Tuberous sclerosis physical examination

Images of the nail shown below are courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

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  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]
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  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]
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  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]
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  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]
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  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]
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  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]
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  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]
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  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]
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  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]
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  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]
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  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]
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  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]
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  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]
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  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]
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  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]
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  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]
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  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]
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  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]
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  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]
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  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]
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  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]
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  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]
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  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]
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  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]
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  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]
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  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]
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  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]
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  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]
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  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]
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  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]
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  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]
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  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]
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  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]

• 
  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]
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  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]

• 
  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]
• 
  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]
• 
  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]
• 
  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]
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  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]

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  Tuberous sclerosis. Adapted from Dermatology Atlas.^[1]

The skin is examined under a Wood’s lamp. The most common skin abnormalities include:

• Facial angiofibromas
• Ungual or subungual fibromas
• Hypomelanic macules (“ash leaf spots”)
• Forehead plaques
• Shagreen patches
• Molluscum fibrosum or skin tags
• Cafe-au-lait spots or flat brown marks
• Poliosis

• Pitted tooth enamel
• Rubbery growths on the tongue or gums

• Retinal lesions – astrocytic hamartomas, which may cause blindness.
• Non-retinal lesions associated with TSC include
  • Coloboma
  • Angiofibromas of the eyelids
  • Papilledema (related to hydrocephalus)

• A heart murmur can be heard due to the obstruction of blood flow by rhabdomyomas.

• Coarse rales are heard when lung parenchyma is involved.
• Bronchial breathing and bronchophony are heard on auscultation when multiple cysts occur in the lungs.

• Rough growths under or around the fingernails and toenails

• Abnormal size of head in children – due to hydrocephalus