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Cutis laxa, autosomal recessive

MedGen UID:
784021
Concept ID:
C3665335
Disease or Syndrome
Synonym: Cutis Laxa, Autosomal Recessive
SNOMED CT: Cutis laxa, autosomal recessive (59451000)
 
Related genes: EFEMP2, ATP6V0A2, FBLN5, ALDH18A1, PYCR1
 
OMIM®: 219100

Definition

Cutis laxa is a collection of disorders that are typified by loose and/or wrinkled skin that imparts a prematurely aged appearance. Face, hands, feet, joints, and torso may be differentially affected. The skin lacks elastic recoil, in marked contrast to the hyperelasticity apparent in classical Ehlers-Danlos syndrome (see 130000). These properties are nearly always attributable to loss, fragmentation, or severe disorganization of dermal elastic fibers (summary by Davidson and Giro, 2002). The clinical spectrum of autosomal recessive cutis laxa is highly heterogeneous with respect to organ involvement and severity. Type I autosomal recessive cutis laxa (ARCL1) is a specific, life-threatening disorder with organ involvement, lung atelectasis and emphysema, diverticula of the gastrointestinal and genitourinary systems, and vascular anomalies. Associated cranial anomalies, late closure of the fontanel, joint laxity, hip dislocation, and inguinal hernia have been observed but are uncommon. Diminution of elastic fibers throughout the dermis and abnormal elastin components by electron microscopy are pathognomonic (summary by Morava et al., 2009). Classification of autosomal recessive cutis laxa is further divided into type II (ARCL2), associated with bone dystrophy, joint laxity, and developmental delay; and type III (ARCL3), or de Barsy syndrome, which presents very severe symptoms, with ocular involvement and mental retardation (summary by Davidson and Giro, 2002). For a phenotypic description and a discussion of genetic heterogeneity of autosomal dominant cutis laxa, see 123700. Genetic Heterogeneity of Autosomal Recessive Cutis Laxa Also see ARCL1B (614437), caused by mutation in the FBLN4 gene (EFEMP2; 604633); ARCL1C (613177), caused by mutation in the LTBP4 gene (FAM72A; 614710); and ARCL1D (620780), caused by mutation in the FBLN3 gene (EFEMP1; 601548). ARCL2A (219200) is caused by mutation in the ATP6V0A2 gene (611716). ARCL2B (612940) is caused by mutation in the PYCR1 gene (179035). ARCL2C (617402) is caused by mutation in the ATP6V1E1 gene (108746). ARCL2D (617403) is caused by mutation in the ATP6V1A gene (607027). ARCL2E (619451) is caused by mutation in the LTBP1 gene (150390). ARCL3A (219150) is caused by mutation in the ALDH18A1 gene (138250). ARCL3B (614438) is caused by mutation in the PYCR1 gene (179035). [from OMIM]

Additional description

From MedlinePlus Genetics
The X-linked form of cutis laxa is often called occipital horn syndrome. This form of the disorder is considered a mild type of Menkes syndrome, which is a condition that affects copper levels in the body. In addition to sagging and inelastic skin, occipital horn syndrome is characterized by wedge-shaped calcium deposits in a bone at the base of the skull (the occipital bone), coarse hair, and loose joints.

Researchers have described several different forms of cutis laxa. The forms are often distinguished by their pattern of inheritance: autosomal dominant, autosomal recessive, or X-linked. In general, the autosomal recessive forms of cutis laxa tend to be more severe than the autosomal dominant forms, although some people with autosomal dominant cutis laxa are severely affected. In addition to the features described above, people with autosomal recessive cutis laxa can have delayed development, intellectual disability, seizures, problems with movement, or eye or bone abnormalities.

Cutis laxa can also affect connective tissue in other parts of the body, including the heart, blood vessels, intestines, and lungs. The disorder can cause heart problems and abnormal narrowing, bulging, or tearing of critical blood vessels. Affected individuals may have soft out-pouchings in the lower abdomen (inguinal hernia) or around the belly button (umbilical hernia). Sacs called diverticula can also develop in the walls of certain organs, such as the bladder and intestines. During childhood, some people with cutis laxa develop a life-long lung disease called emphysema, which can make it difficult to breathe. Depending on which organs and tissues are affected, the signs and symptoms of cutis laxa can range from mild to life-threatening.

Other rare conditions, including arterial tortuosity syndrome, geroderma osteodysplastica, and RIN2 syndrome, are sometimes classified as cutis laxa-related conditions, because affected individuals can have loose, sagging skin. These conditions each have a particular pattern of signs and symptoms affecting different tissues and body systems.

The term "cutis laxa" is Latin for loose or lax skin, and this condition is characterized by skin that is sagging and not stretchy (inelastic). The skin often hangs in loose folds, causing the face and other parts of the body to have a droopy or wrinkled appearance. Extremely wrinkled skin may be particularly noticeable on the neck and in the armpits and groin.

Cutis laxa is a disorder of connective tissue, which is the tissue that provides structure and strength to the muscles, joints, organs, and skin. Most cases are inherited, but some are acquired, which means they do not appear to be caused by genetic variations. While signs and symptoms of inherited cutis laxa are often noticeable in infancy or childhood, acquired cutis laxa typically appears later in life. This summary primarily describes inherited forms of cutis laxa.    https://medlineplus.gov/genetics/condition/cutis-laxa

Professional guidelines

PubMed

Dimopoulou A, Fischer B, Gardeitchik T, Schröter P, Kayserili H, Schlack C, Li Y, Brum JM, Barisic I, Castori M, Spaich C, Fletcher E, Mahayri Z, Bhat M, Girisha KM, Lachlan K, Johnson D, Phadke S, Gupta N, Simandlova M, Kabra M, David A, Nijtmans L, Chitayat D, Tuysuz B, Brancati F, Mundlos S, Van Maldergem L, Morava E, Wollnik B, Kornak U
Mol Genet Metab 2013 Nov;110(3):352-61. Epub 2013 Aug 24 doi: 10.1016/j.ymgme.2013.08.009. PMID: 24035636

Recent clinical studies

Etiology

Vogt G, El Choubassi N, Herczegfalvi Á, Kölbel H, Lekaj A, Schara U, Holtgrewe M, Krause S, Horvath R, Schuelke M, Hübner C, Mundlos S, Roos A, Lochmüller H, Karcagi V, Kornak U, Fischer-Zirnsak B
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Angelini C, Thibaud M, Aladjidi N, Bessou P, Cabasson S, Colson C, Espil-Taris C, Goizet C, Husson M, Morice-Picard F, De Sandre-Giovannoli A, Pédespan JM
Neuropediatrics 2020 Aug;51(4):245-250. Epub 2020 Mar 6 doi: 10.1055/s-0040-1701671. PMID: 32143220
Hebson C, Coleman K, Clabby M, Sallee D, Shankar S, Loeys B, Van Laer L, Kogon B
Eur J Pediatr 2014 May;173(5):671-5. Epub 2013 Nov 26 doi: 10.1007/s00431-013-2217-y. PMID: 24276535
Sawyer SL, Dicke F, Kirton A, Rajapkse T, Rebeyka IM, McInnes B, Parboosingh JS, Bernier FP
Am J Med Genet A 2013 May;161A(5):1148-53. Epub 2013 Mar 26 doi: 10.1002/ajmg.a.35827. PMID: 23532871

Diagnosis

Zaman Q, Iftikhar A, Rehman G, Khan Q, Najumuddin, Jan A, Khan J, Anas M, Laiba, Umair M, Muthaffar OY, Abdulkareem AA, Bibi F, Naseer MI, Jelani M
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Dimopoulou A, Fischer B, Gardeitchik T, Schröter P, Kayserili H, Schlack C, Li Y, Brum JM, Barisic I, Castori M, Spaich C, Fletcher E, Mahayri Z, Bhat M, Girisha KM, Lachlan K, Johnson D, Phadke S, Gupta N, Simandlova M, Kabra M, David A, Nijtmans L, Chitayat D, Tuysuz B, Brancati F, Mundlos S, Van Maldergem L, Morava E, Wollnik B, Kornak U
Mol Genet Metab 2013 Nov;110(3):352-61. Epub 2013 Aug 24 doi: 10.1016/j.ymgme.2013.08.009. PMID: 24035636

Prognosis

Morlino S, Nardella G, Castellana S, Micale L, Copetti M, Fusco C, Castori M
Am J Med Genet A 2021 Mar;185(3):955-965. Epub 2020 Dec 27 doi: 10.1002/ajmg.a.62047. PMID: 33369135
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J Hum Genet 2019 Jul;64(7):609-616. Epub 2019 Apr 24 doi: 10.1038/s10038-019-0602-8. PMID: 31015584
Kantaputra PN, Kaewgahya M, Wiwatwongwana A, Wiwatwongwana D, Sittiwangkul R, Iamaroon A, Dejkhamron P
Am J Med Genet A 2014 Sep;164A(9):2370-7. Epub 2014 Jun 24 doi: 10.1002/ajmg.a.36630. PMID: 24962763
Dimopoulou A, Fischer B, Gardeitchik T, Schröter P, Kayserili H, Schlack C, Li Y, Brum JM, Barisic I, Castori M, Spaich C, Fletcher E, Mahayri Z, Bhat M, Girisha KM, Lachlan K, Johnson D, Phadke S, Gupta N, Simandlova M, Kabra M, David A, Nijtmans L, Chitayat D, Tuysuz B, Brancati F, Mundlos S, Van Maldergem L, Morava E, Wollnik B, Kornak U
Mol Genet Metab 2013 Nov;110(3):352-61. Epub 2013 Aug 24 doi: 10.1016/j.ymgme.2013.08.009. PMID: 24035636
Sawyer SL, Dicke F, Kirton A, Rajapkse T, Rebeyka IM, McInnes B, Parboosingh JS, Bernier FP
Am J Med Genet A 2013 May;161A(5):1148-53. Epub 2013 Mar 26 doi: 10.1002/ajmg.a.35827. PMID: 23532871

Clinical prediction guides

Morlino S, Nardella G, Castellana S, Micale L, Copetti M, Fusco C, Castori M
Am J Med Genet A 2021 Mar;185(3):955-965. Epub 2020 Dec 27 doi: 10.1002/ajmg.a.62047. PMID: 33369135
Karacan İ, Diz Küçükkaya R, Karakuş FN, Solakoğlu S, Tolun A, Hançer VS, Turanlı ET
Turk J Haematol 2019 Feb 7;36(1):29-36. Epub 2018 Nov 26 doi: 10.4274/tjh.galenos.2018.2018.0325. PMID: 30474613Free PMC Article
Li L, Ye Y, Sang P, Yin Y, Hu W, Wang J, Zhang C, Li D, Wan W, Li R, Li L, Ma L, Xie Y, Meng Z
Biomed Res Int 2017;2017:4184106. Epub 2017 Jan 18 doi: 10.1155/2017/4184106. PMID: 28194412Free PMC Article
Dimopoulou A, Fischer B, Gardeitchik T, Schröter P, Kayserili H, Schlack C, Li Y, Brum JM, Barisic I, Castori M, Spaich C, Fletcher E, Mahayri Z, Bhat M, Girisha KM, Lachlan K, Johnson D, Phadke S, Gupta N, Simandlova M, Kabra M, David A, Nijtmans L, Chitayat D, Tuysuz B, Brancati F, Mundlos S, Van Maldergem L, Morava E, Wollnik B, Kornak U
Mol Genet Metab 2013 Nov;110(3):352-61. Epub 2013 Aug 24 doi: 10.1016/j.ymgme.2013.08.009. PMID: 24035636
Sawyer SL, Dicke F, Kirton A, Rajapkse T, Rebeyka IM, McInnes B, Parboosingh JS, Bernier FP
Am J Med Genet A 2013 May;161A(5):1148-53. Epub 2013 Mar 26 doi: 10.1002/ajmg.a.35827. PMID: 23532871

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