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Angiofibromas:
pink or skin-colored telangiectatic papules. Commonly in the
nasolabial folds and on the cheeks and chin. Usually in children
< 10 years and increase in size and number until adolescence,
remaining unchanged thereafter. Other areas include in and
around nails (ungual fibromas), scalp, and forehead. In the oral
mucosa, they may be observed in the lips, dorsa of tongue, and
palate. Dental pitting occurs in about 90% of patients.
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Periungual fibromas (Koenen
tumors): smooth, firm, flesh-colored papules emerging from the
nail folds. These are noted around puberty and may increase in
frequency as the patient ages.
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Shagreen patches:
flesh-colored soft plaques that are frequently in the
lumbosacral area but may occur anywhere on the trunk. The
surface may be pebbly (resembling pigskin or untanned leather)
with prominent follicular openings. They are usually noticed
during the first decade.
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Ash-leaf patches: ovoid,
hypopigmented, ash leaf–shaped
white
macules that can be found on the trunks or limbs.
White macules offer an excellent opportunity for early diagnosis
because they may be found at birth or early infancy. The use of
Wood lamp accentuates these macules. Three or more white macules
at birth should alert the clinician of the possibility of
tuberous sclerosis.
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Other skin signs:
guttate leukoderma, café-au-lait macules, and poliosis.