Worrying white patches

If the patient says it has been there from birth and that he has a couple of others, then consider tuberous sclerosis.

Look to see if there are any raised slightly rough areas of skin called shagreen (leather) patches and then examine the face for small pink or red papules, especially around the nasal cheek folds. These are angiofibromas but they only start to develop around puberty. Later, patients may develop small pointed protrusions at the lateral edge of the nails called periungual fibromas.

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