The next patient you see with juvenile "acne" may have adenoma sebaceum—one of the manifestations of the inherited disease, tuberous sclerosis. This particular "acne" will be centrally clustered, dome-shaped instead of conical, rather vascular, will lack blackheads and pustules, and most importantly will occur in a child who is prepubertal and therefore too young to have true acne (Fig 1). These hamartomatous growths are composed of vascular, epithelial, glandular, and collagenous elements and have characteristic histologic elements.
Mental retardation and seizures develop in most patients with tuberous sclerosis during early childhood. Some, however, do not show central-nervoussystem signs, and their condition, therefore, is not recognized before the appearance of their cutaneous lesions. Many adults with this disease lead normal lives and are not aware of the serious portent of their skin lesions. Unfortunately, there is no guarantee that cerebral calcifications, mental retardation, and all the manifestations of tuberous sclerosis will
Halprin KM. The "Acne" of Tuberous Sclerosis. JAMA. 1967;199(7):492–493. doi:10.1001/jama.1967.03120070104017
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