiovascular disease and/or diabetes. Some studies have described Frank's sign as a marker of cardiovascular disease but not linked to the severity of the condition. In contrast, other studies have rebutted any association between Frank's sign and coronary artery disease in diabetics. There have also been reported cases of Frank's sign assisting in the diagnosis of cerebral infarctions. A link between Frank's sign and premature aging and the loss of dermal and vascular fibers has also been hypothesized. Some studies have focused upon bilateral ELC.
- Grade 3 - A deep crease across the whole of the earlobe
- Grade 2b - Creased more than halfway across the earlobe
- Grade 2a - A superficial crease across the earlobe
- Grade 1 - A small amount of wrinkling on the earlobe
Notable individuals with Franks' sign
- George W. Bush
- Barney Frank
- Mel Gibson
- Steven Spielberg
- Lech Walesa
- Narendra Modi
- Tom Cruise
- Frank ST (August 1973). "Aural sign of coronary-artery disease". N. Engl. J. Med. 289 (6): 327–8. doi:10.1056/NEJM197308092890622. PMID 4718047.
- Mallinson, Tom; Brooke, David (2017). "Frank's Sign as a clinical marker of cardiovascular disease". Journal of Paramedic Practice. 9 (1): 8-10. doi:10.12968/jpar.2017.9.1.8.
- Miot, H.A., Molina de Medeiros, M. etal (2006). Association between coronary artery disease and the diagonal earlobe an preauricular creases in men. Anais Brasileiros de Dermatologia. vol.81 no.1
- Mustafa Ahmed, M.D. (13 August 2014). "Earlobe Crease And Heart Disease – Fact Or Myth?". Abel Healthcare. Retrieved 8 February 2015.
- Lesbre JP, Castier B, Tribouilloy C, Labeille B, Isorni C (January 1987). "[Frank's sign and coronary disease]". Ann Cardiol Angeiol (Paris) (in French). 36 (1): 37–41. PMID 3827155.
- Davis TM, Balme M, Jackson D, Stuccio G, Bruce DG (October 2000). "The diagonal ear lobe crease (Frank's sign) is not associated with coronary artery disease or retinopathy in type 2 diabetes: the Fremantle Diabetes Study". Aust N Z J Med. 30 (5): 573–7. doi:10.1111/j.1445-5994.2000.tb00858.x. PMID 11108067.
- George Griffing, M.D. (March 2014). "Frank's Sign". The New England Journal of Medicine. 370 (15). doi:10.1056/NEJMicm1213868.
- Evrengül H, Dursunoğlu D, Kaftan A, et al. (2004). "Bilateral diagonal earlobe crease and coronary artery disease: a significant association". Dermatology. 209 (4): 271–5. doi:10.1159/000080847. PMID 15539887.