DDx
Diagnostic Considerations
Consider the following:
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Angiofibromas (differentiate from acne vulgaris by telangiectasia, absence of comedones and pustules, and a relatively asymptomatic nature)
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Shagreen patch (must be differentiated from connective tissue nevi)
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Hypopigmented spots (may need to be differentiated from nevus anemicus, nevus achromicus, and early vitiligo)
Differential Diagnoses
Media Gallery
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Facial angiofibromas in a young man with tuberous sclerosis complex.
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Dysplastic periungual fibroma involving the great toe in a patient with tuberous sclerosis.
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Tables
Table. Clinical Criteria for Diagnosing Tuberous Sclerosis Complex
| Major Features | Minor Features |
| Hypomelanotic macules (≥3, at least 5 mm in diameter) | Confetti skin lesions |
| Angiofibromas (≥3) or fibrous cephalic plaque | Dental enamel pits (>3) |
| Ungual fibromas (≥2) | Intraoral fibromas (≥2) |
| Shagreen patch | Retinal achromatic patch |
| Multiple retinal hamartomas | Multiple renal cysts |
| Cortical dysplasiasa | Nonrenal hamartomas |
| Subependymal nodules | |
| Subependymal giant cell astrocytoma | |
| Cardiac rhabdomyoma | |
| Lymphangioleiomyomatosis (LAM) plus | |
| Angiomyolipomas (≥2)b | |
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a Includes tubers and cerebral white matter radial migration lines.
b A combination of the two major clinical features (LAM and angiomyolipomas) without other features does not meet criteria for a definite diagnosis. |
