Paired Ear Creases of the Helix (PECH): A Possible Physical Sign

Diagonal ear lobe creases, often known as Frank's sign, are a folding in the skin of the ear lobe. Many studies have found an association between diagonal ear lobe creases and coronary artery disease. To our knowledge, this is the first report of paired ear creases of the helix. They may have similar relevance to cardiovascular disease as the diagonal ear lobe creases. We report the case of a 68-year-old South Asian man with coronary artery disease and a diagonal ear lobe crease. On closer inspection of the auricle, he also had ear creases on the helix on the same side. We postulate that diagonal ear lobe creases and paired ear creases of the helix are formed due to pressure during sleep on a hard surface. The pathophysiological association of these creases to coronary artery disease and metabolic syndrome are not well understood. We report a new possible sign: paired ear creases of the helix which may have similar clinical significance as the diagonal ear lobe crease with respect to cardiovascular disease.