Skin findings include Initially pale, ash leaf-shaped macules, which develop during infancy or early childhood Angiofibromas of the face (adenoma sebaceum), which develop during later childhood Congenital shagreen patches (raised lesions resembling an orange peel), usually on the back Subcutaneous nodules Café-au-lait spots Subungual fibromas, which can develop any time during childhood or early adulthood Skin Manifestations of Tuberous Sclerosis Complex Ash-Leaf Spots in Tuberous Sclerosis Complex Ash-leaf spots are depigmented areas present in > 90% of patients with tuberous sclerosis complex.