This lesion develops in 21 percent of patients with tuberous sclerosis. Shagreen patches may develop between two and six years of age. Ungual fibromas are flesh-colored papules that may displace and distort the nail bed. These lesions are found in 19 percent of patients with tuberous sclerosis. 2 Ungual fibromas are more prominent in adolescents and adults, and they are fairly specific to tuberous sclerosis.
Patients can also have sublingual or perilingual fibromas.
Cardiac Manifestations Cardiac rhabdomyomas occur in 50 percent of patients with tuberous sclerosis. These lesions can be detected by echocardiography. Although the rhabdomyomas are frequently asymptomatic, they may cause heart failure in infants because of outflow obstruction of one or both ventricles. 11 Rhabdomyomas decrease in size with age. Most patients with tuberous sclerosis develop seizures, usually beginning before two years of age.