Fig. 1

Skin and brain abnormalities in patients with TSC. a Facial angiofibromas are found in many children with TSC. While they begin as flat red macules on the face, they progress to raised red papules (*) that tend to spread over the cheeks and nose in a distinctive manner. b Shagreen patches (raised irregular skin lesions) are often found on the lower back. They are not usually seen in young children but can be a specific sign of TSC in older children and adults. c Hypopigmented macules (Ash Leaf spots) are the most common skin abnormality in TSC and can be seen even at birth. The typically have an irregular appearance with most patients having >5 lesions. d FLAIR (Fluid Inversion Recovery) MRI images of the brain show both tubers (black arrows) and SEN (white arrows). Patient photographs by author obtained with consent