Tuberous sclerosis

The patient has adenoma sebaceum (which is usually distributed in a butterfly pattern over the central face) and 
subungual fibromaOther lesions which may be present (usually on the trunk) are shagreen patches (these are 
localized thickening of the skin with a rough surface) and ash-leaf patches (hypopigmented areas which are best
seen with Wood's light ie. ultraviolet light).

Further examination:

  • mention you like to examine the fundus for astrocytic hamartoma (the patients may have profound mental 

  • retardation making fundal examination difficult).
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subungual fibroma
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Shagreen patches
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