A nine-year-old boy presented to us with recurrent episodes of convulsions over the preceding two years. His family and birth history was unremarkable. He had learning difficulties and poor scholastic performance. Cutaneous examination revealed multiple non-tender, dark brown and skin-coloured telangiectatic papules of varying size over the face (Fig. 1). In addition, he had three oblong hypopigmented macules over the upper back. Systemic examination including ophthalmoscopy was normal. Computerized tomographic (CT) scan of brain revealed multiple calcified subependymal nodules of different size. Based on the features, a diagnosis of tuberous sclerosis was established. Subsequent echocardiography and ultrasonography of the abdomen were normal.

The distinctive facial lesions in the present patient were angiofibromas, also referred by a misnomer – adenoma sebaceum. These are pink, dark brown, or skin-colored telangiectatic papules, often observed in the nasolabial folds and on the cheeks and chin. Pathologically, they are hamartomas, and composed of fibro-vascular tissue. They usually present after 2 years of age and gradually increase in size and number until adolescence. Besides tuberous sclerosis, angiofibroma may also be seen in multiple endocrine neoplasia type I and Birt-Hogg-Dube syndrome. Treatment of these skin lesions is usually required for cosmetic concerns, and different forms of laser being the best option.