title: Acral lesions in tuberous sclerosis complex: insights into pathogenesis.
abstract: BACKGROUND
  Patients with tuberous sclerosis complex (TSC) are predisposed to developing ungual fibromas and other acral lesions.
  
  
  OBJECTIVE
  We sought to determine the numbers, types, and locations of acral skin lesions in TSC.
  
  
  METHODS
  We examined and photographed 76 adult women with TSC.
  
  
  RESULTS
  The age of the patients ranged from 20 to 69 years, with a mean age of 39 +/- 11 years. Ungual fibromas were observed in 61 of 76 patients (80%). Periungual fibromas were more common than subungual fibromas, were more common on the feet than the hands, and showed the greatest frequency on the fifth toe. Longitudinal grooves in the nails occurred with or without a visible fibroma. Longitudinal short red streaks--lesions that we term "red comets"--were observed in 22 patients (29%). Longitudinal leukonychia was observed in 14 patients (18%). One patient had isolated digital overgrowth and one patient had pachydermodactyly.
  
  
  CONCLUSIONS
  No men or children were included in this study.
  
  
  CONCLUSIONS
  Examination of patients for skin lesions of TSC could be improved by including inspection for longitudinal nail grooves, red comets, longitudinal leukonychia, and splinter hemorrhages in addition to ungual fibromas. The anatomic distribution of TSC ungual fibromas is not random and appears consistent with trauma-promoted tumor formation.
authors.affiliation: Department of Dermatology, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814, USA.
authors.forename: Capt Shelley L
authors.initials: CS
authors.lastname: Aldrich
authors.forename: Chien-Hui
authors.initials: CH
authors.lastname: Hong
authors.forename: Leslie
authors.initials: L
authors.lastname: Groves
authors.forename: Cara
authors.initials: C
authors.lastname: Olsen
authors.forename: Joel
authors.initials: J
authors.lastname: Moss
authors.forename: Thomas N
authors.initials: TN
authors.lastname: Darling
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005350:Fibroma / Q000209:etiology* / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D009260:Nail Diseases / Q000209:etiology* / Q000473:pathology; D009262:Nails / Q000473:pathology; D012867:Skin / Q000473:pathology; D012871:Skin Diseases / Q000209:etiology* / Q000473:pathology; D014402:Tuberous Sclerosis / Q000150:complications* / Q000473:pathology; D055815:Young Adult
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