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Cardiofaciocutaneous (CFC) syndrome is a RASopathy characterized by craniofacial dysmorphology, congenital heart disease, dermatological abnormalities (most commonly hyperkeratotic skin and sparse, curly hair), growth retardation and intellectual disability.
No HPO annotations are available for this condition.
Age of onset: newborn period, at birth.
Cardiofaciocutaneous (CFC) syndrome is a multiple congenital anomaly disorder in which individuals may have dysmorphic craniofacial features, cardiac issues, skin and hair abnormalities, hypotonia, eye abnormalities, gastrointestinal dysfunction, seizures, and varying degrees of neurocognitive delay . While many features have been seen in association with this condition, individuals with CFC syndrome display phenotypic variability and therefore not all have every finding. Polyhydramnios is present in the vast majority of fetal cases diagnosed in utero. Maternal hyperemesis gravidarum, gestational diabetes, gestational hypertension, and preeclampsia may occur, and subjective decrease in fetal movement may be observed prenatally. Second- and third-trimester ultrasound abnormalities may include polyhydramnios, macrocephaly, macrosomia, and renal and cardiac abnormalities. Operative delivery is not uncommon. Neonatal outcomes of CFC individuals may include irregular heartbeat, intubation, need for feeding tube, edema, chylothorax, and hyperbilirubinemia, which may be confounded by the increased rate of prematurity . Table 2. Cardiofaciocutaneous Syndrome: Frequency of Select Features
Feature | Frequency | Comment |
|---|---|---|
Nearly all | Common | Less frequent |
Hypotonia motor developmental delay | Seizures | Behavioral issues |
Source: GeneReviews — "Cardiofaciocutaneous Syndrome"
Cardiofaciocutaneous (CFC) syndrome is one the RASopathies: a group of syndromes having overlapping clinical features resulting from a common pathogenetic mechanism . No consensus clinical diagnostic criteria have been established. The diagnosis of CFC syndrome is suspected by clinical findings and confirmed by molecular genetic testing.
Cardiofaciocutaneous (CFC) syndrome should be suspected in individuals with the following clinical features:
Source: GeneReviews — "Cardiofaciocutaneous Syndrome"
Costello syndrome. By definition, individuals identified as having a heterozygous HRAS pathogenic variant have the diagnosis of Costello syndrome. Costello syndrome is characterized by the following:
Source: GeneReviews — "Cardiofaciocutaneous Syndrome"
Cardiofaciocutaneous syndrome is included in newborn screening programs (Severe Combined Immunodeficiency) in 49 states.
Biomarker and diagnostic research for cardiofaciocutaneous syndrome has been reported in the published literature.
No approved treatments are currently available for cardiofaciocutaneous syndrome. The disease remains an area of unmet medical need.
Clinical practice guidelines for cardiofaciocutaneous (CFC) syndrome have been published (full text). Evaluations Following Initial Diagnosis To establish the extent of disease and needs in an individual diagnosed with CFC syndrome, the evaluations summarized (if not performed as part of the evaluation that led to diagnosis) are recommended. Table 4. Recommended Evaluations Following Initial Diagnosis in Individuals with Cardiofaciocutaneous (CFC) Syndrome
System/Concern | Evaluation | Comment |
|---|---|---|
Constitutional | Complete physical exam incl measurement of growth parameters | To assess for poor growth |
Neurologic | Neurologic eval1 | To incl brain MRI in persons w/rapid in head growth, regression of developmental skills, seizures, changes in neurologic findings, or concerns about optic nerve hypoplasia on ophthalmologic eval; Consider EEG if seizures are a concern. |
Development | Developmental assessment | To incl motor, adaptive, cognitive, speech-language eval; Eval for early intervention/ special education Psychiatric/ |
Behavioral | Neuropsychiatric eval | For persons age 12 mos: screening for behavior concerns incl sleep disturbances, ADHD, anxiety, /or findings suggestive of ASD Gastrointestinal/ |
Feeding |
Source: GeneReviews — "Cardiofaciocutaneous Syndrome"
Individuals with CFC syndrome report heat intolerance; therefore, overexposure to heat and strenuous activity should be avoided. Hydrate as needed. In individuals with evidence of peripheral neuropathy, drugs with a neurotoxic effect should be avoided, per standard supportive treatment according to the individual's neurologist or rehabilitation medicine specialist.
Source: GeneReviews — "Cardiofaciocutaneous Syndrome"
Search ClinicalTrials.gov in the US and EU Clinical Trials Register in Europe for access to information on clinical studies for a wide range of diseases and conditions. Note: There may not be clinical trials for this disorder.
Source: GeneReviews — "Cardiofaciocutaneous Syndrome"
7 trials found
To monitor existing manifestations, the individual's response to supportive care, and the emergence of new manifestations, the evaluations in are recommended. Lifelong periodic follow up is warranted. Table 6. Recommended Surveillance for Individuals with Cardiofaciocutaneous Syndrome
System/Concern | Evaluation | Frequency |
|---|---|---|
Development | Monitor developmental progress educational needs. | At each visit |
Eyes | Monitor for ocular issues (such as myopia, hyperopia, cataracts) by ophthalmologist | Every 6-12 mos as directed by ophthalmologist |
Musculoskeletal | Assess for scoliosis3,4 | At each visit until skeletal maturity |
Hearing | Hearing eval | Every 2-3 yrs, or more frequently if hearing loss has been identified |
Cardiovascular5 | Blood pressure measurement | At each clinic visit Persons up to age 20 yrs |
Skin | Dermatologic eval for skin issues, progression of nevi formation, monitoring of lymphedema | Annually or as directed by dermatologist Endocrine |
Source: GeneReviews — "Cardiofaciocutaneous Syndrome"
Estimated prevalence: <1 in 1,000,000 (VERY_RARE).
7 clinical trials registered, 4 recruiting. Interventions under study include other interventions. Pipeline includes 4 NA. Research is primarily sponsored by academic and government institutions.
NCT ID | Title | Phase | Sponsor | Status |
|---|---|---|---|---|
[NCT04395495](https://clinicaltrials.gov/study/NCT04395495) | RASopathy Biorepository | — | Children's Hospital Medical Center, Cincinnati | RECRUITING |
[NCT06355622](https://clinicaltrials.gov/study/NCT06355622) | Prevalence and Characterization of Pain in RASopathies | NA | Fondazione Policlinico Universitario Agostino Gemelli IRCCS | UNKNOWN |
[NCT06331117](https://clinicaltrials.gov/study/NCT06331117) | Effect of RAS/MAPK Pathway Hyperactivation on Growth' and Bone' Profile of the RASopathies | NA | Fondazione Policlinico Universitario Agostino Gemelli IRCCS | UNKNOWN |
[NCT07005297](https://clinicaltrials.gov/study/NCT07005297) | Clinical Genetics Branch Eligibility Screening Survey | — | National Cancer Institute (NCI) | NOT_YET_RECRUITING |
[NCT05761314](https://clinicaltrials.gov/study/NCT05761314) | Solid Tumors in RASopathies | NA | Fondazione Policlinico Universitario Agostino Gemelli IRCCS | RECRUITING |
52 publications have been identified in PubMed for cardiofaciocutaneous syndrome. Research spans Review / Meta-Analysis (35%), Case Report / Case Series (33%), and Epidemiology / Natural History (17%).
Research Type | Count | % of Total |
|---|---|---|
Research summaries | 18 | 35% |
Patient case studies | 17 | 33% |
Disease patterns and progression | 9 | 17% |
Laboratory research | 5 | 10% |
Other research | 1 | 2% |
Testing and diagnosis research | 1 |
Kubiszewski H (2026). [PMID: 41904990](https://pubmed.ncbi.nlm.nih.gov/41904990/). *Advances in clinical and experimental medicine : official organ Wroclaw Medical University*. [Review / Meta-Analysis]
Ngulube MM (2026). [PMID: 40198060](https://pubmed.ncbi.nlm.nih.gov/40198060/). *Unknown Journal*. [Other]
Zhu T (2026). [PMID: 42040894](https://pubmed.ncbi.nlm.nih.gov/42040894/). *Hum Mutat*. [Basic Science / Preclinical]
Genç A (2026). [PMID: 42261585](https://pubmed.ncbi.nlm.nih.gov/42261585/). *Clin Genet*. [Basic Science / Preclinical]
Kocak Eker H (2026). [PMID: 41854160](https://pubmed.ncbi.nlm.nih.gov/41854160/). *Clin Genet*. [Basic Science / Preclinical]
Świeca A (2026). [PMID: 41694643](https://pubmed.ncbi.nlm.nih.gov/41694643/). *Clinical case reports*. [Epidemiology / Natural History]
Kim J (2026). [PMID: 41904680](https://pubmed.ncbi.nlm.nih.gov/41904680/). *Genetics in medicine : official journal of the American College of Medical Genetics*. [Epidemiology / Natural History]
Corso BM (2026). [PMID: 41675685](https://pubmed.ncbi.nlm.nih.gov/41675685/). *Molecular syndromology*. [Case Report / Case Series]
Kökcü Karadağ Şİ (2026). [PMID: 41708578](https://pubmed.ncbi.nlm.nih.gov/41708578/). *Scandinavian journal of immunology*. [Review / Meta-Analysis]
Weaver KN (2026). [PMID: 41230721](https://pubmed.ncbi.nlm.nih.gov/41230721/). *Current opinion in pediatrics*. [Review / Meta-Analysis]
Data assembled from 6 of 12 sources · Last updated Sep 20, 2026, 3:07 PM UTC
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European rare disease database
Genetic and Rare Diseases Info Center
To incl eval of aspiration risk nutritional status; Consider swallowing study /or studies for GERD.; Consider eval for gastrostomy tube placement in persons w/dysphagia /or aspiration risk.; Be mindful of possible malrotation.; Assessment for signs/symptoms of constipation |
Eyes | Ophthalmologic eval | To assess for ptosis, amblyopia, refractive error, strabismus, optic nerve abnormalities, cataracts, delayed visual maturation, cortical visual impairment, or more complex findings that may require subspecialty referral |
Musculoskeletal | Orthopedics/ physical medicine rehab/ PT OT eval | To incl assessment of:; Gross motor fine motor skills; Contractures, hip dysplasia, kyphoscoliosis; Mobility, ADL, need for adaptive devices; Need for PT (to improve gross motor skills) /or OT (to improve fine motor skills) |
Hearing | Audiologic eval | Assess for hearing loss. |
Cardiovascular | Cardiac eval incl measurement of blood pressure, echocardiogram, electrocardiogram | With special assessment for pulmonary stenosis, hypertrophic cardiomyopathy, /or septal defects; If there are concerns about arrhythmia, then consider 24-hour Holter eval. |
Genitourinary | Abdominal ultrasound | To evaluate for renal (rarely) splenic anomalies Consider pelvic ultrasound. |
Skin | Dermatologic eval2 | Skin issues typically evolve over time.; If there is significant lymphedema or large hemangiomas, consider referral to vascular anomalies specialist or clinic. |
Endocrine | Consider obtaining TSH, free T4, IGF-1, IGFBP-3. | Consider referral to endocrinologist. Consider celiac disease screening in those w/growth failure. Physical exam for evidence of precocious puberty in children for initiation progression through puberty in adolescents Obtain DXA scan in younger older adults |
Hematologic/Lymphatic | CBC w/platelet count, platelet function studies, von Willebrand screening | In persons w/history of bruising or bleeding problems, consider referral to hematologist if there are abnormalities on these screening blood tests.; Eval for bleeding issues should be done prior to any invasive or surgical procedure. |
Respiratory/Sleep | Clinical assessment for signs symptoms of tracheomalacia in infants young children | Laryngotracheal abnormalities such as laryngotracheomalacia laryngeal clefts have been reported. Consider sleep study. |
Clinical study results | 1 | 2% |