Focal dermal hypoplasia
General Information (adopted from Orphanet):
Synonyms, Signs: |
FDH DHOF FODH goltz syndrome goltz-gorlin syndrome |
Number of Symptoms | 170 |
OrphanetNr: | 2092 |
OMIM Id: |
305600
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ICD-10: |
Q82.8 |
UMLs: |
C0016395 |
MeSH: |
D005489 |
MedDRA: |
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Snomed: |
205573006 2298005 |
Prevalence, inheritance and age of onset:
Prevalence: | 300 cases [Orphanet] |
Inheritance: |
X-linked dominant [Orphanet] |
Age of onset: |
Neonatal [Orphanet] |
Disease classification (adopted from Orphanet):
Parent Diseases: |
Connective tissue disease with eye involvement
-Rare eye disease -Rare genetic disease Ectodermal dysplasia syndrome -Rare developmental defect during embryogenesis -Rare genetic disease -Rare skin disease Genetic mixed dermis disorder -Rare genetic disease Genetic multiple congenital anomalies/dysmorphic syndrome - variable intellectual deficit -Rare genetic disease Lens shape anomaly -Rare eye disease -Rare genetic disease Malformation syndrome with hamartosis -Rare developmental defect during embryogenesis -Rare genetic disease Mixed dermis disorder -Rare skin disease Multiple congenital anomalies/dysmorphic syndrome - variable intellectual deficit -Rare developmental defect during embryogenesis Syndromic developmental defect of the eye -Rare developmental defect during embryogenesis -Rare eye disease -Rare genetic disease X-linked syndromic intellectual deficit -Rare genetic disease -Rare neurologic disease |
Symptom Information:
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(HPO:0008678) | Renal hypoplasia/aplasia | Occasional [Orphanet] | 127 / 7739 | |||
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(HPO:0000073) | Ureteral duplication | 11 / 7739 | ||||
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(HPO:0000066) | Labial hypoplasia | 10 / 7739 | ||||
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(HPO:0000060) | Clitoral hypoplasia | 9 / 7739 | ||||
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(HPO:0000028) | Cryptorchidism | 347 / 7739 | ||||
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(HPO:0000126) | Hydronephrosis | 119 / 7739 | ||||
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(HPO:0000072) | Hydroureter | Occasional [Orphanet] | 146 / 7739 | |||
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(HPO:0000107) | Renal cyst | Frequent [Orphanet] | 126 / 7739 | |||
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(HPO:0000085) | Horseshoe kidney | 39 / 7739 | ||||
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(HPO:0100542) | Abnormal localization of kidney | Frequent [Orphanet] | 64 / 7739 | |||
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(HPO:0000252) | Microcephaly | 832 / 7739 | ||||
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(HPO:0000307) | Pointed chin | Occasional [Orphanet] | 45 / 7739 | |||
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(HPO:0011331) | Hemifacial atrophy | Frequent [Orphanet] | 79 / 7739 | |||
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(HPO:0011478) | True anophthalmia | 17 / 7739 | ||||
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(HPO:0003191) | Cleft ala nasi | 8 / 7739 | ||||
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(HPO:0000324) | Facial asymmetry | 57 / 7739 | ||||
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(HPO:0000684) | Delayed eruption of teeth | 117 / 7739 | ||||
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(HPO:0006297) | Hypoplasia of dental enamel | 64 / 7739 | ||||
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(HPO:0000164) | Abnormality of the teeth | Frequent [Orphanet] | 291 / 7739 | |||
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(HPO:0000668) | Hypodontia | 81 / 7739 | ||||
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(HPO:0000175) | Cleft palate | 349 / 7739 | ||||
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(HPO:0000682) | Abnormality of dental enamel | Very frequent [Orphanet] | 102 / 7739 | |||
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(HPO:0000204) | Cleft upper lip | 193 / 7739 | ||||
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(HPO:0000528) | Anophthalmia | 42 / 7739 | ||||
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(HPO:0000677) | Oligodontia | 41 / 7739 | ||||
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(HPO:0000455) | Broad nasal tip | 67 / 7739 | ||||
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(HPO:0009804) | Reduced number of teeth | Very frequent [Orphanet] | 137 / 7739 | |||
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(HPO:0006482) | Abnormality of dental morphology | Very frequent [Orphanet] | 81 / 7739 | |||
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(HPO:0000689) | Dental malocclusion | Frequent [Orphanet] | 114 / 7739 | |||
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(HPO:0000568) | Microphthalmia | 183 / 7739 | ||||
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(HPO:0000446) | Narrow nasal bridge | Occasional [Orphanet] | 29 / 7739 | |||
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(HPO:0000567) | Chorioretinal coloboma | 26 / 7739 | ||||
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(HPO:0007676) | Hypoplasia of the iris | 22 / 7739 | ||||
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(HPO:0000526) | Aniridia | 12 / 7739 | ||||
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(HPO:0008056) | Aplasia/Hypoplasia affecting the eye | Frequent [Orphanet] | 142 / 7739 | |||
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(HPO:0008053) | Aplasia/Hypoplasia of the iris | Frequent [Orphanet] | 38 / 7739 | |||
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(HPO:0000648) | Optic atrophy | 238 / 7739 | ||||
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(HPO:0001132) | Lens subluxation | 13 / 7739 | ||||
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(HPO:0001089) | Iris atrophy | 8 / 7739 | ||||
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(HPO:0000486) | Strabismus | Frequent [Orphanet] | 576 / 7739 | |||
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(HPO:0000612) | Iris coloboma | Frequent [Orphanet] | 116 / 7739 | |||
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(HPO:0007663) | Reduced visual acuity | 100 / 7739 | ||||
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(HPO:0000639) | Nystagmus | 555 / 7739 | ||||
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(HPO:0000610) | Abnormality of the choroid | Frequent [Orphanet] | 11 / 7739 | |||
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(HPO:0001083) | Ectopia lentis | Frequent [Orphanet] | 45 / 7739 | |||
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(HPO:0000481) | Abnormality of the cornea | Frequent [Orphanet] | 124 / 7739 | |||
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(HPO:0000505) | Visual impairment | 297 / 7739 | ||||
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(HPO:0000357) | Abnormal location of ears | Very frequent [Orphanet] | 328 / 7739 | |||
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(HPO:0004452) | Abnormality of the middle ear ossicles | Very frequent [Orphanet] | 26 / 7739 | |||
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(HPO:0000598) | Abnormality of the ear | Very frequent [Orphanet] | 98 / 7739 | |||
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(HPO:0000369) | Low-set ears | 372 / 7739 | ||||
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(HPO:0000410) | Mixed hearing impairment | 22 / 7739 | ||||
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(HPO:0000377) | Abnormality of the pinna | 111 / 7739 | ||||
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(HPO:0000402) | Stenosis of the external auditory canal | 22 / 7739 | ||||
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(HPO:0001249) | Intellectual disability | 1089 / 7739 | ||||
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(HPO:0002557) | Hypoplastic nipples | 33 / 7739 | ||||
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(HPO:0002558) | Supernumerary nipple | 40 / 7739 | ||||
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(HPO:0100259) | Postaxial polydactyly | 85 / 7739 | ||||
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(HPO:0001770) | Toe syndactyly | Very frequent [Orphanet] | 149 / 7739 | |||
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(HPO:0002650) | Scoliosis | Frequent [Orphanet] | 705 / 7739 | |||
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(HPO:0001374) | Congenital hip dislocation | 51 / 7739 | ||||
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(HPO:0009380) | Aplasia of the fingers | Very frequent [Orphanet] | 51 / 7739 | |||
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(HPO:0001180) | Hand oligodactyly | 17 / 7739 | ||||
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(HPO:0002414) | Spina bifida | Frequent [Orphanet] | 47 / 7739 | |||
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(HPO:0000773) | Short ribs | 70 / 7739 | ||||
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(HPO:0001171) | Split hand | 72 / 7739 | ||||
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(HPO:0100257) | Ectrodactyly | 27 / 7739 | ||||
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(HPO:0010442) | Polydactyly | 69 / 7739 | ||||
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(HPO:0006101) | Finger syndactyly | Very frequent [Orphanet] | 198 / 7739 | |||
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(HPO:0002475) | Myelomeningocele | 29 / 7739 | ||||
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(HPO:0005930) | Abnormality of epiphysis morphology | Very frequent [Orphanet] | 119 / 7739 | |||
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(HPO:0002817) | Abnormality of the upper limb | Very frequent [Orphanet] | 25 / 7739 | |||
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(HPO:0100559) | Lower limb asymmetry | Very frequent [Orphanet] | 30 / 7739 | |||
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(HPO:0006608) | Midclavicular hypoplasia | 1 / 7739 | ||||
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(HPO:0010621) | Cutaneous syndactyly of toes | 36 / 7739 | ||||
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(HPO:0000772) | Abnormality of the ribs | Frequent [Orphanet] | 146 / 7739 | |||
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(HPO:0001849) | Foot oligodactyly | 9 / 7739 | ||||
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(HPO:0010743) | Short metatarsal | 56 / 7739 | ||||
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(HPO:0100490) | Camptodactyly of finger | Very frequent [Orphanet] | 212 / 7739 | |||
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(HPO:0001839) | Split foot | 28 / 7739 | ||||
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(HPO:0001159) | Syndactyly | 140 / 7739 | ||||
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(HPO:0010740) | Osteopathia striata | 3 / 7739 | ||||
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(HPO:0001162) | Postaxial hand polydactyly | 119 / 7739 | ||||
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(HPO:0001156) | Brachydactyly syndrome | 180 / 7739 | ||||
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(HPO:0001829) | Foot polydactyly | 41 / 7739 | ||||
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(HPO:0009700) | Finger symphalangism | 55 / 7739 | ||||
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(HPO:0012165) | Oligodactyly | 18 / 7739 | ||||
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(HPO:0009381) | Short finger | 45 / 7739 | ||||
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(HPO:0010760) | Absent toe | Very frequent [Orphanet] | 15 / 7739 | |||
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(HPO:0004691) | 2-3 toe syndactyly | 50 / 7739 | ||||
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(HPO:0010049) | Short metacarpal | 99 / 7739 | ||||
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(HPO:0001161) | Hand polydactyly | Very frequent [Orphanet] | 71 / 7739 | |||
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(HPO:0100670) | Rough bone trabeculation | Very frequent [Orphanet] | 12 / 7739 | |||
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(HPO:0009803) | Short phalanx of finger | 79 / 7739 | ||||
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(HPO:0011867) | Abnormality of the wing of the ilium | Frequent [Orphanet] | 123 / 7739 | |||
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(HPO:0010622) | Neoplasm of the skeletal system | Occasional [Orphanet] | 30 / 7739 | |||
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(HPO:0003298) | Spina bifida occulta | 67 / 7739 | ||||
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(HPO:0006660) | Aplastic clavicles | Frequent [Orphanet] | 70 / 7739 | |||
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(HPO:0001388) | Joint laxity | 117 / 7739 | ||||
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(HPO:0006638) | Midclavicular aplasia | 1 / 7739 | ||||
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(HPO:0001155) | Abnormality of the hand | Very frequent [Orphanet] | 54 / 7739 | |||
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(HPO:0002566) | Intestinal malrotation | 89 / 7739 | ||||
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(HPO:0000775) | Abnormality of the diaphragm | Occasional [Orphanet] | 62 / 7739 | |||
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(HPO:0001537) | Umbilical hernia | Occasional [Orphanet] | 206 / 7739 | |||
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(HPO:0002027) | Abdominal pain | Occasional [Orphanet] | 184 / 7739 | |||
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(HPO:0002036) | Hiatus hernia | 24 / 7739 | ||||
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(HPO:0006554) | Acute hepatic failure | Occasional [Orphanet] | 20 / 7739 | |||
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(HPO:0004299) | Hernia of the abdominal wall | Very frequent [Orphanet] | 176 / 7739 | |||
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(HPO:0002577) | Abnormality of the stomach | Occasional [Orphanet] | 84 / 7739 | |||
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(HPO:0001539) | Omphalocele | Occasional [Orphanet] | 102 / 7739 | |||
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(HPO:0001545) | Anteriorly placed anus | 55 / 7739 | ||||
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(HPO:0000776) | Congenital diaphragmatic hernia | 36 / 7739 | ||||
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(HPO:0001540) | Diastasis recti | 23 / 7739 | ||||
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(HPO:0000023) | Inguinal hernia | 181 / 7739 | ||||
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(HPO:0100867) | Duodenal stenosis | Occasional [Orphanet] | 29 / 7739 | |||
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(HPO:0004322) | Short stature | 1232 / 7739 | ||||
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(HPO:0002299) | Brittle hair | 52 / 7739 | ||||
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(HPO:0008070) | Sparse hair | 94 / 7739 | ||||
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(HPO:0001597) | Abnormality of the nail | Very frequent [Orphanet] | 115 / 7739 | |||
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(HPO:0001802) | Absent toenail | 6 / 7739 | ||||
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(HPO:0000963) | Thin skin | Very frequent [Orphanet] | 96 / 7739 | |||
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(HPO:0002164) | Nail dysplasia | 82 / 7739 | ||||
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(HPO:0001009) | Telangiectasia | 46 / 7739 | ||||
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(HPO:0007588) | Reticular hyperpigmentation | 9 / 7739 | ||||
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(HPO:0002232) | Patchy alopecia | 4 / 7739 | ||||
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(HPO:0001817) | Absent fingernail | 2 / 7739 | ||||
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(HPO:0100585) | Telangiectasia of the skin | Very frequent [Orphanet] | 66 / 7739 | |||
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(HPO:0004334) | Dermal atrophy | Very frequent [Orphanet] | 34 / 7739 | |||
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(HPO:0200043) | Verrucae | 11 / 7739 | ||||
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(HPO:0001000) | Abnormality of skin pigmentation | Very frequent [Orphanet] | 105 / 7739 | |||
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(HPO:0001031) | Subcutaneous lipoma | Frequent [Orphanet] | 112 / 7739 | |||
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(HPO:0007546) | Linear hyperpigmentation | 2 / 7739 | ||||
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(HPO:0001596) | Alopecia | Frequent [Orphanet] | 162 / 7739 | |||
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(HPO:0008069) | Neoplasm of the skin | Frequent [Orphanet] | 84 / 7739 | |||
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(HPO:0008065) | Aplasia/Hypoplasia of the skin | Very frequent [Orphanet] | 81 / 7739 | |||
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(HPO:0008404) | Nail dystrophy | 89 / 7739 | ||||
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(HPO:0010783) | Erythema | Frequent [Orphanet] | 138 / 7739 | |||
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(HPO:0001629) | Ventricular septal defect | Occasional [Orphanet] | 316 / 7739 | |||
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(HPO:0001643) | Patent ductus arteriosus | Occasional [Orphanet] | 228 / 7739 | |||
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(HPO:0004760) | Congenital septal defect | Occasional [Orphanet] | 69 / 7739 | |||
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(HPO:0011718) | Abnormality of the pulmonary veins | Occasional [Orphanet] | 6 / 7739 | |||
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(HPO:0001600) | Abnormality of the larynx | 15 / 7739 | ||||
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(HPO:0006703) | Aplasia/Hypoplasia of the lungs | Occasional [Orphanet] | 79 / 7739 | |||
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(HPO:0009125) | Lipodystrophy | Occasional [Orphanet] | 54 / 7739 | |||
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(HPO:0001522) | Death in infancy | Very frequent [Orphanet] | 275 / 7739 | |||
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(OMIM) | Papillomatosis | 4 / 7739 | ||||
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(HPO:0001274) | Agenesis of corpus callosum | 142 / 7739 | ||||
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(OMIM) | Asymmetric breast | 1 / 7739 | ||||
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(MedDRA:10072883) | Brachydactyly | 153 / 7739 | ||||
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(OMIM) | Protruding, simple ears | 1 / 7739 | ||||
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(HPO:0012740) | Papilloma | Very frequent [Orphanet] | 17 / 7739 | |||
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(OMIM) | Asymmetric skull | 6 / 7739 | ||||
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(HPO:0045026) | Abnormality of the mediastinum | Occasional [Orphanet] | 6 / 7739 | |||
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(OMIM) | Hidrocystomas | 1 / 7739 | ||||
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(OMIM) | Hypoplastic fingertip epidermal ridges | 1 / 7739 | ||||
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(HPO:0030037) | Bifid ureter | 2 / 7739 | ||||
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(OMIM) | Skeletal asymmetry | 1 / 7739 | ||||
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(OMIM) | Arborescent papillomas (axillae, periumbilical area, anus, vulva) | 1 / 7739 | ||||
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(OMIM) | Microcephaly, mild | 4 / 7739 | ||||
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(OMIM) | Failure of pubic bone fusion | 1 / 7739 | ||||
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(OMIM) | Bifid ureter | 2 / 7739 | ||||
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(OMIM) | Linear or reticular hyperpigmentation | 1 / 7739 | ||||
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(OMIM) | Notched incisors | 1 / 7739 | ||||
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(HPO:0000238) | Hydrocephalus | 278 / 7739 | ||||
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(HPO:0001423) | X-linked dominant inheritance | 69 / 7739 | ||||
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(HPO:0002308) | Arnold-Chiari malformation | 42 / 7739 | ||||
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(HPO:0012758) | Neurodevelopmental delay | Frequent [Orphanet] | 949 / 7739 | |||
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(MedDRA:10025421) | Macule | Very frequent [Orphanet] | 55 / 7739 | |||
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(OMIM) | Localized cutaneous deposits of superficial fat | 1 / 7739 | ||||
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(OMIM) | Esophageal papillomas | 1 / 7739 |
Associated genes:
ClinVar (via SNiPA)
Gene symbol | Variation | Clinical significance | Reference |
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Additional Information:
Clinical Description OMIM |
Focal dermal hypoplasia is inherited as an X-linked dominant with in utero lethality in males. The features include atrophy and linear pigmentation of the skin, herniation of fat through the dermal defects, and multiple papillomas of the mucous ... |
Molecular genetics OMIM |
Wang et al. (2007) cohybridized genomic DNA of girls with FDH with reference female DNA onto a genomewide oligonucleotide comparative genomic hybridization (CGH) array and identified a 219-kb region of copy number loss in 11p11.23 in DNA from ... |
Diagnosis GeneReviews | Focal dermal hypoplasia is a multisystem disorder primarily involving the skin, skeletal system, eyes, and face. The diagnosis of focal dermal hypoplasia should be considered in individuals with either of the following:... Gene SymbolTest MethodMutations DetectedMutation Detection Frequency by Test Method 1, 2, 3Test AvailabilityAffected MalesCarrier FemalesPORCNSequence analysis | Sequence variants 415/17 reported 5142/155 reported 6ClinicalDeletion analysis 7Large deletions 80/17 reported13/155 reported1. The ability of the test method used to detect a mutation that is present in the indicated gene2. Estimates based on 155 individual positive test results which are curated in the PORCN @ LOVD database [Lombardi et al 2011] 3. The exact detection rate is uncertain, however of those with positive findings, deletions represent 8.4% and other mutations represent 91.6%. Males with mosaic mutations represent 9.7% of all described cases with mutations in PORCN @ LOVD [Bronholdt et al 2009, Froyen et al 2009, Fernandes et al 2010, Lombardi et al 2011]. It has been suggested that mutations can be identified in nearly all well-characterized cases of FDH [Lombardi et al 2011], but that diagnostic yields are lower when samples from clinical cases with less defined phenotypes are submitted to clinical diagnostic labs to rule out FDH, varying from 34% [Fernandes et al 2010] to 62.5% [Lombardi et al 2011].4. Examples of mutations detected by sequence analysis may include small intragenic deletions/insertions and missense, nonsense, and splice site mutations; typically, exonic or whole-gene deletions/duplications are not detected.5. All males reported thus far where a mutation in PORCN has been confirmed have been mosaic for the mutation. Mutations have not been found or described in all reported affected males [Tollefson & McEvoy 2009, Lasocki et al 2011].6. Sequence analysis of genomic DNA cannot detect deletion of one or more exons or the entire X-linked gene in a heterozygous female.7. Testing that identifies deletions/duplications not readily detectable by sequence analysis of the coding and flanking intronic regions of genomic DNA; included in the variety of methods that may be used are: quantitative PCR, long-range PCR, multiplex ligation-dependent probe amplification (MLPA), and chromosomal microarray (CMA) that includes this gene/chromosome segment.8. Reported deletions have ranged from an intragenic deletion (exons 1-4) [Bornholdt et al 2009] to large genomic deletions including PORCN and neighboring genes of up to 0.5 Mb [Wang et al 2007, Lombardi et al 2011].Interpretation of test resultsFor issues to consider in interpretation of sequence analysis results, click here.Females may be mosaic for mutations in PORCN. In sequence analysis, mosaicism for a missense or other non-frameshifting mutation can be difficult to detect and may produce a false negative test result [Grzeschik et al 2007, Bornholdt et al 2009].46,XY males with an identified mutation thus far have been mosaic for mutations in PORCN [Wang et al 2007, Grzeschik et al 2007, Bornholdt et al 2009, Maas et al 2009, Fernandes et al 2010, Vreeburg et al 2011, Yoshihashi et al 2011]. In sequence analysis, mosaicism for a missense or other non-frameshifting mutation can be difficult to detect and may produce a false negative test result [Wang et al 2007, Maas et al 2009, Lasocki et al 2011]. Testing of affected tissues in these cases can result in increased detection of the mutation [Maas et al 2009]. Information on specific allelic variants may be available in Molecular Genetics (see Table A. Genes and Databases and/or Pathologic allelic variants).Testing StrategyTo confirm/establish the diagnosis in a female proband1.Perform sequence analysis.2.In females, if no mutation is identified on sequence analysis, test for large deletions by deletion/duplication analysis. This can be achieved by fluorescence in situ hybridization or other targeted methods to search for a PORCN-including deletion. The locus is also well covered on most clinical CMA tests. To confirm/establish the diagnosis in a male probandSequence analysis. No male has been reported to have a germline mutation and careful attention may be required to detect low levels of mosaicism. Analysis of affected tissues (e.g., skin biopsy) can be considered in males if the results performed on DNA from other sources (e.g. blood sample, saliva) do not detect a mutation [Maas et al 2009]. Males with a 47,XXY karyotype can have a heterozygous mutation on one of their two X chromosomes [Alkindi et al 2012].Prenatal diagnosis and preimplantation genetic diagnosis (PGD) for at-risk pregnancies requires prior identification of the disease-causing mutation in the family.Genetically Related (Allelic) DisordersAccording to Van Allen & Myhre [1991], Van Allen-Myhre syndrome is either a severe form of or allelic to focal dermal hypoplasia. This has been confirmed in a report in which an individual with Van Allen-Myhre syndrome [Hancock et al 2002] was found to have a pathogenic mutation in PORCN [personal observation; case reported by Wang et al 2007]. Angioma serpiginosum has been hypothesized to be allelic to focal dermal hypoplasia [Blinkenberg et al 2007]. A deletion of PORCN was subsequently reported in one affected individual [Houge et al 2008], but this was later disputed and proposed to be a case of FDH instead of a case of angioma serpiginosum [Happle 2009] Severe presentations of FDH with abdominal wall closure defects that are in the spectrum of pentalogy of Cantrell or limb-body wall complex anomaly have been reported [Hancock et al 2002, Maas et al 2009, Scott et al 2009, Smigiel et al 2011]. In some of these affected individuals, PORCN mutations have been detected [Maas et al 2009, Lombardi et al 2011, Smigiel et al 2011]. Whether mutations in PORCN can cause isolated forms of these conditions has not been established.
Clinical Description GeneReviews | Focal dermal hypoplasia is a multisystem disorder caused by developmental abnormalities in mesodermal and ectodermal structures and thus primarily involves the skin, skeletal system, eyes, and face. The manifestations vary among affected individuals and many have only a subset of the characteristic features. Nearly all individuals have at least a few of the skin manifestations.... |
Genotype-Phenotype Correlations GeneReviews | Information on genotype-phenotype correlations in focal dermal hypoplasia is limited.... |
Differential Diagnosis GeneReviews | Microphthalmia with linear skin defects (MLS). Similar skin and ophthalmologic manifestations may be seen in MLS; however, limb and skeletal malformations are uncommon in MLS. MLS is caused by deletions and point mutations of HCCS [Wimplinger et al 2006]; thus, as was previously proposed [Van den Veyver 2002], MLS and focal dermal hypoplasia are not allelic conditions [Harmsen et al 2009; Author, unpublished data]. ... |
Management GeneReviews | To establish the extent of disease and needs in an individual diagnosed with focal dermal hypoplasia, the following evaluations are recommended:... |
Molecular genetics GeneReviews |
Information in the Molecular Genetics and OMIM tables may differ from that elsewhere in the GeneReview: tables may contain more recent information. —ED.... Gene SymbolChromosomal LocusProtein NameLocus SpecificHGMDPORCNXp11 | Probable protein-cysteine N-palmitoyltransferase porcupinePORCN @ LOVDPORCNData are compiled from the following standard references: gene symbol from HGNC; chromosomal locus, locus name, critical region, complementation group from OMIM; protein name from UniProt. For a description of databases (Locus Specific, HGMD) to which links are provided, click here.Table B. OMIM Entries for Focal Dermal Hypoplasia (View All in OMIM) View in own window 300651PORCUPINE, DROSOPHILA, HOMOLOG OF; PORCN 305600FOCAL DERMAL HYPOPLASIA; FDHNormal allelic variants. PORCN has 15 exons, 14 of which are coding exons. It undergoes alternative splicing, resulting in five transcript variants.Pathologic allelic variants. Disease-causing mutations include nonsense, frameshift, and missense mutations as well as genomic deletions that delete the entire PORCN locus. The deletions also delete a variable number of flanking genes [Grzeschik et al 2007, Wang et al 2007].Normal gene product. PORCN encodes the human homolog of Drosophila porcupine [Caricasole et al 2002]. The gene product, human probable protein-cysteine N-palmitoyltransferase porcupine, has five isoforms that result from alternative splicing and in mouse studies was found to be expressed in a wide variety of tissues. Most information about its function is derived from studies of its highly conserved mouse, Drosophila, and recently also zebrafish homologs, where porcupine has been shown to be required for secretion and signaling of most WNT proteins from WNT-producing cells [van Amerongen & Nusse 2009, Chen et al 2012, Clevers & Nusse 2012] and may play a role in fine-tuning Wnt protein levels. WNTs are important morphogens that are secreted from producing cells and interact with specialized receptors and co-receptors (FZD/LRP5 or 6) on target cells. This activates the canonical WNT pathway, resulting in intracellular stabilization and translocation into the nucleus of β-catenin, where it activates specific target genes that are important for normal development [Clevers & Nusse 2012]. It may also be required to activate other non-canonical Wnt signaling [Proffitt & Virshup 2012]. Wnt-3a is retained in the endoplasmic reticulum of cultured cells when Porcn is inactivated [Takada et al 2006, Clevers & Nusse 2012]. Wnt signaling is required for induction, proliferation, morphogenesis, and maintenance of most organs. Abnormal gene product. Focal dermal hypoplasia is caused by loss-of-function mutations and deletions of PORCN. Loss of function of orthologs in mouse cells and Drosophila results in failure of WNT proteins to be secreted from the endoplasmic reticulum in WNT-producing cells, with defective downstream WNT signaling [Tanaka et al 2000, Takada et al 2006]. Inactivation of Porcn in mouse embryos has resulted in early embryonic lethality and revealed that it is required for gastrulation and normal development of mesoderm and ectoderm-derived structures [Barrott et al 2011, Biechele et al 2011, Liu et al 2012]. Conditional inactivation of Porcn in developing skin causes alopecia because hair follicles do not form [Liu et al 2012] and in developing limbs causes skeletal defects reminiscent of those seen in human patients with FDH [Barrott et al 2011, Liu et al 2012]. Inactivation in zebrafish has resulted in defects that are consistent with a role of protein-cysteine N-palmitoyltransferase porcupine in non-canonical Wnt-signaling in this organism [Chen et al 2012]. Inactivation in a tumor cell line, has suggested that porcupine may also function in other pathways in these transformed cells [Covey et al 2012]. Whether these last two new findings are relevant to the function in normal human cells or contribute to the defects found in FDH is currently unknown. The new mouse models will be helpful in the future to further understand the normal function of porcupine and to test potential new therapies for those symptoms that are progressive or first present after birth.