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Features include always present findings: Elevated circulating follicle stimulating hormone level and Decreased serum estradiol; and common findings: Secondary amenorrhea, Streak ovary, and Primary amenorrhea. 6 total HPO annotations.
Organ System | Phenotype Count | Example Features |
|---|---|---|
Hormones | 3 | Secondary amenorrhea, Precocious puberty in females, Primary amenorrhea |
TP63 function has not been fully characterized.
Premature ovarian failure 21 is associated with mutations in the TP63 gene on chromosome 3.
Note: Pathogenic variants have been described on two TP63 isoforms: the TAp63 isoform, encoded by NM_003722.4, and the Np63 isoform, encoded by NM_001114982.1, which is 39 amino acids shorter and has an alternate N-terminal TA domain. See for details. AEC syndrome. All pathogenic variants associated with AEC syndrome occur in either the sterile alpha motif (SAM) domain (82%) or the Np63-specific N-terminal domain (18%). Pathogenic variants in the N-terminal domain that introduce premature termination codons lead to the use of an alternative start codon and to the consequent production of Np63 isoforms lacking the N-terminal domain, which are specifically associated with AEC syndrome.
A TP63-related disorder should be suspected/considered in individuals with a combination of the following findings.
Clinical findings
Ankyloblepharon filiforme adnatum
Dermal erosions
Signs of ectodermal dysplasia
No approved treatments are currently available for premature ovarian failure 21. The disease remains an area of unmet medical need.
No clinical practice guidelines for TP63-related disorders have been published. Evaluations Following Initial Diagnosis To establish the extent of disease and needs in an individual diagnosed with a TP63 -related disorder, the evaluations summarized (if not performed as part of the evaluation that led to the diagnosis) are recommended. Table 4. Recommended Evaluations Following Initial Diagnosis in Individuals with a TP63-Related Disorder
Table 6.
Recommended Surveillance for Individuals with a TP63-Related Disorder
System/Concern | Evaluation | Frequency
Hypodontia | Prosthodontic assessment | Per dental specialist
Hearing loss | Audiologic testing | Per audiologist/otolaryngologist
Source: GeneReviews — "TP63-Related Disorders"
No clinical trials have been registered for premature ovarian failure 21.
74 publications have been identified in PubMed for premature ovarian failure 21. Research spans Epidemiology / Natural History (42%), Review / Meta-Analysis (23%), and Basic Science / Preclinical (19%).
Research Type | Count | % of Total |
|---|---|---|
Disease patterns and progression | 31 | 42% |
Data assembled from 6 of 12 sources · Last updated Sep 19, 2026, 4:31 AM UTC
Online Mendelian Inheritance in Man
Lab test results |
1 |
Elevated circulating follicle stimulating hormone level |
The TP63-related disorders include the overlapping phenotypes summarized in and fully described in the text that follows. Table 2. TP63-Related Disorders: Comparison of Phenotypes by Select Features Feature | TP63-Related Disorder
AEC | ADULT | EEC3 | Limb-mammary | SHFM4 | Orofacialcleft 8 |
|---|---|---|---|---|---|
Ankyloblepharon filiforme adnatum | X | — | — | — | — |
Ectodermal dysplasia | X | X | X | — | — |
Rare | Hypohidrosis1 | X | X | — | — |
X | Nail dysplasia | X | X | Mild | X |
Sparse hair | X | X | X | — | — |
Tooth abnormalities | X | X | X | X | — |
Cleft lip/palate | X | — | — | — | — |
X | X | — | — | — | — |
X Split-hand/foot malformation / syndactyly | X | X | X | X | X |
Lacrimal duct obstruction | X | X | X | X | — |
Dermal erosions | X | — | — | — | — |
Hypopigmentation | X | X | X | — | — |
Hypospadias | X | — | — | — | — |
X | Trismus | X | Excessive freckling | X | Hypoplastic breasts |
Source: GeneReviews — "TP63-Related Disorders"
Source: GeneReviews — "TP63-Related Disorders"
Reduced penetrance or possible germline mosaicism has been documented in a small number of individuals and families.
Reduced penetrance for SHFM4 and ADULT syndrome has been reported.
A few individuals who do not appear to be clinically affected have had more than one child with AEC syndrome. These occurrences may be the result of reduced penetrance, but are more likely the result of somatic and germline mosaicism in one parent.
In one family, the TP63 pathogenic variant present in affected fraternal twins was also present in the phenotypically normal mother. The data suggested somatic mosaicism in the mother [van Bokhoven, unpublished data] with presumed germline mosaicism.
Source: GeneReviews — "TP63-Related Disorders"
Hypohidrosis
Nail dysplasia
Sparse hair
Tooth abnormalities
Freckles in sun-exposed areas
Cleft lip/palate
Split-hand/foot malformation and/or syndactyly
Lacrimal duct obstruction
Hypopigmentation
Hypospadias
Hypoplastic nipples/breasts
Source: GeneReviews — "TP63-Related Disorders"
Table 3. Genes of Interest in the Differential Diagnosis of TP63-Related Disorders
TP63-Related Disorder | Differential Diagnosis | Gene/GeneticMechanism | MOI | Overlapping Features | Distinguishing Features |
|---|---|---|---|---|---|
AEC syndrome | Epidermolysis bullosa simplex (EBS) | EXPH5 KRT5 KRT14 | — | — | — |
TGM5 | ARAD | Skin erosions at birth | Erosions in AEC syndrome are typically more superficial not assoc w/formation of bullae.; Nondermatologic features dermatopathology also distinguish EBS from AEC syndrome. Autosomal recessive congenital ichthyosis | ABCA12 ALOX12B ALOXE3 CASP14 CERS3 CYP4F22 LIPN NIPAL4 PNPLA1 SDR9C7 SLC27A4 | — |
TGM1 | AR | Erythroderma w/collodion membrane in newborn period1 | AEC is not assoc w/collodion membrane or ichthyosis. Curly hair-ankyloblepharon-nail dysplasia syndrome (CHANDS)(OMIM 214350) | — | — |
RIPK4 | AR | Ankyloblepharon hair changes | CHANDS typically does not incl significant facial/oral clefting or skin erosions that are virtually universal in AEC syndrome. Cocoon syndrome2 | — | — |
CHUK | ARAD | Ankyloblepharon, cleft lip/palate, ectodermal dysplasia | Cocoon syndrome is assoc w/hypogammaglobulinemia recurrent infections (features not observed in AEC syndrome) | — | — |
SHFM4 | SHFM1(OMIM 183600) | — | — | — | — |
DLX5 | AD | Split-hand/foot malformation | SHFM1 is assoc w/high incidence of hearing loss.; Findings are largely restricted to limbs. | — | — |
Dental lacrimal duct abnormalities are seen in 10% of persons.3 SHFM3(OMIM 246560) | 10q24 contiguous gene duplication | AD | SHFM3 is not assoc w/lacrimal, dental, or ectodermal abnormalities (beyond nail abnormalities assoc w/developmental defects of the digits).4 | — | — |
SHFM6(OMIM 225300) | WNT10B5 | AR | SHFM6 is not assoc w/lacrimal, dental, or ectodermal abnormalities. | — | — |
TP63-related disorders generally | Hypohidrotic ectodermal dysplasia (HED) | EDA EDAR EDARADD | — | — | — |
WNT10A | ADARXL | Hypotrichosis, hypohidrosis, hypodontia | Hypohidrosis in HED is severe enough to impair body temperature regulation, a problem not seen in TP63-related disorders. | — | — |
Source: GeneReviews — "TP63-Related Disorders"
Genetic testing for TP63 is available. Testing is considered confirmatory for diagnosis.
Biomarker and diagnostic research for premature ovarian failure 21 has been reported in the published literature.
System/Concern | Evaluation | Comment |
|---|---|---|
Ocular issues | Ophthalmologic eval | Evaluate for ankyloblepharon, lacrimal duct atresia/obstruction, dry eyes, blepharitis. Skin, hair, nail |
issues | Dermatologic eval | — |
Dental anomalies | Dental prosthodontics evals | Assess for need for implants. |
Cleft lip/palate | Eval by multispecialty cleft team | — |
Hearing loss | Otolaryngologic eval auditory evoked responses | Breast/nipple |
asymmetry | Plastic surgery eval | — |
Growth delay | Nutritional eval | Further assessment by gastroenterologist may be needed. Developmental |
delay | Developmental assessment | Limb malformations |
counseling | By genetics professionals1 | To inform affected persons their families re nature, MOI, implications of a TP63-related disorder to facilitate medical personal decision making Family support/ resources |
Treatment of Manifestations in Individuals with a TP63-Related Disorder Manifestation/Concern | Treatment | Considerations/Other |
Ankyloblepharon filiforme adnatum | These strands of tissue between upper lower eyelids are often small autolyse shortly after birth; larger ones may require surgical separation by ophthalmologist. | — |
Lacrimal duct atresia/obstruction | Possible need for probing or surgical intervention per ophthalmologist | — |
Dry eyes / blepharitis | Hydrating ocular drops or gels | — |
Skin erosions | Gentle wound care periodic, dilute bleach soaks (Dakins solution) to prevent secondary infection | Occlusive dressings should not be used, as they tend to stimulate granulation tissue. Treat secondary infections w/topical or oral antibiotics or antifungal agents when appropriate. |
Sparse hair / alopecia | Wigs can be used as desired. | Hypodontia |
Cleft lip/palate | Care managed by a multispecialty cleft team | — |
Hearing loss | Myringotomy for conductive hearing loss from chronic otitis media | — |
Breast/nipple asymmetry | Females: significant breast asymmetry may be corrected w/plastic surgery. | — |
Growth delay | Optimization of oral caloric intake | Gastrostomy tube placement may be considered. |
Developmental delay | Assessment treatment by developmental pediatrician /or child neuropsychologist | — |
Limb malformations | OT hand/foot surgery as needed to optimize function | — |
Psychological impact of phenotypic features | Referral for psychological support/counseling as necessary | OT = occupational therapy Surveillance Table 6. |
Source: GeneReviews — "TP63-Related Disorders"
Prolonged exposure to sunlight should be avoided to:
Prevent sunburn of hypopigmented areas and increase in contrast between the patchy areas of hyper- and hypopigmentation seen in AEC syndrome;
Minimize freckling of skin in individuals with ADULT syndrome.
Source: GeneReviews — "TP63-Related Disorders"
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 — "TP63-Related Disorders"
View trials for premature ovarian failure 21
Phenotype severity distribution: 2 always present features, 3 common features.
Research summaries
17 |
23% |
Laboratory research | 14 | 19% |
Patient case studies | 4 | 5% |
New treatment approaches | 4 | 5% |
Testing and diagnosis research | 2 | 3% |
Other research | 1 | 1% |
Clinical study results | 1 | 1% |
Koyun Alvuroğlu E (2026). [PMID: 42098761](https://pubmed.ncbi.nlm.nih.gov/42098761/). *BMC Womens Health*. [Basic Science / Preclinical]
Jacques LJ (2026). [PMID: 41679255](https://pubmed.ncbi.nlm.nih.gov/41679255/). *Radiography (Lond)*. [Review / Meta-Analysis]
Cheina S (2026). [PMID: 41453445](https://pubmed.ncbi.nlm.nih.gov/41453445/). *J Gynecol Obstet Hum Reprod*. [Epidemiology / Natural History]
Shao Z (2026). [PMID: 41634747](https://pubmed.ncbi.nlm.nih.gov/41634747/). *J Ovarian Res*. [Review / Meta-Analysis]
Stokar J (2026). [PMID: 41518227](https://pubmed.ncbi.nlm.nih.gov/41518227/). *Diabetes Metab Res Rev*. [Epidemiology / Natural History]
Li Y (2026). [PMID: 42152118](https://pubmed.ncbi.nlm.nih.gov/42152118/). *Reprod Health*. [Epidemiology / Natural History]
Grandi G (2026). [PMID: 42132994](https://pubmed.ncbi.nlm.nih.gov/42132994/). *Fam Cancer*. [Epidemiology / Natural History]
Simko S (2026). [PMID: 42155811](https://pubmed.ncbi.nlm.nih.gov/42155811/). *J Gynecol Obstet Hum Reprod*. [Epidemiology / Natural History]
Beekman MJ (2026). [PMID: 41724092](https://pubmed.ncbi.nlm.nih.gov/41724092/). *Maturitas*. [Clinical Trial Publication]
Zhao K (2026). [PMID: 42216054](https://pubmed.ncbi.nlm.nih.gov/42216054/). *J Ovarian Res*. [Review / Meta-Analysis]