Earlobe Creases - Types, Pathophysiology, and Symptoms

Introduction:

The ear lobe is usually smooth in children and adults. When a line or a wrinkle appears on the smooth surface, it cannot be neglected. These creases present may be linked to severe conditions. They may also be related to genetic factors, like race, earlobe shape, who is going to develop these creases, etc. These creases are found to be associated with heart diseases. It is not always associated with heart disease but might be due to facial malformation also.

What Is an Earlobe Crease?

The ear lobe crease (ELC) is a line or a wrinkle seen among children or young adults. When a crease or line is present on these smooth surfaces, it is found to have an association with rare diseases. The prevalence of ELC increases with age. It appears later in life. ELC may also be due to sleeping position but this gets resolved during the day.

ELC is a clinical sign first described by Frank in 1973. Many studies have been conducted since thereafter and found that there is an association between coronary artery disease (CAD) and ELC. A case report has found a link between macrophage activity, aging, and maintaining earlobe collagen.

What Are the Types of Earlobe Creases?

There are three types of ELCs are found. These include;

• Diagonal Earlobe Creases (DELCs): It is also known as Frank’s sign.

• Preauricular Vertical Creases: These are vertical lines present in front of the tragus. It may be single or more.

• Paired Ear Creases Of the Helix (PECH): Two creases present at the upper pole of the ear helix.

The development of these creases and their association with cardiometabolic disorders are not known.

What Is the Pathophysiology of DELCs?

Theories vary with no definitive answer. Frank observed this sign in 20 patients who had angina. Many studies were conducted to know the relationship between coronary artery diseases, peripheral vascular diseases, and cerebrovascular diseases. DELCs are generally present among those who had previous coronary bypass surgery. The risk of developing vascular diseases is not clear. Some of the reports suggest micro-vascular disease in the middle ear lobe. Others observed that there is a shortening of length in telomeres of individuals with metabolic syndrome as a general aging and atherosclerotic mechanism.

What Is the Grading System Of DELCs?

The grading system of DELCs is linked to cardiovascular events based on length, depth, bilateralism, and inclination.

• Unilateral incomplete (least severe).

• Unilateral complete.

• Bilateral complete (most severe).

Other classifications include:

• Grade 1: Wrinkling.

• Grade 2A: Superficial crease.

• Grade 2B: Crease more than 50 % across the earlobe.

• Grade 3: Deep cleft across whole ear lobe.

What Is the Mechanism of Development Of ELCs?

It is always necessary to differentiate between skin creases and skin folds. Skin creases are permanent and irreversible lines developed due to traction by the attachment to the underlying deep structures but skin folds occur due to loose and sagging skin which is because of skin elasticity and they are not permanent.

Obesity especially visceral obesity is found to be a risk factor for cardiovascular and metabolic disorders. With increased research, it is been found that a causal relationship between visceral obesity with cardiovascular and other metabolic disorders is present and it is independent of total body weight.

Visceral fat depots include fat in the organs and in between the organs in the abdomen, thoracic region, and head. Buccal fat pad (BFP) and abdominal fat look identical though they both are situated in different parts of the body and even their sizes were corresponding to each other even in a person with normal weight. In overweight individuals, the size of the BFP was found to be correlated to parameters like body weight and body mass index (BMI). the distance between the inferior earlobes is the strongest predictor of the size of the visceral adipose tissue.

One of the studies done in 1977 showed an association between obesity with DELC. A recent study has reported that there is an association between visceral obesity of BFP and premature coronary disease which is termed sideburns obesity syndrome.

What Are the Symptoms of CAD?

If an individual or healthcare provider identifies an ELC, then must be checked for cardiovascular diseases. Symptoms of CAD (coronary artery disease) tend to get worsen with exercise and resolve at rest. They include:

• Pain in the chest or pressure.

• Pain in the shoulders or lower jaw.

• Radiating chest pain to the left arm.

• Pain or swelling in the leg.

• Shortness of breath.

• Fatigue.

Cardiovascular disease is considered the leading cause of death, regular checkups have to be done.

Why is an Earlobe Crease Considered to Be Associated With Cardiovascular Diseases?

A lot of research was done and observed that diagonal crease is related to cardiovascular diseases. Theories are

1. Lack of Blood Supply: Arteries supply oxygenated blood to the earlobe so that tissues are well nourished. But in CAD, arteries do not work properly. This reason for the formation of creases in the earlobes.

2. Changes In DNA: One study showed that changes in the DNA of particular chromosomes caused CAD and atherosclerosis.

3. Loss Of Elastin: Elastin is a protein in the body. This protein is responsible for the elasticity and strength of tissues. Loss of elastin is linked to loss of elastin in major arteries. The appearance of the crease may be due to a lack of blood supply.

4. Obesity: It is a risk factor for CAD and ELC is a sign of obesity.

5. Aging: Many studies have shown that aging and ELC are associated with the risk of CAD, and heart attack, independent of chronological aging.

Conclusion:

The earlobe crease is a line present on the earlobe. It is a simple sign that may indicate cardiovascular disease. This clinical sign should not be neglected. ELCs help one to identify the underlying serious conditions which are life-threatening. It also helps seek medical attention at the earliest which facilitates effective treatment. Knowing about this condition also helps in preventing cardiovascular diseases by adopting lifestyle changes such as having a good diet, and doing exercises regularly, which in turn may improve the quality of life.