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Journal of the American Academy of Dermatology
Volume 63, n° 2
pages 244-251 (août 2010)
Doi : 10.1016/j.jaad.2009.08.042
accepted : 19 August 2009
Original Articles

Acral lesions in tuberous sclerosis complex: Insights into pathogenesis

Capt Shelley L. Aldrich, USAF, MC, MD a, Chien-Hui Hong, MD, MS a, c, Leslie Groves, BS a, Cara Olsen, DrPH b, Joel Moss, MD, PhD d, Thomas N. Darling, MD, PhD a,
a Department of Dermatology, Uniformed Services University of the Health Sciences, Bethesda, Maryland 
b Biostatistics Consulting Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland 
c Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan 
d Translational Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 

Reprint requests: Thomas N. Darling, MD, PhD, Department of Dermatology, Uniformed Services University of Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814.

Patients with tuberous sclerosis complex (TSC) are predisposed to developing ungual fibromas and other acral lesions.


We sought to determine the numbers, types, and locations of acral skin lesions in TSC.


We examined and photographed 76 adult women with TSC.


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.


No men or children were included in this study.


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.

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Key words : fingernails, periungual fibroma, subungual fibroma, toenails, tuberous sclerosis complex

 The first two authors contributed equally to this article.
 Supported by a Clinical Scientist Development Award from the Doris Duke Charitable Foundation, R01 CA100907, and the Intramural Research Program of the National Institutes of Health, National Heart, Lung, and Blood Institute.
 Conflicts of interest: None declared.

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