Comparison of hair manifestations in cardio-facio-cutaneous and Costello syndromes highlights the influence of the RAS pathway on hair growth

J Eur Acad Dermatol Venereol. 2020 Mar;34(3):601-607. doi: 10.1111/jdv.16082. Epub 2020 Jan 2.


Background: Abnormal hair growth is a defining feature of RASopathies, syndromes caused by germline mutations in the RAS pathway. However, detailed hair manifestations and the mechanisms of altered hair growth in RASopathies are poorly delineated.

Objectives: To identify distinguishing clinical features and investigate how the RAS pathway influences hair growth by performing a systematic and detailed side-by-side comparison of hair manifestations in cardio-facio-cutaneous syndrome (CFCS) and Costello syndrome (CS), two RASopathies caused by mutations in the downstream and upstream elements of the RAS pathway, respectively.

Methods: Sixteen individuals with CFCS and 23 individuals with CS were enrolled. Mutation data were recorded. Scalp hair, eyebrows and eyelashes of individuals with CFCS or CS were examined for texture, colour, density and morphology. Scalp hairs were examined by light microscopy.

Results: While both syndromes displayed abnormal hair, striking differences were observed, including darker and thicker scalp hair and sparse eyebrows and eyelashes in CFCS. By contrast, synophrys, trichomegaly and abnormalities of the scalp hair shafts were observed in CS. Possible correlation with straight hair and genotype was observed in CS.

Conclusion: The results emphasize the role of the RAS pathway in hair growth, improve accuracy of clinical diagnosis of CFCS and CS and provide a foundation for identification of therapeutic targets.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Costello Syndrome / complications*
  • Ectodermal Dysplasia / complications*
  • Facies
  • Failure to Thrive / complications*
  • Female
  • Hair / growth & development*
  • Hair Diseases / etiology*
  • Heart Defects, Congenital / complications*
  • Humans
  • Male
  • Signal Transduction
  • Young Adult
  • ras Proteins / physiology*


  • ras Proteins

Supplementary concepts

  • Cardiofaciocutaneous syndrome