What's your diagnosis?
Tuberous sclerosis. This autosomal dominant disease with widely variable penetrance has its main effects on the skin, central nervous system, eye, kidney, and heart. Figures 14-64 and 14-65 illustrate angiofibromas, previously named adenoma sebaceum, one of the most common cutaneous manifestations. The pink-to-red dome-shaped papules usually appear between the ages of 2 and 6, and, early in the clinical course, can be confused with acne. The angiofibromas may be symmetrically distributed over the entire face but are usually most concentrated on the cheeks.