"Elevator Diagnoses": Skin Findings Associated with Heart Disease
A colleague of mine recently told me about a fortuitous boat outing for his step father. Some family members had gotten together on a hot summer day to enjoy time out on the water. My colleague related how his step father had his shirt off and his wife, also a doctor, made note of an unusual mole on his abdomen. She advised getting the mole biopsied. He did so, and it turned out to be melanoma in an early stage.
In medicine, we informally refer to such experiences as "elevator diagnoses." In other words, significant medical findings are often recognizable to the medical eye in non-office settings, across the room (or the elevator).
A recent long-term study has correlated four readily visible skin findings with an increased risk of heart disease.
The Copenhagen Heart Study
35 years ago, nearly 11,000 patients were enrolled in the Copenhagen Heart Study. Basically, these people were put under the microscope; everything from their demographics, to their habits, to their physical characteristics was examined. At the 35 year mark, certain trends were identified in comparing those who went on to develop heart disease with those who didn't.
Interesting skin findings corelated with heart disease:
Ear Lobe Creases - Folds extending from the opening of the ear, diagonal down the earlobe were found to bear significance. This association has been suspected for quite some time, but has now been proven thanks to the Copenhagen study - the results of which showed that earlobe creases were associated with an 11% increased risk for heart attack.
Xanthelasma - Light yellow, chalky plaques on the eyelids are called xanthelasma. These plaques are made up of cholesterol and are deposited just under the skin. The study found that the presence of xanthelasma was associated with a 35% increased risk for heart attack.
Temporal-Frontal Baldness - Baldness in the front of the hairline and in the temples was associated with a 14% increased risk for heart disease in men only. While there was an increased risk in women, female baldness is uncommon, making the discovery of such an association difficult.
Crown Baldness - Circular baldness on the top of the head was associated with a 40% increased risk for heart disease in men only.
Multiple Signs Present - Individuals in the study with at least three of the four findings were 60% more likely than those with no findings to develop heart disease.
Not on the List
While the above quirky findings yielded an association, other symptoms of aging were not associated (such as gray hair or number of wrinkles). As expected, the usual risk factors of cholesterol levels, consistent blood pressure elevations, and experience with smoking were significant.
The Benefit of an Elevator Diagnosis
These finding, like elevated cholesterol or hypertension, confer risk for heart disease. If risk is significant, testing should be performed to determine definitively if the malady is present. As cardiac disease is often sneaky and elusive, every available clue is important - whether this be something determined from examining the blood cholesterol or something visible across the elevator.